hepatitis tx Flashcards
Peginterferon alfa
HBV agent/HCV agent
MOA: inhibits viral penetration, tln, txn, protein processing, maturation and release
- must be given subq: but has slower clearance, 1x/week injections
ADR’s: experience flu-like illness w/in first week
- increase in hepatic enzymes
- neurotoxicity, meylosupression, fatigue
CI’s: hepatic decomposition, psychiatric disease
Adefovir
HBV agent
Nucleoside/NT analogs (NA’s): interfere w/ viral replication- inhibit HBV DNA pol, chain termination after incorporation into viral DNA
ADR’s: h/a, diarrhea, ab. pain; nephrotoxicity
Entecavir
HBV agent
Nucleoside/NT analogs (NA’s): interfere w/ viral replication-
MOA: inhibits DNA polymerase
ADR’s: welll- tolerated
** first line therapy for HBV
Lamivudine
(3TC) HBV agent
Nucleoside/NT analogs (NA’s): interfere w/ viral replication-
MOA: inhibits DNA pol
ADR’s: excellent safety profile, including use during pregnancy
USE: has high amount of resistnace, not first line therapy
Telbivudine
HBV agent
Nucleoside/NT analogs (NA’s): interfere w/ viral replication
MOA- inhibits DNA pol via competitive inhibition, causing chain termination
CIS’s: concurrent use w/ interferon alfa can cause peripheral neuropathy
not recommended first line
Tenofovir
HBV agent
Nucleoside/NT analogs (NA’s): interfere w/ viral replication-
MOA: comp. inhibits DNA pol, causing chain termination
ADR’s: nausea, diarrhea, vomiting, decreased bone mineral density
Use: recommended first-line therapy for HBV
resistance is rare
Ribavarin
HCV agent
MOA: inhibits initiation/elongation of RNA –> inhibition of viral protein synth (inhibits RNA pol)
ADR’s: dose dependent hemolytic anemia , teratogenic, oncogenic
Used for Chronic HCV
CI’s: anemia, ESRF, ischemic vascular disease, pregnancy
simeprevir
(OLYSIO) HCV agent
MOA: direct acting antiviral
ADR’s: skin rash/puritis
DDI’s: avoid with CYP inducers (rifampin) – super expensive tx
Sofosbuvir
(Sovaldi) HCV agent
MOA: direct acting antiviral - inhibits RNA pol
ADR’s: fatigue, h/a, insomnia
expensive!!!
Boceprevir
(Incivek) HCV agent = protease inhibitor
no longer recommended
Telaprevir
(Victrelis) HCV agent = protease inhibitor
no longer recommended
+ HBsAG
HBV surface protein; high level occur during acute/chronic infection - means pt. is infectious
+ anti-HBs
interpreted as recovery or immunity from HBV - also arise after succesful vaccination
+ anti-HBc
total hepatitis B core Ab - appears at onset of infection (will persist for life) and indicates previous or ongoing infection
IgM anti-HBc
delineates recent infection with HBV w/in 6 mos
HBeAg
indicates high levels of HBV - found during acute and chronic infection, indicating viral replication
HBeAB
indicates lower levels of HBV - spontaneous Ag to AB conversion is a good predictor of viral clearance
which of following is NOT a tx goal for HBV?
Viral cure
three risks if not cured? cirrhoisis, HCC, hepatic failure
seroconversion is a good predictor of viral clearance
which drug class would be preferred if pt. has decompensated liver disease
nucleoside/nucleotide analogs
first line tx for HBV?
tenofovir and entecavir
high resistance for HBV?
lamuvidine, telbivudine
favorable response to tx of HCV?
genotype 2
low baseline HCV-RNA
no cirrhosis
what is an SVR?
sustained virologic response - absence of HCV RNA by polymerase chain reaction for 6 mos. after completion of therapy -
assoc/ w/ improved liver histology, decrease risk of cancer….
HCV tx?
Peginterferon, ribavirin, sofosbuvir
pregnancy category x?
ribavirin - must have negative pregnancy test at baseline and up to six months after tx - needs two forms of barrier tx.
mechanism of action of sofosbuvir?
directing acting antiviral- inhibits RNA polymerase (incorporated into HCV RNA and causes chain termination of RNA)
ribavirin adverse effect?
hemolytic anemia
- pregnancy X drug
IFN contraindicated/use with caution?
hepatic decomposition, AI disease, cardiac arrythmia, pregnancy
caution: psychiatric disease, epilepsy, thyroid disease, renal insufficiency
inhibits DNA pol?
adefovir, entecavir, lamivudine, telbivudine, tenofovir
inhibits RNA pol?
ribavirin, sofosbuvir
inhibits viral penetration, tln, maturation?
peginterferon
inhibits viral protease?
semeprevir, boceprevir, teleprever
common side effect of peginterferon?
flu like illness
psych problems?
peginterferon
first-line tx for HBV?
entecavir, tenofovir
HCV tx?
peginterferon, ribavirin
+
(sofusbuvir also, but its expensive! )
Fatigue, scleral icterus,
and pallor.
ribavirin
when is IFN ineligible?
Hepatic decomposition Autoimmune disease Cardiac arrhythmia Pregnancy (Category C?) Caution Psychiatric disease Epilepsy Thyroid disease Renal insufficiency
