Tx for Viral Hepatitis Flashcards
what are the goals of chronic HBV treatment
suppression of HBV DNA to undetectable levels
seroconversion of HBeAg from + –> -
reduce AST/ALT
what are the endpoints that correlate w/ the goals of chronic HBV Tx
improvement in necro-inflam dz
decreased risk of HCC & cirrhosis
decrease need for liver transplant
how is the HBV tx diff from HCV
cure is rare (cure is common in HCV)
in HBV tx - replication is suppressed w/o eradicating the virus
covalently closed circular vrial DNA in stable form is indefinitely w/i the cell = reservior for HBV throughout life –> capacity to reactivate
*relapse is more common if co-infected w/ HDV
what are the drugs used for chronic HBV and what are the respective adverse effects
Entecavir:
type?
indication?
adverse effect?
BB-warning?
=HBV nucleoside analogue reverse transcriptase
- chronic HBV in adults & kinds (>= 2 yo) w/ active viral replication OR persistent elevation in ALT/AST OR histologically active
MC rxn = HA, fatigue, dizzy, nausea
BB warning: severe acute post-Tx exacerbation, pt co-infected w/ HIV & HBC - Lactic acidosis and hepatomeg
Tenofovir Disoproxil
type
indications
adverse effect
BB warning
neucleotide analog HIV-1 RT (-) and HBV RT (-)
use w/ other antiretroviral agent to Tx HIV-1 infxn in adults and kinds (>= 2 yo)
pt w/ compenstated liver dx - MC rxn = nausea
BB: post-tx exacerbation of hep, lactic acidosis/severe hepatomeg w/ steatosis
what is the warning/precaution for tenofovir disoproxil use
new onset or worsen renal impairment
(acute renal failure & Fancomi syndrome)
Adefovir
type
indication
contraindication
adverse rxn
nucleotide analoug
chronic HBV in pt >= 12 to
DO NOT give to pt w/ previous hypersensitivity to any of its components
rxn= in compensated dz pt = asthenia, increased CK in pre/post transplantation lamivudin-resistant liver dz pts
what are the warning/precautions for adefovir use
nephrotoxicity - monitor renal fxn during use (in all pt but esp in pt w/ pre-existing risk of renal impairment)
severe acute exacerbation of hep
what are the drug interxns for adefovir
coadmin w/ drugs that decrease renal fxn or compete for active tubulr secretion can cause increase concentration of adefovir or coadministered drug
lamivudine
type
indication
contraindication
adverse rxn
nucleoside analogue RT (-)
combo w/ other antiretroviral agent for HIV-1 tx
DO NOT use if hypersensitive to lamivudine
MC rxn in adults = HA, nausea, malasie/fatigue, nasal sign/symp, diarrhea, cough
what are the warnings/precautions for lamivudine
in coinfected pt (HIV/HBV) - can get lamivudine resistant HBV
pancreatitis
Telibivudine
type
indication
contraindication
adverse rxn
nucleoside analogue RT (-)
chronic HBV in adults w/ viral replication and either persistent elevation of AST/ALT or histologically active dz
DO NOT: combo this w/ PEGylated IFN a2a –> increased risk for peripheral neuropathy
MC rxn - fatigue, increase CK, HA, cough, diarrhea, abd pain/distention, nausea, arthralgia, pyrexia, rash, back pain, dizzy, myalgia, ALT increased, dyspepsia, insomnia
PEG IFN a2a
indication
contraindication
adverse rxn
chronic HCV w/ compensated liver dz NOT previously treated w/ IFN-a
in pt w/ histo evidence of cirrhosis & compensated liver dz
&&& chronic HBV w/ compensated liver dz and evidence of viral replication/liver inflam
NOT for: AIH, hepatic decompensation in pt w/ cirrhosis & neonates/infants
MC rxn: fatigue/asthenia, pyrexia, myalgia and HA
what is the goal of HCV treatment
viral eradication
sustained viral response (SVR): absence of detectable virema 24 wks after completion of therapy
SVR -associated w/ improvement in liver histo, reduction in rsk of end stage liver dz, HCC and regression of cirrhosis (late relapse <5% pt who achieve SVR)
what is the tx for acute hep C
delay for minimun 6 months after inital infxn bc rate of clearance for acute HCV = 20-35 %
if tx given after - use the same tx as chronic HCV
what direct acting antiviral combos are used for chronic HCV w/o cirrhosis
what are their side effects
what is the suffix for NS3/4A protease (-)
-previr
what is the suffix for NS5A (-)
-asvir
what is the suffix for NS5B polymerase (-)
-buvir
PEG IFN a2b
indication
contraindication
adverse rxn
BB warning
chronic HCV only! >= 18 yo w/ compensated liver dz w/ Hx of blood or blood-product exposure and/or are HCV antibody positive.
DO NOT give to: Hypersensitivity to IFN-a or any component of the product, AIH, or decompensated liver dz
MC rxn “flu-like” symptoms, fever, headache, chills, myalgia, and fatigue. More severe toxicities = higher doses and may be difficult for patients to tolerate
BB warning: cause/aggravate fatal or life-threatening neuropsychiatric,
autoimmune, ischemic, and infectious disorders
Elbasvir/Grazoprevir
indications
contraindications
adverse rxn
fixed dose combo w/ elbasavir -HCV Ns5A (-) & grazoprevir -HCV Ns3/4A protease (-)
DO NOT give to pt w/ moderate-severe hepatic impairment
MC rxn = fatigue, HA and nausea
what is the warning/precaution that should be taken when prescribing elbasvir/grazoprevir
ALT elevations
what are drug interaxns of elabsavir/granzoprevir
DO NOT give w/ mod CYP3A inducer - bc may decrease plasma concentration of elabsavir/granzoprevir
ledipasvir/sofobuvir
indications
adverse effects
ledipasvir - NS5A (-) and sobosbuvir - NS5B polymerase (-)
use for chronic HCV
adverse rxn = fatigue/HA
what is the warning/precaution that comes w/ ledipasvir/sofobuvir
use w/ other products conating sobosbuvir
what is the drug interxn of ledipasvir/sofobuvir
polyglycoprotein inducers (rifampin and st. john wort)
may change concentration
velpatasvir/sofosbuvir
indications
contraindications
adverse rxn
velpatasvir - NS5A (-) /sofosbuvir- NS5B polymerase (-)
chronic HCV w/o cirrhosis or w/ compensated cirrhosis OR w/ decompensated cirrhosis for use in combination w/ ribavirin
DO NOT give to pts who have contraindication to ribavirin
MC rxn - HA, fatigue; MC rxn of V/S+ribavirin in pt w/ decompensation cirrhosis = fatigue, anemia, nausea, diarrhea, insomnia, HA
what are the warnings/precautions that come with velpatasvir/sofosbuvir
can potentiate bradycardia w/ amiodarone co-administration
caution when using in pt receiving B-blocker or those w/ underlying cardiac comorbidity &/or advanced liver disease
what are drug interxns of velpatasvir/sofosbuvir
PGP inducers &/or moderate to potent CYP inducers (rifampin, st. john wort, carbamazepine)
decrease concetration of V &/or S
Ribivarin
type
indications
contraindications
adverse rxn
BB warning
nucleoside analogue
chronic HCV in combo w/ IFN-a2a in >= 5 yo w/ compensated liver dz who has not been treated w/ IFN-a yet & adults w/ chronic HCV co-infected w/ HIV
NOT for pregnant pt or men w/ female partner thats pregnant; or hemoglobinopathies
MC rxn = fatigue/asthenia, pyrexia, myalgia and HA
BB warning: SERIOUS D/Os & RIBAVIRIN-ASSOCAITED EFFECTS - birth defects/fetal death; DO NOT USE in preg pt OR 6 months after
Boceprevir
type
indication
contraindication
adverse rxn
NS3/4A protease (-)
chronich HV in combo w/ PEG-IFN a & ribavirin in pt w/ compensated liver dz (including cirrhosis) who were previously tx of have failed w/ previous IFN/ribavirin tx
DO NOT GIVE pregnant pt, men whose partner is preg, hemaglobinpathies, AIH, neonates/infants, hepatic decompensation w/ cirrhosis
MC rxn = fatigue, anemia, nausea, HA, dysgeusia
what is the warning/precaution of the use of Boceprevir with Ribavirin and Peginterferon alfa
ribavirin can cause birth defect/fetal death
