Hepatitis Tx I Flashcards
Agents for Hep B virus
peginterferon alfa adefovir entecavir lamivudine telbivudine tenofovir
agents for Hep C virus
pegintergeron alfa ribavirin simeprevir sofosbuvie protease inhibitors: roceprevir and telaprevir
how to confirm hep virus
serologic tests
which hep virus is DNA
hep B
Hep C is transmitted most commonly
injection drug users
serologic test for HepAvirus
IgM Ab
Tx HepA
prevention and prophylaxis
Ig for pre and post exposure prophylaxis
vaccination preferred
Sx HepB
fever, anorexia, nausea, vomtiing, jaundice, dark urine, pale stools, abnominal pain
serologic tests for Hep B
HBsAg- active infection
antiHBs- recovery or immunity, successful vaccination
antiHBc- previous or ongoing infection
IgM antiHBc delineates recent infection in past 6 mo
HBeAg viral replication
HBeAb clearing virus
What serologic levels will be increased in acute infection HBV
HBsAg, antiHBc IgM antiHBc
what serologic levels will be increased in chronically infected HBV
HBsAg, antiHBc
patient had Hep B virus and cleared
what will titers show
antiHBc and anti HBs
is HBV curable
no
goals of therapy for HBV
suppress replication
prevent complications
seroconvert HBeAg to Ab
reduce need for liver transplantation
when to Tx HBV
risk of liver related morbidity and mortality is foreseeable
non-pharm management for HBV
vaccinate sexual and household contacts
avoid alcohol
vaccinate HAV
first vaccine against major human cancer, HCC
HBV vaccine
msot common blood borne pathogen
hep C
85% hep c develop what
chronic HCV so increased risk cirrhosis, HCC and end stage liver failure
chronic Sx HCV
fatigue, RUQ pain, nausea, poor appetite
goals of HCV therapy
eradicate virus
absent RNA for 6 mo
Indications for HCV Tx
all patients with evidence of chronic HCV in prev 6 mo
untreated patients with HCV
patients not to Tx HCV in
decompensated liver disease or Hx of severe uncontrolled psychiatric disorder
factors associated with favorable Tx response for HCV Tx
HCV genotype 2 or 3
absence cirrhosis
low preTx HCV RNA level
pros and cons of Interferon alfa
pros: finite duration, no resistance, responses durable
cons: side effects, not used in patients with decompensated disease
MOA interferon alfa
inhibits viral penetration, translation, transcription, protein processing, maturation and release
enhanced phagocytic activity
how is peginterferon administered? why?
subcutaneoulsy because slower clearance
have to adjust for renal impairement
adverse effects interferon alfa
flu like illness (resolves with cont Tx)
transient inc in hepatic enzymes
adverse effects chronic Tx interferon alfa
neurotoxicity with chronic Tx with myelosuppression and profound fatigue, weight loss, rash, cough, myalgia, alopecia, tinnitus, reversible hearing loss, retinopathy, penumonitis
contraindications interferon alfa
hepatic decompensation, autoimmune disease, Hx cardiac arrhythmia, pregnancy
cautions for using interferon alfa
psychiatric disease, epilepsy, thyroid disease, ischemic cardiac disease, severe renal insufficiency, cytopenia
Therapeutic uses interferon alfa
chronic HBV and HCV
drug drug interactions interferon alfa
may increase levels of theophylline and methadone
not recommended with didanosine(inc hepatic failure) or zidoyudine (exacerbate cytopenias)
MOA nucleoside/nucleotide analogs
interfere viral replication
what are pros and cons to nucleoside analogs vs interferon
PO administration that is better tolerated and higher response rate, can be used chronic therapy or htose with liver disease
cons: sustained response limited after discontinuation
resistance, peripheral neuropathy, lactic acidosis and hepatic steatosis
what are the nucleoside/tide analogs
adefovir and dipivoxil
entecavir
lamivudine
MOA adefovir dipivoxil
inhibit HBV DNA polymerase, chain termination after incorporation into viral DNA
adverse effects adefovir dipivoxil
HA, diarrhea, abdominal pain, potential nephrotoxicity
therapeutic use adefovir and dipivoxil
wide range DNA RNA viruses like HBV HIV and herpes
not rec as first line HBV
R to adefovir dipivoxil
adefovir-R rt233 HBV mutatns
no cross R with lamivudine
MOA entecavir
inhibits DNA polymerase (base priming, reverse transcriptase and DNA synthesis)
what to tell patient if on entecavir
take on empty stomach
adverse effects entecavir
HA, dzziness, nausea
Therapeutic use entecavir
first line HBV
MOA lamivudine
inhibits DNA polymerase, competes for incoporation into viral DNA, causes chain termination
adverse effects lamivudine
excellent safety profile
can have HA nausea and dizziness
if HIV patient inc risk pancreatitis
what analog can you use in pregnant woman
lamivudine
Therapeutic use lamivudine
HIV Tx
rapildy suppress HBV not rec as 1st line b/c resistance
cross R with entecavir
MOA telbivudine
inhibits DNA polymerase (competitive) causes chain termination
adverse effects telbivudine
fatigue, HA, abdominal pain, increased creatine kinase levels, nausea, vomiting
contraindications telbivudine
avoid with interferon alfa b/c peripheral neuropathy
therapeutic use telbivudine
rapidly suppresses HBV and causes HBeAg seroconversion
not rec as 1st line b/c Resistance
cross R with lamivudine
MOA tenofovir
competitvely inhibits DNA polymerase, chain termination
adverse effects tenofovir
nausea, diarrhea, vomiting, decreased bone mineral density (give Ca and vit D supp)
therapeutic use tenofovir
first line HBV
HIV Tx
resistance rare
