Pharm-Viral Hepatitis

Question 1

treatment of acute HBV infection

Answer 1

95% resolve, little need for intervention unless fulminant (lamivudine?, nRTI)

Question 2

goal with tx of chronic HBV

Answer 2

suppress virus (prevent flare, prevent progression to cirrhosis and HCC)

Question 3

treatment of HBeAg+ disease is based on level of ____ and ____

Answer 3

HBV DNA; ALT

Question 4

if HBV DNA is less than 2K, you should?

Answer 4

monitor only

Question 5

if HBV DNA is more than 2K and ALT is normal you should?

Answer 5

monitor ALT or consider biopsy (treat if significant dz)

Question 6

if HBV DNA is more than 2K and ALT is elevated you should?

Answer 6

begin long-term treatment

Question 7

treatment of HBV+ compensated cirrhosis should be initiated when?

Answer 7

HBV DNA is >2000

Question 8

all patients with decompensated cirrhosis should be ______; patients with _____ should be treated with _____ medications

Answer 8

put on a waitlist for transplant; oral tx (NO interferon)

Question 9

there is a ____ threshhold for treatment of patients who are HBeAg+ and a ____ threshhold for tx of patients who are anti-Hbe+

Answer 9

higher; lower

Question 10

first line agents for chronic HBV in US are?

Answer 10

entecavir, tenofovir, PegIFN

Question 11

these HIV medications are also active against HBV

Answer 11

emtricitabine, truvada (emtric/tenofovir)

Question 12

these should not be used to treat HBV infection because they have a black box warning for lactic acidosis

Answer 12

oral nucleosides (adefovir, lamivudine)

Question 13

patients with HBeAg are monitored every 3-4 months to check for?

Answer 13

seroconversion to anti-HBeA

Question 14

the goal of HCV tx is to?

Answer 14

CURE the disease (when tx is deemed necessary)

Question 15

how long and how severe are the side effects for HCV tx?

Answer 15

6-12 months of therapy with lots of side effects

Question 16

current recommendations for dose and duration of PEG-IFN + ribaviron depend on _____

Answer 16

genotype of HCV (G1/4 have longer, stronger tx)

Question 17

conjunction tx for HCV genotype 1 includes ____, which improves SVR rates and can decrease duration of tx

Answer 17

protease inhibitor (telaprevir, boceprevir)

Question 18

major side effects of interferon

Answer 18

depression, blood dyscrasias, thyroid disorders, fatigue/flue-like sx

Question 19

major side effect of ribavirin

Answer 19

anemia

Question 20

side effects of telaprevir

Answer 20

rash, anorectal sx

Question 21

side effects of boceprevir

Answer 21

anemia, dysgeusia

Question 22

neutropenia is worse with (interferon/peg-interferon)

Answer 22

peg-interferon (for severe forms)

Question 23

relationship between interferon and thrombocytopenia

Answer 23

minimal, not much risk of TCP

Question 24

what are three major causes of depression in HCV

Answer 24

interferon-induced, baseline mental illness, and substance abuse (occurs in 30-60% of pts)

Question 25

thyroid dysfunction occurs in ___% of pts receiving INF, and up to ___% of those become thyroid antibody positive (IIT)

Answer 25

15%, 40% (IRREVERSIBLE)

Question 26

most frequently reported extrahepatic sx in pts with HCV

Answer 26

fatigue (could be related to depression and therapy)

Question 27

flu-like sx from interferon tx are worse (early/late) in therapy (what do you tx it with?)

Answer 27

early (tx with acetaminophen)

Question 28

genotic polymorphisms in the IL28B gene confer SVR advantage to what races?

Answer 28

caucasian, asian

Question 29

name 3 classes of new HCV drugs

Answer 29

2nd gen protease inhibitors, nucleoside pol inhibitors, non-nucleoside pol inhibitors