Hepatitis Tx

Question 1

What are the preferred antivirals?

Answer 1

Tenofovir and Entacavir

Question 2

HBV resistance occurs when?

Answer 2

WHen mutations occur in the HBV polymerase.

Tends to be structure specific.

Question 3

Which drug does not inhibit HBV polymerase

Answer 3

Adefovir

Question 4

All of the antivirals are Triphosphates except

Answer 4

Adefovir and Tenofovir

Question 5

Why are the oral antiviral drugs first line therapy over Interferon?

Answer 5

Because they are better tolerated and suppres the virus better

Question 6

Lamivudine is what type of drug?

Answer 6

Nucleoside/tide structural analog

Question 7

Lamivudine MOA

Answer 7

Prodrug adenosine analog

Question 8

Lamivudine AE

Answer 8

GFR and RTS

Question 9

Adefovir is what type of structural analog

Answer 9

Acyclic phosphate

Question 10

Adefovir MOA

Answer 10

Adenosine analog (not a prodrug like lamivudine)

Question 11

Adefovir AE

Answer 11

GFR and RTS, Also may cause lactic acidosis and steatorrhea (hepatotoxic)

Question 12

Tenofovir os what type of structural analog

Answer 12

Acyclic phosphate.

Question 13

Tenofovir moa

Answer 13

cytosine analog

Question 14

What can yo do to increase the bioavailability of tenofovir?

Answer 14

Take with a high fat meal

Question 15

Important AE of TENOFOVIR

Answer 15

Renal toxicity in pts with renal dz. Make sure t test serum creatinine and BUN.

• MAKE SURE to ask pts about bone pain or muscle pain as this may be a sign of renal tubolopathy
• Tenofovir ( a retroviral) Has also been shown to cause osteoporosis. Give with calcium and Vit d

Question 16

Avoid taking Tenofovir with other nephrotoxic agents like

Answer 16

Tylenol

Question 17

Emtricitabine

Answer 17

can be used for co-infections….its a cytosine analog

Question 18

Interferon 2a used against

Answer 18

HBV

Question 19

IFN 2b used for

Answer 19

HCV

Question 20

AE of IFN

Answer 20

flu like, neuropsych (depression and seizures), myelosuppresion, high LFTs, Transient thyroid disturbance

Question 21

How the fuck do IFNs work

Answer 21

They agonize IFN receptors (JAK/STAT) that upregulate enzymes like adenosine deaminase, PKR, and oligoadenylate cyclase—-all of which are endonucleases which cleave viral DNA , Inh dsRNA, Inh Viral penetration, uncoating, and release

Question 22

HCV genotype 1

Answer 22

Pegylated IFN 2B + Ribavirin + Telaprevir

Question 23

What does Ribavirin do?

Answer 23

Increases immune clearance, lowers GTP, Mutates RNA. transiently decreases HCV RNA but normalizes ALT

Question 24

Ribavirin absorption increased with

Answer 24

high fat meal

Question 25

AE of Ribavirin

Answer 25

Hemolytic anemia, MI, difficulty breathing

Question 26

Telepravir and Boceprevir mech

Answer 26

Inhibit NS3

Question 27

When are telepravir and boceprevir added?

Answer 27

after four weeks of Interferon + Ribavirin

Question 28

Rash?

Answer 28

Telapravir

Question 29

Male teratogen

Answer 29

Ribavirin