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(J2) GI II Test 2 > Viral Hepatitis Pharm > Flashcards

Viral Hepatitis Pharm Flashcards

1
Q

What is the goal of HBV treatment?

A
  • HBV DNA suprpression to undetectable levels
  • seronegativity to HBeAg (sometimes HBsAg
  • reduction of transaminase

These correspond to:

  • decreased liver damage
  • decreased risk for cirrhosis and HCC
  • decreased likelihood for need of liver transplant
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2
Q

When is HBV treated (acute/chronic)?

A
  • only chronic HBV is treated
  • acute HBV will often resolve on its own
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3
Q

What is the common mechanism of action in most drugs used to treat HBV?

What limitation does this give treatment of HBV?

A

nucleoside/nucleotide reverse transcriptase inhibitors (NTRI)

only effective against actively replicating virus due to MOA

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4
Q

What side effects are commonly shared by HBV NTRIs?

A
  • headache
  • nausea
  • fatigue
  • nasal symptoms
  • cough
  • diarrhea
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5
Q

What black box warning is common in most drugs used to treat HBV?

What HBV drug does not come with this warning?

A
  • lactic acidosis
  • severe exacerbation of HBV infection upon discontinuation

adefovir does not have this warning

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6
Q

What is entecavir?

(indications)

A

HBV NTRI (nucleoside)

Indications: (active HBV)

  • adults
  • children >2
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7
Q

What contraindications/adverse effects are associated with entecavir?

A

none

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8
Q

What is tenofovir disoproxil?

(indications)

A

HIV1/HBV NTRI (nucleotide)

Indications:

  • HIV-1 infection in adults or children >2
  • HBV in adults and children >12
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9
Q

What contraindications/adverse effects are associated with tenofovir disoproxil?

A

renal impairment

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10
Q

What is adefovir?

(indications)

A

HBV NTRI (nucleotide)

Indications:

HBV infection in adult and children >12

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11
Q

What contraindications/adverse effects are associated with adefovir?

A
  • nephrotoxicity
  • weakness and increased creatinine
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12
Q

What is lamivudine?

(indications)

A

HIV-1/HBV NTRI (nucleoside)

Indications:

  • HIV-1 infection in adults
  • HBV infection in adults
  • co-infection
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13
Q

What contraindications/adverse effects are associated with entecavir?

A

-pancreatitis

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14
Q

What is telbivudine?

(indications)

A

HBV NTRI (nucleoside)

Indications:

-HBV in adults

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15
Q

What contraindications/adverse effects are associated with telbivudine?

A

not to be administered with PEG interferon alfa-2a -> peripheral neuropathy

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16
Q

Which HBV treatments are also used in HIV-1 treatment?

A
  • tenofovir disoproxil
  • lamivudine

many of the others are effective against HIV-1 but at levels that are too high to be safe and are therefore not approved for use

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17
Q

What non-NTRI is used to treat HBV?

A

PEG interferon alfa-2a

18
Q

What are the two PEG interferon’s used to treat viral hepatitis?

Which viral hepatitis do they treat?

A
  • PEG interferon alfa-2a -> HBV and HCV (HCV with ribivrin)
  • PEG interferon alfa-2b -> HCV only
19
Q

What is the MOA of PEG interferons?

A

interferon analogs -> drive MHC I expression and stimulate cytotoxic T cell response (viral related immune responses)

20
Q

What black box warning is associated with PEG interferon alfa-2a/b?

A

causes or aggravates neurospsychiatric, autoimmune, ischemic, and infectious

21
Q

What are the side effects of PEG interferons?

A

flu-like symptoms

22
Q

What are contraindications of PEG interferon alfa-2a?

A
  • autoimmune hepatitis (worsens CD8+ mediated destruction)
  • decompensated liver disease
  • neonates/infants (birth defects)
23
Q

What are contraindications of PEG interferon alfa-2b?

A
  • autoimmune hepatitis (worsens CD8+ mediated destruction)
  • decompensated liver disease
24
Q

What is the goal of HCV treatment?

A

eradicatin of the virus -> “sustained viral response” (absence of detectable signs of infection 24 weeks after treatment completion)

Corresponds to

  • decreased liver damage
  • decreased risk for cirrhosis and HCC
  • possible regression of cirrhosis
25
Q

When is HCV treated (acute/chronic)?

A

chronic > acute but both are treated

acute HCV is likley to progress to chronic HCV but some cases don’t -> treatment is usually delayed in the acute stage to see if virus is cleared on its own

26
Q

What are the main MOAs of HCV treatment?

What suffix is associated with each?

A
  • NS3/4A protease inhibitors -> “-previr”
  • NS5A** inhibitors -> “-asvir**”
  • NS5B polymerase inhibitors -> “-buvir”
27
Q

What is ribivarin?

(indications)

A

HCV nucleoside polymerase inhibitor

Indications:

  • HCV with interferon alfa-2a in children >5
  • chronic HCV w/ HIV co-infection in adults
28
Q

What black box warning is associated with ribivarin?

A

risk of birth defects or fetal death

  • not to be used during or 6 months prior to pregnancy
  • not to be used by male sexual partner of pregnant females
29
Q

What contraindications/adverse effects are associated with ribivarin?

A
  • hemoglobinopathies
  • pregnancy/males with pregnant partners (black box warning)
30
Q

What is elbasvir/grazoprevir?

(indication)

A

elbasvir/grazoprevir

combination drug; NS5A inhibitor + NS3/4A protease inhibitor

Indications:

-treatment of HCV in adults

31
Q

What contraindications/adverse effects are associated with elbasvir/grazoprevir?

A

-elevated ALT

Contraindications:

-moderate or severe hepatic impairment (these drugs are metabolized in the liver)

32
Q

What drug interactions occur with elbasvir/grazoprevir?

A

CYP3A inducers increase metabolism of elbasvir/grazoprevir

33
Q

What is ledipasvir/sofosbuvir?

(indications)

A

ledipasvir/sofosbuvir

combination drug; NS5A inhibitor + nucleotide NS5B polymerase inhibitor

Indications:

-treatment of HCV in adults

-only in combination with ribavirn

34
Q

What contraindications/adverse effects are associated with ledipasvir/sofobuvir?

A

only given in combo with ribavirn -> ribavirn contraindications apply

  • pregnancy/ males with pregnant partners
  • hemoglobinopathies
35
Q

What drug interactions occur with velpatasvir/sofobuvir?

A
  • polyglycoprotein (PGP) inducers (rifampin, St. John’s wort)
  • CYP inducers
36
Q

What is velpatasvir/sofosbuvir?

(indications)

A

velpatasvir/sofosbuvir

combination drug; NS5A inhibitor + nucleotide NS5B polymerase inhibitor

Indications:

  • HCV w/o cirrhosis or with compensated cirrhosis in adults
  • HCV w/ decompensated cirrhosis in combination with ribivarin in adults
37
Q

What contraindications/adverse effects are associated with velpatasvir/sofobuvir?

A

ribivarin contrainidcations apply in decompensated cirrhosis:

-pregnancy/ males with pregnant partners

-hemoglobinopathies

38
Q

What drug interactions occur with ledipasvir/sofobuvir?

A

polyglycoprotein (PGP) inducers (rifampin, St. John’s wort)

39
Q

What is boceprevir?

(indications)

A

HCV NS3/4A inhibitor

Must be given in combo with:

-PEG interferon alfa and ribivarin

Indications:

-chronic HCV with compensated liver disease in adults

40
Q

What contraindications/adverse effects are associated with boceprevir?

A

When given with ribivarin:

  • pregnancy/ males with pregnant partners
  • hemoglobinopathies

(J2) GI II Test 2 (12 decks)

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