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Pharmacology & Drugs > GI- Antiviral For Hepatitis B And C > Flashcards

GI- Antiviral For Hepatitis B And C Flashcards

1
Q

Which patients can and cannot be given interferon alpha as a treatment

A

Only given in patients with well compensated livers, as noncompensated cirrhosis patients may lead to liver failure

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2
Q

What is the difference in pharmacokenetics between interferon alpha 2b and PEGylated interferon alpha 2a/2b

A

Regular interferon 2b has to be given daily

PEG has a longer half-life, more consistent blood levels, and slower clearance

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3
Q

What is the mechanism that administration of interferon alpha helps to clear a viral infection

A
  • Infected cells will undergo lysosomes lysis
  • Macrophages and NK cells are stimulated to clear infected cells
  • Healthy cells upregulate antiviral properties.
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4
Q

What is the mechanism of action of interferon alpha

A
  • Binds to JAk1 and tyrosine kinase 2 (TYK2)
  • Activation of STAT
  • Transcription of interferon stimulated genes
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5
Q

What are the proteins created by healthy cells as a result of transcription due to interferon alpha

A
  • ZAP
  • IFIT family
  • OAS-RNAseL pathway
  • PKR
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6
Q

What is the cause of the hepatitis “flare” as a result of interferon alpha administration

A
  • HBV antigens decrease, and the ALT levels increase
  • Caused by the interferon causing the lysis of the infected hepatocytes, so we see some liver damage, but also a decrease in the HBV levels
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7
Q

WHat are the contraindications and side effects of interferon administration

A

Contraindicated:pregnant or pts with cirrhosis

Side effects: Bone marrow suppression, neurotoxicity, flu like syndrome

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8
Q

What is the target for nucleoside and nucleotide based anti-hep drugs

A

DNA reverse transcriptase and DNA polymerase inhibitors

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9
Q

Can nucleosides and nucleotides be used in patients with cirrhosis

A

Yes

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10
Q

What is the mechanism of action for NRTI

A

Aka nucleoside/nucleotide reverse transcriptase inhibitors

-Inhibits the replication machinery of HBV and HCV

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11
Q

What is required for NRTIs to work properly

A

Kinase activities that convert the nucleosides into nucleotides

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12
Q

What is the group on nucleosides/tides that prevent the hepatitis virus from being able to replicate

A

The lack of OH groups

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13
Q

What are the nucleoside analogues used to treat HBV infection

A
  • Lamivudine
  • Telbivudine
  • Entecavir
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14
Q

What are the nucleotide analogues used to treat HBV infection

A

Tenofovir

Adefovir

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15
Q

What is the mechanism of action for tenofovir

A

Adenosine nucleotide analog

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16
Q

What is the first line treatment for wild type HBV

A

Tenofovir

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17
Q

What patients can be administered tenofovir

A

Patients with resistance to lamivudine, telbivudine, or entecavir
*Due to resistance to tenofovir being rare

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18
Q

Which patients should avoid treatment with tenofovir

A

Those with kidney issues as is a strong proximal renal tubule nephrotoxin

19
Q

What is the mechanism of action for entecavir

A

Guanosine nucleoside analog

20
Q

What is the relation of resistance to entecavir

A
  • Rare to be resistant in a naive patient

- Resistance to lamivudine gives about 50% resistance to entecavir

21
Q

What is the better choice of drug for hepatitis B in those patients with renal insufficiency

A

Entecavir

22
Q

What is the rate of resistance in lamivudine

A

Long term efficacy is not good due to the frequent mutation in the catalytic domain of HBV polymerase

23
Q

What is the mutation in HBV polymerase that leads to decreased efficacy of long term treatment of lamivudine

A

YMDD to YVDD (methionine to valine)

24
Q

In 2011, what was the standard of treatment for HCV that had some success

A

PEGylated interferon alpha + ribavirin

25
Q

What is the mechanism of action for ribavirin

A
  • Guanosine nucleotide that interferes with GTP production
  • inhibits the capping of viral mRNA
  • Inhibits viral RNA polymerase
  • Upregulates interferon stimulated genes (ISGs)
26
Q

What are the complication of ribavirin

A
  • Anemia

- Pregnancy

27
Q

What is the mechanism of action of telaprevir

A

First generation protease inhibitor at NS3 catalytic site

28
Q

What is the mechanism of boceprevir

A

First generation protease inhibitor at NS3 catalytic site

29
Q

What is the mechanism of action of simeprevir

A

Second generation protease inhibitor at catalytic site NS3

30
Q

What is the mechanism of action of Sofobuvir

A

Nucleotide analog, NS5B inhibator, aka site NS5B in the RNA dependent RNA polymerase

31
Q

Which genotypes of HCV are disrupted by sofosbuvir

A

All genotypes

32
Q

What is the mechanism of action for ledipasvir

A

Inhibits NS5A

33
Q

What is the mechanism of action for elbasvir

A

Inhibits NS5A

34
Q

What is the mechanism of action for velpatasvir

A

Inhibits NS5A

35
Q

Which hepatitis would the drug Ribavirin be given for

A

HCV

36
Q

Which hepatitis would the drug simeprevir be given for

A

HCV

37
Q

Which hepatitis would the drug telaprevir be given for

A

HCV

38
Q

Which hepatitis would the drug boceprevir be given for

A

HCV

39
Q

Which hepatitis would the drug grazoprevir be given for

A

HCV

40
Q

Which hepatitis would the drugsofosbuvir be given for

A

HCV

41
Q

Which hepatitis would the drug ledipasvir be given for

A

HCV

42
Q

Which hepatitis would the drug elbasvir be given for

A

HCV

43
Q

Which hepatitis would the drug velpatasvir be given for

A

HCV

Pharmacology & Drugs (43 decks)

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