Lecture 6: Drugs Used to Treat Viral Hepatitis Flashcards
What are 6 drugs commonly used to treat Chronic Hepatitis B Virus infections? (E/TD/AP/L/T/IA)
Entecavir Tenofovir Disoproxil Adenofir Pipivoxil Lamivudine Telbivudine Interferon Alfa-2a
What are 6 drugs commonly used to treat Chronic Hepatitis C Virus Infections? (IA/EG/LS/VS/R/B)
PEG Interferon Alfa-2b Elbasvir and Grazoprevir (dual therapy) Ledipasvir and Sofosbuvir (dual therapy) Velpatasvir and Sofosbuvir (dual therapy) Ribivarin Boceprevir
Entecarvir
What is its MOA, what is it indicated for, and what are its 4 Black Box warnings (HE/HIV/LA/H)
MOA: hepatitis B virus nucleoside analogue reverse transcriptase
I: chronic Hep B in adults/kids < 2 yrs with active viral replication, and elevated serum aminotransferases or histologically active disease
BB: severe exacerbation of Hep B, patients with HIV infection (do NOT use), lactic acidosis, hepatomegaly
Tenofovir Disoproxil
What is its MOA, what is it indicated for, what patients should it NOT be used with, and what are 3 Black Box Warnings?
MOA: nucleotide analog HIV-1 and HBV reverse transcriptase inhibitor
I: used in combo for HIV-1 infections in adults and kids 2+ AND for chronic HBV in adults and kids 12+
- do NOT use with pts who have RENAL PROBLEMS (can cause renal impairment)
BB: exacerbation of hepatitis post-treatment, lactic acidosis, hepatomegaly w/steatosis
Adefovir
What is it indicated for, what is its main contraindication, and what are two major warnings of use (N/HE)
I: nucleotide analogue for treatment of Chronic HBV in patients 12+ and older
C: do not use on pts. with HYPERSENSITIVITY to any product components
W: inc. risk of NEPHROTOXICITY (monitor renal function during therapy) and hepatitis exacerbation
Adenofir
What are two adverse reactions to use and how does it interact with other drugs?
AR: asthenia (compensated patients) and inc. creatinine (pre/post-transplantation lamivudine-resistant liver disease patients
DI: coadministration w/drugs that reduce renal function/compete for active tubular secretion can INCREASE serum CONCENTRATIONS
Lamivudine
What is it, what is it indicated for, what are 4 Black Box Warnings, and what is a precaution of use?
- nucleoside analogue reverse transcriptase inhibitor
I: used in combo with other agents to treat HIV-1 infection and HBV coninfection
BB: HBV exacerbation, lactic acidosis, hepatomegaly, different formulations
W: lamivudine-resistant HBV strains associated with antiretroviral regimens; contraindicated in patients with lamivudine hypersensitivity
Telbivudine
What is it, what is it indicated for, what is a contraindication, and what are 3 Black Box Warnings?
- nucleoside analogue reverse transcriptase inhibitor
I: chronic HBV in adult patients w/evidence of viral replication and either elevated serum aminotransferase or active disease
C: inc. risk of peripheral neuropathy (w/PEGylated interferon alfa-2a coadministration)
BB: HBV exacerbation, lactic acidosis, hepatomegaly with steatosis
Telbivudine
What is a molecule that is commonly increased with drug use?
inc. Creatinine Kinase
PEG Interferon Alfa-2a
What two things is it indicated for, what is a Black Box Warning of use, and what 3 things is it contraindicated in (AH/DC/NI)
I: chronic HCV with compensated liver disease not treated prior with Interferon Alpha (cirrhosis) AND chronic HBV with compensated liver disease (viral rep and liver inflammation)
BB: serious disorders and ribavirin-associated effects
C: autoimmune hepatitis, hepatic decompensation in pts with cirrhosis, use with neonates/infants
PEG Interferon Alfa-2b
What is it indicated for, what is a Black Box Warning of use (N/A/I/I), and what 3 things is it contraindicated in (H/AAH/DLD)
I: chronic HCV in pts 18+ w/compensated liver disease with history of blood exposure or are HCV Ab (+)
BB: aggravates life-threatening neuropsychiatric, autoimmune, ischemic, infectious disorders
C: hypersensitivity to interferon alpha, autoimmune hepatitis, decompensated liver disease
Elbasvir and Grazoprevir
What are they indicated for, what is a contraindication, what molecule can it elevate, and how does it interact with other drugs?
I: fixed-dose combination product with NS5A inhibitor (E) and HS3/4A protease inhibitor (G) to treat HCV
C: pts. with moderate/severe hepatic impairment
- can elevate ALT levels
DI: co administration with moderate CYP3A inducers NOT recommended
Ledipasvir and Sofosbuvir
What are they indicated for, what are they NOT recommended for use with, and how do they interact with other drugs?
I: fixed dose combination product with HS5A inhibitor (L) and HCV nucleotide analog NS5B polymerase inhibitor (S)
- NOT recommended for use with other drugs containing Sofosbuvir
DI: poly-glycoprotein inducers (rifampin, St. Johns wort) coadministration NOT recommended
Velpatasvir and Sofosbuvir
What are they indicated for (2), what is a major contraindication, and what are warnings of use (CC/BB)
I: fixed dose combination product of HCV nucleotide analog NS5B polymerase inhibitor (S) and HCV NS5A inhibitor (V)
- treat adult patients w/Chronic HCV
- w/o cirrhosis or w/compensated cirrhosis
- w/decomp. cirrhosis with ribavirin combination
C: not for patients with ribavirin contraindication
W: caution in pts using beta blockers or who have cardiac comorbidities/advanced liver disease (can potentiate bradycardia w/amiodarone coadmin)
Ribivarin
What is it indicated for (2), what are BB Warnings of use, and what are two contraindications of use?
I: nucleoside analogue indicated for chronic HCV infection in COMBO with Interferon alfa-2a in pts 5+ with compensated liver disease and adult CHC patients co-infected with HIV
BB: birth defects and fetal death (no for pregnant patients or 6 months after treatment)
C: pregnant women/men w/pregnant partners AND hemoglobinopathies
