Pharm - Hep C Flashcards
Candidates for tx during acute infection
- those at high risk of transmission (high risk behaviors; IVDAs, HIV-infected, MSM)
- those at high risk of complications d/y underlying liver dz or severe presentation
- those w/ limited access to tx
- those who have contraindications to all oral DAA regimens
- those who desire and are committed to early tx
ID the patient who should be treated for a chronic infection
- all pts w/ virologic evidence of chronic HCV infection
- i.e: detectable HCV viral level over a six month period
- exceptions: short life expectancies
What are the 3 classes of meds to tx hep C?
- direct-acting antivirals (DAA)
- ribavirin
- pegylated interferons
What are the 4 classes of direct acting antivirals (DAA)
- NS3/4A PIs
- NS5A inhibitors
- NS5B NPIs
- NS5B NNPIs
NS3/4A PIs
5
*the “-previrs”
- grazoprevir
- glecaprevir
- paritaprevir
- voxilaprevir
- simeprevir
important note about the NS3/4A PIs
they are always used in combo w/ other antiviral agents
NS3/4A PIs MoA
inhibit NS3/4A serine protease, an enzyme that is involved in post-translational processing and replication of HCV
NS5A inhibitors MoA
- NS5A plays a role in viral replication and the assembly of the hep C virus
- it’s inhibited by these drugs
NS5B NPIs and NNPIs MoA
- NS5B is involved w/ post-translation processing that is necessary for replication of HCV
- it is inhibited
NS5A inhibitors (6)
- the “-asvirs”
- daclatasvir
- elbasvir
- ledipasvir
- ombitasvir
- belpatasvir
- pibrentasvir
NS5B NPI (1)
sofosbuvir
NS5B NNPI (1)
dasabuvir
What is a fixed dose combo drug, and most importantly what is the drug interaction?
- zepatier
- interactions: statins, azoles, oral contraceptives
guideline recommendations for ribavirin and pegylated interferons
-NOT recommended that they be used without additional preferred HCV antiviral agents
how is ribavirin dosed?
based on weight
pegylated interferons are only used for what?
hep C tx
adverse effects of peginterferon and ribavirin
-there are a ton
- neuropsychiatric: depression**, irritability, anger, mood disorders
- fatigue: MC sx
- hematologic toxicity anemia, neutropenia, thrombocytopenia
- teratogenic risks
- hair loss
- migraines
- hearing loss
- flu like sx
- nausea
- derm complications (severe)
- infections
- other viruses: flu, herpes, staph, candida
- respiratory tract sx
- ophthalmologic disorders: MC is ischemic retinopathy
what lab is needed prior to tx w/ ribavirin or peginterferon?
- CBC
- pregnancy testing: *advise MEN and women to not attempt conception until 6 mos after stopping ribavirin
- glucose testing
- thyroid fxn
- ophthalmologic exam
what are the goals of tx for hep C?
- reduce all cause mortality and liver-related health adverse consequences including end stage liver dz and hepatocellular carcinoma
- sustained virologic response
- eradicate HCV RNA
define sustained virologic response
- continued absence of detectable RNA at least 12 weeks following the completion of therapy
- it can be considered cure of HCV infection
what are the effects of HCV cure on the liver?
- decreased liver inflammation (ALT and AST decrease)
- rate of liver fibrosis decreases
- reduced risk of hepatocellular CA
- reduction in liver-related mortality and liver transplantation
what are the factors in regimen selection for treating hepatitis C infection?
- genotype
- patient factors:
- presence of cirrhosis
- treatment hx
what does the patient work up consist of prior to initiating therapy?
- renal fxn
- CBC w/ diff
- alcohol or drug use
- extrahepatic manifestations of HCV
- HIV
- HBV
- severe co-morbitity (cardiac dz)
- potential for drug interaction
what additional assessment should be made in pts whose tx will contain ribavirin?
pregnancy and a contraceptive plan
