Viral Hepatitis drugs

Question 1

is there a treatment for acute hepatitis B

Answer 1

No specific treatment

most often resolves spontaneously

Question 2

what are the goals of chronic HBV therapy

Answer 2

1.
The suppression of HBV DNA to undetectable levels

2.
Seroconversion of HBeAg(or more rarely, HBsAg) from positive to negative

3.
Reduction in elevated serum aminotransferase levels.

Question 3

can chronic HBV be cured?

Answer 3

no it is rare

The covalently closed circular viral DNA exists in stable form indefinitely within the cell serving as a reservoir for HBV throughout the life of the cell and resulting in the capacity to reactivate

relapse is more common in patients co-infected with hepatitis D virus

Question 4

MOA and BB warning of Entecavir

Answer 4

A hepatitis B virus nucleoside analogue reverse transcriptase

• SEVERE ACUTE EXACERBATIONS OF HEPATITIS B especially PATIENTS CO-INFECTED WITH HIV AND HBV
• LACTIC ACIDOSIS
• HEPATOMEGALY

Question 5

are there any contradictions and what are the Adverse reactions of Entecavir

Answer 5

No contradictions

Adverse reactions:
In adults, the most common adverse reactions (≥3%, all severity grades) are
headache, fatigue, dizziness, and nausea. The adverse reactions observed in pediatric patients were consistent with those observed in adults.

Question 6

MOA and BB warning of Tenofovir Disoproxil

Answer 6

Anucleotide analog HIV-1 reverse transcriptase inhibitor and an HBV reverse transcriptase inhibitor.

• LACTIC ACIDOSIS/SEVERE HEPATOMEGALY WITH STEATOSIS
• POST TREATMENT EXACERBATION OF HEPATITIS

Question 7

what are the indications of Entecavir

Answer 7

Indicated for the treatment of chronic hepatitis B virus infection in adults and children at least 2 years of age with evidence of active viral replication and either evidence of persistent elevations in serum aminotransferases (ALT or AST) or histologically active disease.

Question 8

what are the Indications of Tenofovir disoproxil

Answer 8

Used in combination with other antiretroviral agents for the treatment of HIV-1 infection in adults and
pediatric patients 2 years of age and older.
-Used the treatment of chronic hepatitis B in adults and pediatric patients 12 years of age and older. (1)

Question 9

what are the warnings, precautions and adverse effects of Tenofovir disoproxil

Answer 9

WARNINGS AND PRECAUTIONS
New onset or worsening renal impairment: Can include acute renal failure and Fanconi syndrome

ADVERSE RXNS: In HBV-infected subjects with compensated liver disease: most common adverse
reaction (all grades) was nausea (9%).

Question 10

Indications and contradictions in Adefovir

Answer 10

INDICATIONS: is a nucleotide analogue used for the treatment of chronic hepatitis B in patients 12 years of age and older.

CONTRAINDICATIONS: in patients with previously demonstrated hypersensitivity to any of the components of the product.

Question 11

what are the warnings, adverse rxns, and drug interactions of adefovir

Answer 11

WARNINGS/PRECAUTIONS
Nephrotoxicity: Monitor renal function during therapy for all patients, particularly those with pre-existing or other risks for renal impairment.
-Severe acute exacerbations of hepatitis

ADVERSE RXNS: Most common adverse reaction (incidence greater than 10%) in compensated disease patients is asthenia and increased creatinine in pre and post transplantation lamivudine-resistant liver disease patients

DRUG INTERXNS: Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of adefoviror the coadministered drug.

Question 12

what are the MOA and Indications of Telbivudine?

Answer 12

A nucleoside analogue reverse transcriptase inhibitor

Used for the treatment of chronic hepatitis B in adult patients with evidence of viral replication and either evidence of persistent elevations in serum aminotransferases (ALT or AST) or histologically active disease.

Question 13

Contradictions, BB warning, and adverse reactions of Telbivudine

Answer 13

LACTIC ACIDOSIS
SEVERE HEPATOMEGALY WITH STEATOSIS
SEVERE ACUTE EXACERBATIONS OF HEPATITIS B

Combination of Telbivudine with PEGylated interferon alfa-2a: Increased risk of peripheral neuropathy

ADVERSE RXNS: Most common adverse reactions: fatigue, increased creatine kinase (CK), headache, cough, diarrhea, abdominal pain, nausea,arthralgia, pyrexia, rash, back pain, dizziness, myalgia, ALT increased, dyspepsia, insomnia, and abdominal distension.

Question 14

what is the indications of PEG Interferon Alfa-2a

Answer 14

INDICATIONS: Treatment of chronic hepatitis C with compensated liver disease not previously treated with interferon alpha, in patients with histological evidence of cirrhosis and compensated liver disease,
*Treatment of patients with chronic hepatitis B infection who have compensated liver disease and evidence of viral replication and liver inflammation

Question 15

what are the BB warnings, contradictions, and adverse reactions of PEG interferon Alfa-2a

Answer 15

ADVERSE RXNS: Most common are fatigue/asthenia, pyrexia, myalgia, and headache.

BB WARNING: RISK OF SERIOUS DISORDERS AND RIBAVIRIN-ASSOCIATED EFFECTS

CONTRAINDICATIONS:
• Autoimmune hepatitis
• Hepatic decompensation in patients with cirrhosis
• Use in neonates/infant

Question 16

what are the Indications of PEG Interferon Alfa-2b

Answer 16

INDICATIONS: Used for the treatment of chronic hepatitis C in patients 18 years of age or older with compensated liver disease who have a history of blood or blood-product exposure and/or are HCV antibody positive.

Question 17

what are the BB warnings, Contraindications, and adverse reactions of PEG Interferon Alfa-2b

Answer 17

BB WARNING: Can cause or aggravate fatal or life-threatening neuropsychiatric,
autoimmune, ischemic, and infectious disorders.

CONTRAINDICATIONS:• Hypersensitivity to interferon alpha or any component of the product
• Autoimmune hepatitis
• Decompensated liver disease

ADVERSE RXNS: Most frequently reported adverse reactions were “flu-like” symptoms, fever, headache, chills, myalgia, and fatigue. More severe toxicities are observed generally at higher doses and may be difficult for patients to tolerate.

Question 18

when is the end point typically achieved of sustained viral response?

Answer 18

no detectable viremia for 24 weeks after the completion of treatment

Question 19

what is the rate of clearance without treatment for patients

Answer 19

20-30 percent that is why some practitioners delay therapy for minimum of 6 months to see if the infection clears its self

Question 20

what are the Indications of Elbasvir and Grazoprevir?

Answer 20

Is a fixed-dose combination product containing elbasvir, a hepatitis C virus (HCV) NS5A inhibitor,

and Grazoprevir, an HCV NS3/4A protease inhibitor used in the treatment of Hepatitis C.

Question 21

what are the contradictions, warnings, adverse reactions and drug interactions of Elbasvir and Grazoprevir

Answer 21

Contraindications-Patients with moderate or severe hepatic impairment

WARNINGS AND PRECAUTIONS:
ALT elevations:

ADVERSE REACTIONS: The most commonly reported adverse reactions of all intensity were fatigue, headache, and nausea

DRUG INTERACTIONS: Co-administration with moderate CYP3A inducers is not
recommended as they may decrease the plasma concentration of Elbasvir/Grazoprevir.

Question 22

what are the indications of Ledipasvir and Sofosbuvir

Answer 22

• A fixed-dose combination of ledipasvir, a hepatitis C virus (HCV) NS5A inhibitor,

and sofosbuvir, an HCV nucleotide analog NS5B polymerase inhibitor,

• Indicated for the treatment of chronic hepatitis C infection in adults

Question 23

what are the warnings, adverse reactions, and drug interactions of Ledipasvir/sofosbuvir

Answer 23

WARNINGS/PRECAUTIONS: Only recommended with some combination of ribavirin, peginterferon-alfa, simeprevir, ledipasvir, daclatasvir, or velpatasvir

ADVERSE RXNS: Most common are fatigue and headache

DRUG INTERXNS:• Poly glycoprotein inducers (e.g., rifampin, St. John’s wort): May alter concentrations of ledipasvir and sofosbuvir»not recommended

Question 24

what are the Indications of Velpatasvir/Sofosbuvir

Answer 24

• A fixed-dose combination of sofosbuvir, a hepatitis C virus (HCV) nucleotide analog NS5B polymerase inhibitor, and velpatasvir, an HCV NS5A inhibitor,
•
INDICATION: for the treatment of adult patients with chronic HCV infection
•
without cirrhosis or with compensated cirrhosis
•
with decompensated cirrhosis for use in combination with ribavirin

Question 25

what are the contradictions and warnings of Velpatasvir/sofosbuvir

Answer 25

CONTRAINDICATED in patients for whom ribavirin is contraindicated

WARNINGS/PRECAUTIONS:
Can potentiate bradycardia with amiodarone co-administration
•
Caution also in patients receiving beta blockers, or those with underlying cardiac comorbidities and/or advanced liver disease

Question 26

what are the adverse reactions and drug interactions of Velpatasvir/Sofosbuvir

Answer 26

ADVERSE RXNS:
•
Most common are headache and fatigue.
•
The most common adverse reactions with treatment with V/S and ribavirin in patients with decompensated cirrhosis are fatigue, anemia, nausea, headache, insomnia and diarrhea.

DRUG INTERACTIONS:
•
PGP inducers and/or moderate to potent CYP inducers (e.g., rifampin, St. John’s wort, carbamazepine):
•
May decrease concentrations of sofosbuvirand/or velpatasvir. Not recommended

Question 27

what are the indications of Ribivarin

Answer 27

INDICATIONS: A nucleoside analogue indicated for the treatment of chronic hepatitis C virus infection in combination with Interferon alfa-2a in patients 5 years of age and older with compensated liver disease not previously treated with interferon alpha, and used in adult CHC patients co-infected with HIV

Question 28

what are the BB warnings, contradictions, and adverse reactions of Ribivarin

Answer 28

BB WARNING:
RISK OF SERIOUS DISORDERS AND RIBAVIRIN-ASSOCIATED EFFECTS
Birth defects and fetal death with ribavirin: Do not use in pregnancy and for 6 months after treatment.

CONTRAINDICATIONS:
• Pregnant women and men whose female partners are pregnant
• Hemoglobinopathies

ADVERSE RXNS: Most common adverse reactions (frequency greater than 40%) in adults receiving combination therapy are fatigue/asthenia, pyrexia, myalgia, and headache.

Question 29

what are the indications for Boceprevir

Answer 29

A hepatitis C virus (HCV) NS3/4A protease inhibitor indicated for the treatment of chronic hepatitis C (CHC) infection, in combination with peg interferon alfa and ribavirin, in adult patients with compensated liver disease, including cirrhosis, who are previously untreated or who have failed previous interferon and ribavirin therapy.

Question 30

what are the contraindications, warnings and adverse reactions

Answer 30

CONTRAINDICATIONS: All contraindications to peg interferon alfa and ribavirin also apply since Boceprevir must be administered with peg interferon alfa and ribavirin.

Warnings/Precautions: Use of Boceprevir with Ribavirin and Peg interferon alfa:

Ribavirin may cause birth defects and fetal death; avoid pregnancy in female patients and female partners of male patients.

ADVERSE RXNS: Most commonly reported adverse reactions were fatigue, anemia, nausea, headache and dysgeusia.

Question 31

what is the suffix and drugs of all the NS3/4A protease inhibitors

Answer 31

previr

Telaprevir
Boceprevir
Simeprevir
Paritaprevir
Grazoprevir

Question 32

what are the NS5A inhibitors and what are their suffix

Answer 32

asvir

Daclastasvir
Ledipasvir
Velpastasvir
Ombitasvir
Elbasvir

Question 33

what are the NSB5 polymerase inhibitors and what are their suffix

Answer 33

buvir

Nucleosides:
Sofosbuvir

Non-Nucleosides:
Dasabuvir