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GI Test > Hepatitis Pharmacology > Flashcards

Hepatitis Pharmacology Flashcards

1
Q

What is the specific treatment for hepatitis B?

A
  • No specific treatment because it most often resolves spontaneoulsy
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2
Q

What are the goals of HBV therapies?

A
  1. Suppression of HBV DNA to undetectable levels
  2. Seroconversion of HBeAg (or more rarely, HBsAg) from positive to negative
  3. Reduction in elevated serum aminotransferase levels
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3
Q

What are the endpoints of HBV treatment?

A
  • Improvement in necro-inflammatory disease
  • A decreased risk of hepatocellular carcinoma and cirrhosis
  • A decreased need for liver transplantation
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4
Q

What is Entecavir?

A
  • A hepatitis B virus nucleoside analogue reverse transcriptase
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5
Q

What are the BB warnings for Entecavir?

A
  • Severe acute exacerbations of hepatitis B
  • Patients co-infected with HIV and HBV
  • Lactic acidosis
  • Hepatomegly
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6
Q

What are the indications of Entecavir?

A
  • Indicated for the treatment of chronic hepatitis B virus infection in adults and children at least 2 years of age with evidence of active viral replication and either evidence of persistent elevations in serums aminotransferases or histologically active disease
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7
Q

What are some contraindications of Entecavir?

A
  • None
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8
Q

What are some adverse reactions of Entecavir?

A
  • In adults, most common are headache, fatigue, dizziness, and nausea
  • Pediatric patient effects were consistent with those observed in adults
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9
Q

What is Tenofovir Disoproxil?

A
  • A nucleotide analog HIV-1 reverse transcriptase inhibitor and an HBV reverse transcriptase inhibitor
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10
Q

What are the BB warnings for Tenofovir Disoproxil?

A
  • Lactic acidosis/Severe hepatomegaly with steatosis

- Post treatment exacerbation of hepatitis

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11
Q

What are some indications of Tenofovir Disoproxil?

A
  • Used in combination with other antiretroviral agents for the treatment of HIV-1 infection in adults and pediatric patients 2 years of age and older
  • Used for the treatment of chronic hepatitis B in adults and pediatric patients 12 years of age and older
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12
Q

What are some warnings of Tenofovir Disoproxil?

A
  • New onset or worsening renal impairment: Can include acute renal failure and Fanconi syndrome
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13
Q

What are some adverse reactions with Tenofovir Disoproxil?

A
  • In HBV infected subjects with compensated liver disease: most common reaction was nausea
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14
Q

What is adefovir?

A
  • Nucleotide analogue used for the treatment of chronic hepatitis B in patients 12 years of age or older
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15
Q

What are some contraindications of adefovir?

A
  • In patients with previously demonstrated hypersensitivity to any of the components of the product
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16
Q

What are some warnings/precautions of adefovir?

A
  • Nephrotoxicity: monitor renal function during therapy for all patients particularly those with pre-existing or other risks for renal impairment
  • Severe acute exacerbations of hepatitis
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17
Q

What are some adverse reactions of adefovir?

A
  • Most common is asthenia and increased creatinine in pre and post transplantation lamivudine-resistant liver disease patients
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18
Q

What are some drug interactions of adefovir?

A
  • Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of adefovir or the coadministered drug
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19
Q

What is lamivudine?

A
  • Nucleoside analogue reverse transcriptase inhibitor
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20
Q

What are some BB warnings for lamivudine?

A
  • Lactic acidosis
  • Severe hepatomegaly
  • Exacerbations of hepatitis B
  • Different formulations
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21
Q

What are some indications of lamivudine?

A
  • Used in combination with other antiretroviral agents for the treatment of HIV-1 infection
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22
Q

What are some contraindications of lamivudine?

A
  • In patients with previous hypersensitivity reaction to lamivudine
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23
Q

What are some warnings and precautions of lamivudine?

A
  • Co-infected HIV-1/HBV patients
  • Emergence resistant HBV variants associated with lamivudine containing antiretroviral regimens has been reported. Monitor for treatment associated toxicities
  • Pancreatitis: or other significant risk factors for pancreatitis. Discontinue treatment as clinically appropriate
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24
Q

What are some adverse reactions of lamivudine?

A
  • The most common were headache, nausea, malaise and fatigue, nasal signs and symptoms, diarrhea, and cough
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25
Q

What is Telbivudine?

A
  • Nucleoside analogue reverse transcriptase inhibitor
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26
Q

What are some BB warnings for telbivudine?

A
  • Lactic acidosis
  • Severe hepatomegaly with steatosis
  • Severe acute exacerbations of hep B
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27
Q

What are some indications of telbivudine?

A
  • Used for the treatment of chronic hepatitis B in adult patients with evidence of viral replication and either evidence of persistent elevations in serum aminotransferases or histologically active disease
28
Q

What are some contraindications of telbivudine?

A
  • Combination of telbivudine with PEGylated interferon alfa-2a: increased risk of peripheral neuropathy
29
Q

What are some adverse reactions of telbivudine?

A
  • Most common: Fatigue, increased creatine kinase, headache, cough, diarrhea, abdominal pain, nausea, arthralgia, pyrexia, rash, back pain, dizziness, myalgia, ALT increase, dyspepsia, insomnia, and abdominal distention
30
Q

What is the BB warning of PEG interferon alfa-2a?

A
  • Risk of serious disorders and ribavirin associated effects
31
Q

What are the indications of PEG interferon alfa-2a?

A
  • Treatment of chronic hepatitis C with compensated liver disease not previously treated with interferon alpha, in patients with histological evidence of cirrhosis and compensated liver disease
  • Treatment of patients with chronic hepatitis B infection who have compensated and evidence of viral replication and liver inflammation
32
Q

What are some contraindications of PEG interferon alfa-2a?

A
  • Autoimmune hepatitis
  • Hepatic decompensation in patients with cirrhosis
  • Use in neonates/infant
33
Q

What are some adverse reactions?

A
  • Most common are fatigue/astehnia, pyrexia, myalgia, and headache
34
Q

What is BB warning of PEG interferon alfa-2b?

A
  • Can cause or aggravate fatal or life-threatening neuropsychiatric, autoimmune, ischemic, and infectious disorders
35
Q

What are some indications of PEG interferon alfa-2b?

A
  • Used for the treatment of chronic hepatitis C in patients 18 years or older with compensated liver disease who have a history of blood or blood-product exposure and/or are HCV antibody positive
36
Q

What are some contraindications of PEG interferon alfa-2b?

A
  • Hypersensitivity to interferon alpha or any component of the product
  • Autoimmune hepatitis
  • Decompensated liver disease
37
Q

What are some adverse reactions of PEG interferon alfa-2b?

A
  • Most frequently reported were “flu-like” symptoms, fever, headache, chills, nausea, and fatigue
38
Q

What is the goal of HCV treatment?

A
  • Viral eradication
39
Q

What are some indications of Elbasvir/grazoprevir?

A
  • A fixed dose combination product containing:
  • Elbasvir, a hepatitis NS5A inhibitor
  • Grazoprevir, an HCV NS3/4A protease inhibitor used in the treatment of HCV
40
Q

What are some contraindications of Elbasvir/grazoprevir?

A
  • Patients with moderate of severe hepatic impairment
41
Q

What are some warnings and precautions of Elbasvir/grazoprevir?

A
  • ALT elevations
42
Q

What are some adverse reactions of Elbasvir/grazoprevir?

A
  • Fatigue, headache, and nausea
43
Q

What are some drug interactions of Elbasvir/grazoprevir?

A
  • Co-administration with moderate CYP3A4 inducers is not recommended as they may decrease the plasma concentration of Elbasvir/grazoprevir
44
Q

What is ledipasvir/sofosbuvir?

A
  • A fixed dose combination of:
  • Ledipasvir, a hep C NS5A inhibitor
  • Sofosbuvir, an HCV nucleotide analog NS5B polymerase inhibitor
45
Q

What are the indications of ledipasvir/sofosbuvir?

A
  • Treatment of chronic hepatitis C infection in adults
46
Q

What are the warnings of ledipasvir/sofosbuvir?

A
  • Only recommended with some combination of ribavirin
47
Q

What are some adverse reactions of ledipasvir/sofosbuvir?

A
  • Fatigue and headache
48
Q

What are some drug interactions of ledipasvir/sofosbuvir?

A
  • Poly Glycoprotein inducers (St. John’s wort) may alter concentrations of ledipasvir and sofosbuvir»not recommended
49
Q

What is velpatasvir/sofosbuvir?

A
  • Fixed dose combination of:
  • Sofosbuvir: A hepatitis C virus nucleotide analog NS5B polymerase inhibitor
  • Velpatasvir: HCV NS5A inhibitor
50
Q

What are the indications of velpatasvir/sofosbuvir?

A
  • Treatment of adult patients with chronic HCV infection
  • Without cirrhosis or with compensated cirrhosis
  • With decompensated cirrhosis for use in combination with ribavirin
51
Q

What are the contraindications of velpatasvir/sofosbuvir?

A
  • Patients for whom ribavirin is contraindicated
52
Q

What are some warnings of velpatasvir/sofosbuvir?

A
  • Can potentiate bradycardia with amiodarone co-administration
  • Caution also in patients receiving beta blockers or those with underlying cardiac comorbidities and/or advanced liver disease
53
Q

What are some adverse reactions of velpatasvir/sofosbuvir?

A
  • Headache and fatigue
54
Q

What are some drug interactions of velpatasvir/sofosbuvir?

A
  • PGP inducers and/or moderate to potent CYP inducers

- May decrease concentrations of sofosbuvir and/or velpatasvir

55
Q

What are some BB warnings of ribivarin?

A
  • Risk of serious disorders and ribavirin associated effects

- Birth defects and fetal death with ribavirin. Do not use in pregnancy and for 6 months after treatment

56
Q

What are some indications of ribavirin?

A
  • Nucleoside analogue indicated for the treatment of chronic hepatitis C virus infection in combination with interferon alfa-2a in patients 5 years and older with compensated liver disease not previously treated with interferon alpha and used in CHC patients co-infected with HIV
57
Q

What are some contraindications of ribavirin?

A
  • Pregnant women and men whose female partners are pregnant

- Hemnoglobinopathies

58
Q

What are some adverse reactions of ribavirin?

A
  • Most common adverse reactions are fatigue/asthenia, pyrexia, myalgia, and headache
59
Q

What is boceprevir?

A
  • NS3/4A protease inhibitor indicated for the treatment of chronic hepatitis C infection in combination with peginterferon alfa and ribavirin, in adults with compensated liver disease, including cirrhosis, who are previously untreated or who have failed previous interferon and ribavirin therapy
60
Q

What are some contraindications of boceprevir?

A
  • All contraindications to peginterferon alfa and ribavirin also apply since boceprevir must be administered with peginterferon alfa and ribavirin
61
Q

What are some warnings of boceprevir?

A
  • Use of boceprevir with ribavirin and peginterferon alfa:
  • Ribavirin may cause birth defects and fetal death; avoid pregnancy in female patients and female partners of male patients
62
Q

What are some adverse reactions of boceprevir?

A
  • Fatigue
  • Anemia
  • Nausea
  • Headache
  • Dysgeusia
63
Q

What does the ending “previr” mean?

A
  • NS3/4A protease inhibitor
64
Q

What does the ending “asvir” mean?

A
  • NS5A inhibitor
65
Q

What does the ending “buvir” mean?

A
  • NS5B polymerase inhibitor

GI Test (10 decks)

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