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GI2 > Viral Hepatitis Pharm > Flashcards

Viral Hepatitis Pharm Flashcards

1
Q

What are the goals of HBV therapy? (3)

A
  1. Suppression of HBV DNA to undetectable levels,
  2. Seroconversion of HBeAg from pos to neg.
  3. reduced serum amniotransferases
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2
Q

What are the desired endpoints of HBV therapy?

A
  1. Improvement of necroinflammatory disease
  2. decrease risk of hepatocellular carcinoma and cirrhosis
  3. decreased need for liver transplant
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3
Q

Entecavir is HBV or HCV? Mechanism?

A

HBV!

nucleoside analog reverse transcripase

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4
Q 
What HBV tx has BB warning of 
- severe acute hep B exacerbation
in patients co- infected with HIV and HBV
- Lactic acidosis
-hepatospenomegaly
A

Entecavir

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5
Q

When do you use Entecavir for Hep B?

A
  1. persistent ALT/AST elevations
  2. Active viral rep
  3. active disease on histo
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6
Q

What is Tenofovir Disoproxil used to treat? How?

A
  1. Hep B (and HIV)

2. nucleotide analog HIV-1 reverse transcriptase inhibitor and HBV reverse transcriptase inhibitor

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7
Q

I have renal issues and Hep B… Be careful if you give me these drugs!

A
  1. Tenofovir Disoproxil (acute renal failure and Fanconi)

2. Adefovir (causes nephrotoxicity)

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8
Q

When is tenofovir disoproxil indicated?

A

chronic HepB in adults and peds >12 yo

and HIV

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9
Q

What is Adefovir used to treat? How?

A
  1. HepB infection

2. nucleotide analog

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10
Q

What Hep B drugs are associated with Hypersensitivity reactions?

A
  1. Adefovir
  2. Lamivudine

She is SENSITIVE to sourness of LAMInADE (like lemonade and hypersensitivity… I tried)

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11
Q

What is Lamivudine used to treat? How?

A
  1. Chronic Hep B (and HIV)

2. nucleoside analogue reverse transcriptase inhibitor

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12
Q

Who is at risk of developing resistant HBV resistant variants with Lamivudine??

A

HIV/ HBV patients on lamividine-containing antiretroviral regiments.. literally the only 2 things its used for can tag team against it

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13
Q

What are all the issues HBV tx Lamivudine causes?

A
  1. BB warning: Lactic acidosis, severe hepatomegaly, HBV exacerbation,
  2. Pancreatitis
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14
Q

What is Telbivudine used to treat? How?

A
  1. HepB

2. nucleoside analogue reverse transcriptase inhibitor

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15
Q

What Hep B tx combo can result in peripheral neuropathy?

A

Telbivudine + PEGylated interferon alfa-2a

TELly has a PEG leg (leg is in periphery)

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16
Q

Lactic acidosis, severe hepatomegaly with steatosis, and severe acute exacerbations of Hep B are black box warning for what Hep B drug?

A

Telbivudine

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17
Q

What Hep B drug can cause increased creatinine kinase?

A

Telbivudine

18
Q

What drug can be used to treat chronic Hep B and Chronic Hep C?

A

PEG IFN Alfa-2a

  1. Chronic HCV-> with compensated liver not previously treated with interferion alfa and history evidence of cirrhosis and compensated liver disease
  2. Chronic HBV-> compensated liver disease, evidence fo viral replication and liver inflammation
19
Q

What is PEG interferon Alfa 2b used to treat?

A

ONLY Hep C

20
Q

When should PEG Interferion Alfa 2b not be used for Hep C?

A
  1. BB warns: cause/aggravate neuropsychiatric, autoimmune. ischemic, and infectious disorders
  2. Don’t use with hypersensitivity to INF alpha
  3. Don’t used with autoimmune hepatitis
  4. don’t used with decompensated liver disease
21
Q

What is the goal of Hep C treatment?

A

Completely eradicate Hep C virus (unlike Hep B which can’t be cured)

22
Q

Why is hep C tx sometimes delayed 6 months?

A

rate of clearance without therapy is 20-35%

23
Q

What is Elbasvir used to treat? How?

A
  1. Hep C

2. NS5A inhibitor

24
Q

What is Grazoprevir used to treat? How?

A
  1. Hep C

2. NS3/4A protease inhibitor

25
Q

When should you not use Grazoprevir? What can it cause?

A
  1. don’t use in patients with moderate/severe hepatic impairment
  2. can cause ALT elevation
26
Q

What drugs do Elbasvir/Grazoprevir interact with?

A

CYP3A inducers! Can decrease Elba/granzo concentrations

27
Q

What can alter concentrations of ledipasvir and sofosbuvir?

A

Polyglycoprotein inducers such as st. Johns wort and Rifampin

28
Q

What is Ledipasvir used to treat? How?

A
  1. Hep C tx by inhibiting NS5A

2. Combined with Sofosbuvir

29
Q

What is Sofosbuvir used to treat? How?

A
  1. Hep C tx–> nucleotide analog NS5B polymerase inhibitor

2. Combined with Ledipasvir or Velpatasvir

30
Q

What do you need for ledipasvir/sofosbuvir tx?

A

combination of ribavirin

31
Q

What is Velpatasvir used for? How does it work?

A
  1. Hep C drug

2. NS5A inhibitor used with Sofosbuvir

32
Q

When is the Velpatasvir/Sofosbuvir combo indicated for HepC?

A

Chronic Hep C

  1. Without cirrhosis or with compensated cirrhosis
  2. with decompensated cirrhosis in combo with ribavirin
33
Q

I am taking amiodarone and now have potentiated bradycardia after taking a new drug!! What did I take??? Who else might have issues with this drug??

A
  1. Velpatasivir/Sofosbuvir potentiates Brady cardia with amiodarone
  2. Be carful in giving velparasivir/sofosbuvir to patients on beta blockers, those with underlying cardiac comorbidites, or advanced liver disease
34
Q

When could velpatasvir/sofosbuvir have decreased concentrations?

A

In combo with PGP inducer or CYP inducers (rifampin, St. Johns wort, carbamazepine)

35
Q

What Hep C drug can cause serious birth defects/ fetal death?

A

Ribivarin

  • don’t used in pregnancy/ don’t get pregnant within 6 months of treatment
  • if you are a male– can be transferred in seminal fluid, do not use if having intercourse with pregnant woman
36
Q

What is Ribivarin used to treat? How? When?

A
  1. Chronic Hep C tx
  2. Nucleoside analogue
  3. Used in combo with IFN alfa-2a 5yo and older
    - used for compensated liver disease
    - chronic hep c patients co-infected with HIV
37
Q

I have Hep C and a hemoglobinopathy. What should I not take?

A

Ribivarin

38
Q

What is Boceprevir used to treat? How?

A
  1. Boceprevir is HCV tx

2. Used in combo with peginterferon alfa and ribavirin for compensated liver disease (including cirrhosis)

39
Q

What are NS3/NS4A inhibitors (5) for Hep C tx? What is the suffix?

A
  • previr
    1. Telaprevir
    2. Boceprevir
    3. Simeprevir
    4. Paritaprevir
    5. Grazoprevir
40
Q

What is the suffix for NS5A inhibitor hep C drugs? What are they? (5)

A
  • asvir
    1. Daclatasvir
    2. Ledipasvir
    3. Velpatasavir
    4. Ombitasvir
    5. Elbasvir
41
Q

What is the suffix for NS5B RNA polymerase inhibitors? what are they? (2)

A
  • buvir
    1. Sofosbuvir
    2. Dasbuvir

GI2 (1 decks)

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