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GI 2 > Pharm - Hep C > Flashcards

Pharm - Hep C Flashcards

1
Q

Candidates for tx during acute infection

A
  • 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
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2
Q

ID the patient who should be treated for a chronic infection

A
  • all pts w/ virologic evidence of chronic HCV infection
  • i.e: detectable HCV viral level over a six month period
  • exceptions: short life expectancies
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3
Q

What are the 3 classes of meds to tx hep C?

A
  • direct-acting antivirals (DAA)
  • ribavirin
  • pegylated interferons
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4
Q

What are the 4 classes of direct acting antivirals (DAA)

A
  • NS3/4A PIs
  • NS5A inhibitors
  • NS5B NPIs
  • NS5B NNPIs
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5
Q

NS3/4A PIs

5

A

*the “-previrs”

  • grazoprevir
  • glecaprevir
  • paritaprevir
  • voxilaprevir
  • simeprevir
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6
Q

important note about the NS3/4A PIs

A

they are always used in combo w/ other antiviral agents

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7
Q

NS3/4A PIs MoA

A

inhibit NS3/4A serine protease, an enzyme that is involved in post-translational processing and replication of HCV

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8
Q

NS5A inhibitors MoA

A
  • NS5A plays a role in viral replication and the assembly of the hep C virus
  • it’s inhibited by these drugs
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9
Q

NS5B NPIs and NNPIs MoA

A
  • NS5B is involved w/ post-translation processing that is necessary for replication of HCV
  • it is inhibited
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10
Q

NS5A inhibitors (6)

A
  • the “-asvirs”
  • daclatasvir
  • elbasvir
  • ledipasvir
  • ombitasvir
  • belpatasvir
  • pibrentasvir
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11
Q

NS5B NPI (1)

A

sofosbuvir

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12
Q

NS5B NNPI (1)

A

dasabuvir

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13
Q

What is a fixed dose combo drug, and most importantly what is the drug interaction?

A
  • zepatier

- interactions: statins, azoles, oral contraceptives

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14
Q

guideline recommendations for ribavirin and pegylated interferons

A

-NOT recommended that they be used without additional preferred HCV antiviral agents

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15
Q

how is ribavirin dosed?

A

based on weight

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16
Q

pegylated interferons are only used for what?

A

hep C tx

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17
Q

adverse effects of peginterferon and ribavirin

-there are a ton

A
  • 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
18
Q

what lab is needed prior to tx w/ ribavirin or peginterferon?

A
  • CBC
  • pregnancy testing: *advise MEN and women to not attempt conception until 6 mos after stopping ribavirin
  • glucose testing
  • thyroid fxn
  • ophthalmologic exam
19
Q

what are the goals of tx for hep C?

A
  • reduce all cause mortality and liver-related health adverse consequences including end stage liver dz and hepatocellular carcinoma
  • sustained virologic response
  • eradicate HCV RNA
20
Q

define sustained virologic response

A
  • continued absence of detectable RNA at least 12 weeks following the completion of therapy
  • it can be considered cure of HCV infection
21
Q

what are the effects of HCV cure on the liver?

A
  • 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
22
Q

what are the factors in regimen selection for treating hepatitis C infection?

A
  • genotype
  • patient factors:
  • presence of cirrhosis
  • treatment hx
23
Q

what does the patient work up consist of prior to initiating therapy?

A
  • renal fxn
  • CBC w/ diff
  • alcohol or drug use
  • extrahepatic manifestations of HCV
  • HIV
  • HBV
  • severe co-morbitity (cardiac dz)
  • potential for drug interaction
24
Q

what additional assessment should be made in pts whose tx will contain ribavirin?

A

pregnancy and a contraceptive plan

25
Q

what additional assessment should be made in pts whose tx will contain interferon?

A
  • psych hx
  • presence of underlying autoimmune disorders
  • thyroid fxn
  • fasting glucose
  • fundoscopic exam
26
Q

define treatment naive

A

pts who have never received any treatment for HCV infection

27
Q

define treatment-experienced

A
  • patients who had failed prior treatment

- divided into groups by what they were treated with

28
Q

What are the preferred tx regiments for pts w/ genotype 1?

A
  • Harvoni
  • Epclusa
  • Mavyret
29
Q

Harvoni

  • what drugs
  • duration
  • ADRs
A
  • NS5A + NPI
  • duration: 12 weeks
  • ADR: fatigue, HA, insomnia, nausea
30
Q

Epclusa

  • what drugs
  • duration
  • ADRs
A
  • NS5A + NPI
  • duration: 12 weeks if no cirrhosis
  • ADR: fatigue, HA, insomnia, nausea
31
Q

Mavyret

  • what drugs
  • duration
  • ADRs
A
  • NS3/4A PI + NS5A inhibitor
  • duration: 8 weeks for naive no cirrhosis
  • ADR: HA and fatigue
32
Q

monitoring parameters for antiviral therapy

A
  • adherence***
  • ADRs
  • viral monitoring:
  • check viral load at week 4 (should be undetectable)
  • check load at week 6 if present at week 4
  • check load at week 12
  • other lab: CBC, renal and liver fxn, bilirubin
33
Q

what are all of the fixed dose combos?

A
  • zepatier
  • harvoni
  • viekira XR
  • expclusa
  • mavyret
  • vosevi
34
Q

what combo durg should not be used with ribavirin

A

viekira XR

35
Q

combo drugs that are:

  • NS3/4A + NS5A
  • aka -previr + -asvir
A
  • zepatier
  • viekira XR
  • mavyret
36
Q

combo drugs that are:

  • NS5A + NPI
  • aka: -asvir + sofosbuvir
A
  • harvoni

- epclusa

37
Q

vosevi drug combo

A
  • NS3/4A + NS5A + NS5B NPI

- -previr + -asvir + sofosbuvir

38
Q

what are the pangenotypic combo drugs?

A
  • epclusa
  • mavyret
  • vosevi
39
Q

what combo drug only covers gentopye 1?

A

viekira XR

40
Q

zepatier genotype coverage

A
  • 1a
  • 1b
  • 4
41
Q

harvoni genotype coverage

A
  • 1
  • 4
  • 5
  • 6

GI 2 (11 decks)

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