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GI 2 Exam 2 > Viral Hepatitis Pharm - Sheehy > Flashcards

Viral Hepatitis Pharm - Sheehy Flashcards

1
Q

what is primarily used for treatment of patients with well compensated liver disease

A

interferon alpha

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2
Q

cons:

  • dangerous in decompensated cirrhosis
  • parenteral administration
  • side effects in 80% of pt (flu like sx)
A

interferons for HBV

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3
Q

which has a longer half life, PEGylated interferon 2a/2b, or interferon a2b

A

PEGylated

- lasts much longer, so less doses needed

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4
Q

what drug acts in an autocrine fashion, stimulating lysosome lysis?
- also signal nearby macrophages and NK cells to clear infected cell

A

interferons

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5
Q

what is seen as a sign that seroconversion of interferon a is progressing?

A

a hepatitis “flare”

- dangerous in decompensated cirrhosis because the spike would make the cirrhosis worse, more prone to infections

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6
Q

HBV DNA reverse transcriptase inhibitor (NRTI)

  • oral agents that are used to suppress HBV infection
  • better tolerated and higher response rate than interferon a
  • can be used in pts with decompensated cirrhosis
A

nucleosides

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7
Q

what is the active antiviral agent of NRTI’s?

A

nucleotide triphosphate (converted by cellular kinases)

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8
Q

what nucleoside lacks a 3’-OH, and has a 3’ sulfur that prevents the addition of any more nucleotides?

A

lamivudine

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9
Q

lamivudine
telbivudine
entecavir

A

nucleosides

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10
Q

tenofovir

adefovir

A

nucleotides

- have a monophosphate

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11
Q

what causes nucleoside resistance?

A

slow or low conversion of nucleosides into a nucleotide monophosphate allows resistance

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12
Q

nucleotide analog of adenosine

  • first line tx for wild-type HBV
  • used in pts with nucleoside resistance
  • nephrotoxicity (proximal renal tubule)
A

tenofovir

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13
Q

what drug is a better choice for pts with renal insufficiency?

A

entecavir

- is well tolerated, limited side effects

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14
Q

what does a YMDD -> YVDD mutant in catalytic domain of HBV polymerase lead to?

A

subsequent virological breakthrough

- long term efficacy of lamivudine limited by drug resistance

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15
Q

RNA virus that is NOT incorporated into the host DNA

A

HCV

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16
Q

what is the tx of HCV?

A

PEGylated interferon a + ribavirin

  • 24-48 week regimen
  • less than 50% cure rate overall
17
Q

this drug interferes with synthesis of GTP

  • inhibits capping of viral messenger RNA
  • inhibits viral RNA-dependent polymerase of certain viruses
  • potentiates the action of PEGylated interferon 2a and 2b
A

ribavirin

- nucleoside analong of guanosine

18
Q

what are the contraindications of ribavirin?

A

anemia, PREGNANCY (have to take a test every month to make sure they aren’t!)

19
Q

this drug class inhibits the NS3/4A serine protease, which inhibits HCV post-translational processing and replication

A

nonstructural protein (NS) 3/4A protease inhibitors

  • grazoprevir
  • paritaprevir
  • simeprevir
20
Q

which NS3/4A causes fatigue, headache and nausea?

A

grazoprevir

21
Q

which NS3/4A

  • causes pruritis and insomnia
  • is a CYP34A inhibitor -> drug-drug reactions
  • is used in combination with ritonavir
A

paritaprevir

22
Q

which NS3/4A must be take with food to maximize absorption and is generally well tolerated?

A

simeprevir

23
Q

what HCV drug class is highly conserved, having efficacy against all 6 genotypes of HCV?

A

NS5B RNA polymerase inhibitors

  • dasabuvir
  • sofosbuvir
24
Q

non-nucleoside NS5B allosteric inhibitor

  • drug-drug interations, CYP34A
  • most common adverse effects include nausea, pruritis, insomnia
A

dasabuvir

25
Q

NS5B nucleotide analog, prodrug

- generally well tolerated

A

sofosbuvir

26
Q

which NS5A inhibitor is used in combination with grazoprevir, and has adverse effects of fatigue, headache, nausea?

A

elbasvir

27
Q

which NS5A inhibitor is used in combination with sofosbuvir, and has adverse side effects of fatigue, headache, and asthenia (weakness)?

A

ledipasvir

28
Q

which NS5A inhibitors are metabolized by CYP34A?

A

paritaprevir, ritonavir, dasabuvir

29
Q

which drug mentioned is used as a “boosting agent”, helping other drugs to do their job better?

A

ritonavir

30
Q

what is the first once-daily single-tablet regimen for HCV with pangenotypic activity?

A

velpatasvir + sofosbuvir

- most common adverse effects of the combination with sofosbuvir include headache and fatigue

31
Q

what is the tx for co-infected HBV and HCV pt?

A

treatment is directed at the predominant virus (if HBV is worse, treat that first -> once HCV is cured, can target HBV if it reactivates)

NOTE: interferons target both, riboviron has wide scope

GI 2 Exam 2 (6 decks)

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