Viral Hepatitis Pharmacology Flashcards
what drugs are used to treat chronic HBV?
“IT TALE” (think Pennywise the clown has HBV)
Interferon Alfa-2A
Telbivudine
Tenofovir Disproxil
Adenofir Pipivoxil
Lamivudine
Entecavir
what is the MOA of entecavir?
HBV nucleoside analogue reverse transcriptase
what are the black box warnings of entecavir?
severe acute exacerbation of HBV
patients co-infected with HBV and HIV
lactic acidosis
hepatomegaly
what is the MOA of tenofovir disoproxil?
nucleotide analog HIV-1 reverse transcriptase inhibitor and an HBV reverse transcriptase inhibitor
what are the black box warnings of tenofovir disoproxil?
lactic acidosis
severe hepatomegaly with steatosis
post treatment exacerbation of hepatitis
what are some adverse reactions of tenofovir disoproxil?
acute or worsening renal impairment or Fanconi syndrome
nausea
what is the MOA of adefovir dipivoxil?
nucleotide analogue
what are some adverse reactions of adefovir dipivoxil?
nephrotoxicity
severe acute exacerbation of hepatitis
asthenia
increased creatinine
what drug interactions should be considered when giving adefovir dipivoxil?
drugs that reduce renal function or compete for activ tubular secretions
what is the MOA of lamivudine?
nucleoside analogue reverse transcriptase inhibitor
what are the black box warnings of lamivudine?
lactic acidosis
severe hepatomegaly
exacerbation of HBV
what should be considered prior to giving lamivudine to a HIV/HBV co-infected patient?
lamivudine-resistant HBV variants have been reported after giving lamivudine containing regimens
what is the MOA of telbivudine?
nucleoside analogue reverse transcriptase inhibitor?
what are the block box warnings of telbivudine?
lactic acidosis
severe hepatomegaly with steatosis
severe acute exacerbation of HBV
when is telbivudine contraindicated?
combination of telbivudine with PEGylated interferon alfa-2a
risk of peripheral neuropathy
what is the black box warning of interferon alfa-2A?
risk of serious disorders and ribavarin-associated effects
when is interferon alfa-2A contraindictated?
autoimmune hepatitis
hepatic decompensation in patients with cirrhosis
use in neonates/infants
what drugs are used to treat HCV?
“VEILS B”
Velpatasvir/sofosbuvir Elbasvir/grazoprevir Interferon alfa-2A Ledipasvir/sofosbuvir Sofosbuvir/ribavirin Boceprevir
what drug can treat HBV or HCV?
interferon alfa-2A
what is the MOA of elbasvir/grazoprevir?
Elbasvir: NS5A inhibitor
+
Grazoprevir: NS3/4A protease inhibitor
what is a possible warning associated with E/G?
ALT elevation
what drug interactions need to be considered before giving E/G?
do not give with moderate CYP3A inducers
*may decreased the concentration of E/G
what is the MOA of ledipasvir/sofosbuvir?
ledipasvir: NS5A inhibitor
+
sofosbuvir: nucleotide analogue NS5B polymerase inhibitor
what drug interactions need to be considered before giving L/S?
poly-glycoprotein inducers (St. Johns wort and rifampin) may alter concentrations
what is the MOA of velpatasvir/sofosbuvir?
sofosbuvir: nucleotide analogue NS5B polymerase inhibitor
+
velpatasvir: NS5A inhibitor
when is V/S contraindicated?
in patients for whom ribavirin is contraindicated
what are adverse reactions of V/S?
can potentiate bradycardia with amiodarone co-administration
do not give to patients on beta-blockers
do not give to patients with cardiac comorbidities
do not give to patients with advanced liver disease
what drug interactions need to be considered before giving V/S?
poly-glycoprotein inducers (St. Johns wort and rifampin) may alter concentrations
what is the black box warning of ribivarin?
birth defects and fetal death if used for pregnant woman
what is the MOA of ribivarin?
nucleoside analogue
*used in combination with interferon alfa-2A
when is ribivarin contraindicated?
pregnant women AND men whose female partners are pregnant
hemoglobinopathies
what is the MOA of boceprevir?
NS3/4A protease inhibitor
*used in combination with ribavarin and interferon alfa-2A
when is boceprevir contraindicated?
since used with ribivarin - pregnancy and hemoglobinopathies
what are common adverse reactions associated with all HBV/HCV drugs?
headache
nausea
fatigue
