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GEM > 4.13 GI Pharm > Flashcards

4.13 GI Pharm Flashcards

(50 cards)

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1
Q

What viral forms of hepatitis have no pharm treatment?

A

HAV, HDV, HEV

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2
Q

What viral form of viral hepatitis can be cured?

A

HCV

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3
Q

What makes it more likely that a patient will develop chronic HBV (Antigen marker detected for over 6 months) ?

A

The younger the patient is (children)

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4
Q

Because some HBV drugs target the DNA reverse transcriptase, they can also be used to treat what?

A

HIV

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5
Q

What is the goal for treating HBV?

A

Suppress HBV within patients (prevent reactivation) and prevent associated damage of chronic HBV (cirrhosis, HCC, etc.)

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6
Q

What kind of liver cirrhosis if there is some damage but liver is still able to functional adequately with minimal complication?

A

Compensated cirrhosis

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7
Q

Why is it important to screen and treat for HBV in pregnant women?

A

High likelihood of passing it onto child and newborns have highest risk 90% of developing chronic HBV

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8
Q

Can be used to treat HBV and HCV?

A

Interferon a 2A

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9
Q

Immunomodulatory and inhibition of viral processes, type 1 interferons lead to activation of Jak/Stat pathways and transcription of specific mRNAs that help cells respond to viruses

A

Interferon a 2A

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10
Q

What is done to interferon a 2A to increase its half-life?

A

Pegylated

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11
Q

BBW for interferon Alfa 2A?

A

Fatal neuropsychiatric, autoimmune, ischemic and infectious disorders (esp elderly)

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12
Q

ADME and ADSE interferon Alfa 2A?

A

Once a week subcutaneous
Flue like symptoms in 90%
Long term risk of neuropsych, myelosuppresison, etc.

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13
Q

Who should use PEG interferon alpha 2A?

A

Younger, well compensated cirrhosis, patients who don’t want long term treatment

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14
Q

An absolute contra for PEG interferon alpha 2A?

A

Pregnant women with HCV

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15
Q

What are drugs that can be used for treating both HBV and HIV?

A

Tenofovir & Lamivudine

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16
Q

What is a first line HBV for naive patients?

A

Entecavir

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17
Q

Guanine nucleoside analog that inhibits HBV DNA polymerase

A

Entecavir

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18
Q

Why is Entecavir first line for HBV naive?

A

High potency and low resistance (unless resistant to Lamivudine)

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19
Q

BBW for lactic acidosis and severe hepatomegaliy with steatosis and exacerbation of HBV when discontinued?

A

Entecavir

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20
Q

ADME and ADSE for enetcavir?

A

Oral, 15hr half life, renal excretion
Well tolerated but some headaches, fatigue, dizziness, nausea

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21
Q

Adenosine nucleotide analog?

22
Q

Which version of Tenofovir is preferred due to reduced serious side affects?

Study These Flashcards
A

TAF > TDF (bone problems)

23
Q

What are Tenofovir ADSE?

Study These Flashcards
A

GI effects, renal tubulopathy

24
Q

What does Tenofovir interfere with when HBV is resistant against entecavir or Lamivudine?

Study These Flashcards
A

Viral RNA dependent DNA polymerase

25
Incorporated into the viral DNA by HBV polymerase resulting in DNA chain termination (cytidine analog)
Lamivudine
26
What are the HBV specific ADSE for Lamivudine?
Longer half life in liver cells so given at lower concentrations than for ART (HIV therapy)
27
BBW for Lamivudine?
Lactic acidosis, severe hepatomegaly, exacerbations of Hep B when discontinued
28
Has some relatively normal respiratory ADSE (cough, sore throat, nasal effects)?
Lamivudine
29
What drugs can be used to treat HCV?
PEG interferon 2A Ribavirin Sofosbuvir - NS5B Velpatasvir - NS5A Glecaprevir - NS3/4A protease inhib
30
What are the treatment options for HCV?
Interferon + ribavirin Duo: NS5A inh.ib + NS5B inhib OR protease inhib. Triple/Quad N5A inhibitor + NS5B inhib + protease inhib+ CYP3A4 inhib
31
Guanosine analog that interferes with viral mRNA capping, inhibits synthesis of guanosine synthesis, inhibits viral RNA dependent polymerase
Ribavirin
32
What drugs needs to be phosphorylated to become active and can be admin orally or by inhaler?
Ribavirin
33
Ribavirin inhalation is used to treat what?
RSV
34
BBW: NOT monotherapy, hemolytic anemia PO), teratogenic
Ribavirin
35
Uracil analog that inhibits the RNA dependent RNA polymerase found in genotypes 1-6 (NS5B) of HCV?
Sofosbuvir
36
ADSE for Sofosbuvir?
LOTS but especially patients on amiodarone can cause severe bradycardia
37
Inhibits NS5A that may be involved in induction of viral RNA dependent RNA polymerase?
Velpatasvir
38
What is approved to be used in conjunction with Sofosbuvir?
Velpatasvir
39
This combination is considered pangenotypic and curative for HCV?
Velpatasvir + Sofosbuvir
40
What do you need to be cautious for in patients taking Velpatasvir?
HBV reactivation bc of Sofosbuvir AND hypoglycemia in medicated diabetics
41
Potent pan genotypes inhibitor of HCV NS3/4A protease that cleaves the encoded polyprotein essential for viral replication
Glecaprevir
42
What is the Glecaprevir BBW?
HBV reactivation on discontinuation
43
What do you monitor with patients on Glecaprevir?
LFTs, liver dysfunction signs, and diabetes improvement
44
What is the liver extraction rate?
ER = ([before]-[after]) / [before]
45
What does a low ER indicate?
Very little drug is extracted
46
What is teh hepatic clearance?
HC = ER X Q Q= how much blood goes to liver Volume of blood that passes through and is cleared by the liver
47
Low ER drug characteristics?
Minimal metabolism by liver, low first pass effects, high serum binding, changes in liver perfusion rates don’t affect extraction that much
48
What are conditions that can alter hepatic blood flow (and thus High ER drugs)?
CHF, hypotension
49
What are some high ER drugs?
Morphine Nitro Propranolol Isoniazid
50
Low ER ratio drug examples?
Phenytoin Diazepam Digitoxin Warfarin Theophylline TRENDS: zero order drugs

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