Viral Hepatitis Pharm

Question 1

Entecavir:

List the class.
List the indication(s).
Evidence of what is needed before prescribing?

Answer 1

Hepatitis B virus nucleoside analogue reverse transcriptase.

Chronic Hep B virus infection in adults and children >2 years old.

Need evidence of active viral replication and elevations of ALT or AST.

Question 2

Entecavir:

List the BB warnings. (4)
List the adverse reactions.
List the contraindications.

Answer 2

Severe acute exacerbations of Hep B.
Patients coinfected with HIV and HBV.
Lactic Acidosis.
Heptaomegaly

Question 3

Tenofovir Disoproxil:

List the Class.
List the Indications for HIV and CBV.

Answer 3

Nucleotide analog HIV-1 RT inhibitor + HBV RT inhibitor

Used in combination with other antiretroviral agents for the treatement of HIV-1 infection in adults and pediatric patients >2 y.o.

Used to treat CBV in adults and pediatric patients >12 y.o.

Question 4

Tenofovir Disoproxil:

List the BB warnings (3).
List the warnings and precautions.

Answer 4

Lactic acidosis
Severe hepatomegaly with steatosis
Post treatment exacerbation of hepatitis.

Renal impairment

Question 5

Adefovir:

List the Class.
List the indications.

Answer 5

Nucleotide analog

Treatment of chronic Hep B in patients >12 y.o.

Question 6

Adefovir:

List the contraindications
List the warnings/precautions
List the adverse rxns.
List the drug interactions.

Answer 6

Hypersensitivity to any of the components of the product.

Nephrotoxicity.

Compensated disease = asthenia
Pre and post transplantation lamivudine-resistant liver = increased creatinine.

Any drugs that reduce renal fx or compete for active tubular secretion (increase concentrations of one of the two compounds).

Question 7

Lamivudine:

List the class.
List the indications.
List the contraindications.

Answer 7

Nucleoside analogue RT inhibitor

Used in combination with other antiretroviral agents to treat HIV-1.

Previous hypersensitivity to lamivudine.

Question 8

Lamivudine:

List the BB warnings (4)
List the warnings and precautions. (3)

Answer 8

Lactic acidosis
Severe hepatomegaly
Exacerbations of Hep B
Different formulations

Co-infected HIV-1/HBV patients - lamivudine-resistant HBV variants that are resistant
Pancreatitis

Question 9

Telbivudine:

List the class.
List the indications.
List the contraindications

Answer 9

Nucleoside analogue RT inhibitor

Chronic hep B in adults. Must have proof of active disease.

Telbivudine + PEGylated interferon alpha-2a = increased risk of peripheral neuropathy

Question 10

Telbivudine:

List the BB warnings (3)

Answer 10

Lactic acidosis
Severe hepatomegaly with steatosis
Severe acute exacerbations of HEP B

Question 11

PEG Interferon alpha-2a:

List the indications. (2)
List the contraindications (3)

Answer 11

Hep C with compensated liver disease not previously treated with interferon alpha.
Hep B infection who have compensated liver disease and liver inflammation

Autoimmune hepatitis
Hepatic decompensation in patients with cirrhoisis
Use in neonates/infants.

Question 12

PEG interferon alpha-2a:

List the BB warning.

Answer 12

Risk of serious disorders and ribavirin-associated affects

Question 13

PEG Interferon Alpha-2b:

List the indications.
List the contraindications. (3)

Answer 13

HEP C >18 years old with compensated liver disease.

Hypersensitivity to inferon alpha
Autoimmune hepatitis
Decompensated liver disease

Question 14

PEG Interferon Alpha-2b

List the BB warning

Answer 14

Fatal or life-threatening neuropsychiatric, autoimmune, ischemic, and infectious disorders.

Question 15

Elbasvir/Grazoprevir:

List the classes in this combination.
List the treatment
List the contraidications.

Answer 15

Elbasvir (NS5a inhibitor), Grazoprevir (NS3/4A protease inhibitor).

HEP C

Moderate or severe hepatic impairment

Question 16

Elbsavir/Grazoprevir:

List the Warnings/precautions
List the drug interactions

Answer 16

ALT elevation

Co-administration with CYP3a inducers is not recommended. They decrease plasma concentration.

Question 17

Ledipasvir/Sofosbuvir:

List the combination.
List the treatment.
List the warnings/precautions.

Answer 17

Ledipasvir ( NS5a inhibitor), Sofosbuvir (NS5B polymerase inhibitor)

Hep C in adults

Only recommended with some combination of ribavirin, PEG interferon-alfa, simprevir, ledipasvir, daclatasvir, or velpatasvir

Question 18

Ledipasvir/Sofosbuvir:

List the drug interactions

Answer 18

Poly glycoprotein inducers (rifampin, St. John’s wort). May alter drug concentrations.

Question 19

Velpatasvir/Sofosbuvir:

List the combination
List the indication (2)
List the contraindication
List the warnings/precautions (2)

Answer 19

Sofsbuvir ( NS5B polymerase inhibitor), Velpatasvir (NS5A inhibitor)

adults with HCV without cirrhosis or with compensated cirrhosis
If they have decompensated cirrhosis use with ribavirin.

Patients that cant take ribavirin.

Can potentiate bradycardia with amiodarone co-administration.
Caution in patients receiving beta-blockers/ Cardiac comorbidities/Liver disease

Question 20

Velpatasvir/Sofosbuvir:

List the drug interactions.

Answer 20

PGP inducers, CYP inducers… decrease concentration of V/S.

Question 21

Ribivarin:

List the class.
List the indication. (2)
List the contraindications (2)

Answer 21

Nucleoside analogue

Given in combination with interferon alfa-2a in patients >5 with compensated liver disease not previously treated with interferon alpha
used in adult CHC patients co-infected with HIV.

Pregnant women and men whose partners are pregnant.
Hemoglobinopathies

Question 22

Ribivarin:

List the BB warnings (2)

Answer 22

Birth defects and fetal death

Question 23

Boceprevir:

List the class.
List the combination.
List the Indication
List the contraindication

Answer 23

NS3/4A protease inhibitor

PEG interferon alfa and ribavirin

CHC in adult patients with compensated liver disease, who are previously untreated or who have failed previous interferon and ribavirin therapy.

PEG interferon alfa and ribavirin contraindications.

Question 24

Boceprevir:

List the warnings/precautions (2)

Answer 24

Ribavirin may cause birth defects and fetal death. Avoid in pregnancy in female patients and female partners of male patients.