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GIGU2 Exam 2 > Drugs To Treat Viral Hepatits - Dr. Izard > Flashcards

Drugs To Treat Viral Hepatits - Dr. Izard Flashcards

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1
Q

Acute HBV tx

A

No drug

Spontaneously resolves usually

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2
Q

3 things you focus on when tx acute HBV

A
  1. Suppression of HBV DNA to undetectable levels
  2. Seroconversion of HBeAg from + to -
  3. Reduction in AST / ALP
    = decrease HBV replication not eradicating it drugs
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3
Q

Things you avoid when tx and monitoring acute HBV

A
  1. Improvement in necrotizing inflammation
  2. Decrease HCC + cirrhosis
  3. Decrease lover transplant need
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4
Q

HCV tx

A

Rare cure, spontaneous resolve only no drug

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5
Q

Circular DNA or the virus can cause it to reactivate even when suppressed, happens mostly when

A

Co-infected with HDV

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6
Q

Entecavir
Type of MOA drug
When do you use it

A
  1. HBV virus nucleoside analogue reverse transcriptase

2. Chronic HBV with viral replication seen, high ALT/AST or disease seen

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7
Q

Entecavir

4 warnings

A
  1. Severe acute exacerbation of HBV
  2. Don’t use if Pt co-infected with HIV and HBV
  3. Don’t use if Lactic acidosis
  4. Can cause Hepatomegaly
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8
Q

Entecavir adverse effects

A

Headache, dizzy, fatigue , N

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9
Q

Tenofovir Disoproxil
MOA what type of drug
Used for what

A
  1. Nucleuotide analog HIV-1 reverse transcriptase inhibitor and HBV reverse transcriptase inhibitor
  2. To tx HIV-1 and and chronic HBV in 12yo and older
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10
Q

Tenofovir Disoproxil black box warning

A
  1. Lactic acidosis
  2. Severe hepatomegaly + Steatosis = jaundice
  3. Post tx exacerbation of HBV
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11
Q

Tenofovir Disoproxil

Warning sx to look for

A

New insert or worsening renal impairment : Acute renal failure, + Fanconi syndrome

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12
Q

Tenofovir Disoproxil

Adverse reactions

A

N, Nephrotoxic **

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13
Q

Adefovir

MOA and when you use

A
  1. Nucleotide analogue

2. To for chronic HBV over 12yo

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14
Q

Adefovir

Contraindication

A

Hypersensitivity to any components of the product (has solvents that pt can be sensitive to)

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15
Q

Adefovir warnings to look for

A

Nephrotoxicity : monitor renal function during tx ALWAYS

Severe acute exacerbation of HBV

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16
Q

Adverse reactions to. Adefovir

A

As their , high Cr, Iamivudine-resistant liver disease

= Nephrotoxic **

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17
Q

Adefovir drug interactions

A

DONT give with other drug reducing renal function or competing for active tubular secretion (can increase Adefovir concentration)

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18
Q

Lamivudine

MOA and when to use

A
  1. Nucleoside analog reverse transcript inhibitor

2. Treat HIV-1 ad used with other tx drugs

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19
Q

Lamivudine 4 black box warnings

A
  1. Lactic acidosis
  2. Severe hepatomegaly
  3. Exacerbation of HBV
  4. Different formulations (IV, orally, SubQ)
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20
Q

Lamivudine contraindications

A

If pt is sensitive to lamivudine

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21
Q

Lamivudine warnings to look for

A
  1. HIV-1 / HBV co-infection : Iamivudine -resistant HBV variants can form from Iamvudine-containing antiviral tx
  2. Pancreatitis + tx toxicities need to be monitored
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22
Q

Lamivudine adverse reactions

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A

Headache, N D, C

23
Q

Telbivudine

MOA and when

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A
  1. Nucleotide anaglog reverse transcriptase inhibitor

2. Chronic HBV and viral replication seen, high AST/ ALT

24
Q

Telbivudine 3 black box warnings

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A
  1. Lactic acidosis
  2. Severe hepatomegaly + steatosis = jaundice
  3. Severe exacerbation of HBV
25
Telbivudine | Contraindications
If combined with PEGylated Alfa-2a : high risk of peripheral neuropathy
26
Telbivudine adverse reactions
Fatigue, high Cr, headache, cough, abd pain, rash, pyrexia (Fever), ALT increase,
27
PEGylated interfernon alfa-2a (poly-ethyl-glycal interfernon) Used when
1. Chronic HCV + compensated liver disease , no tax with interferon- a before, 2. Cirrhosis or compensated liver disease 3. Chronic HBV with compensated liver disease and viral replication seen and liver inflammation
28
PEGylated interfernon alfa-2a black box warnings
Serious disorders and ribavirin- associated effects (anemia, SOB)
29
PEGylated interfernon alfa-2a contraindications and adverse effects
1. Autoimmune hepatitis 2. Hepatic decompensation in cirrhosis pt (alcoholism can cause this) 3. Neonates or infants = fatigue, asthenia, fever, headache (FLU-LIKE)
30
Goal or HCV drugs
Eradicate the drug , some also regress the cirrhosis and HCC lowered risk = undetectable for 24 weeks
31
HCV spontaneous clearance
20%-35% on its own, so you can delay tax until you seen need to help body resolve it
32
PEG Interferon Alfa-2b | when to use
Chronic HCV in 18yo older, with compensated liver disease + history of blood exposure and / or HCV Ab +
33
PEG Interferon Alfa-2b | Contraindications
Hypersensitivity to interferon -a Autoimmune hepatitis Decompensation liver disease (cirrhosis, fibrosis, alcoholism)
34
PEG Interferon Alfa-2b | Black box warnings
``` Aggregate fatal to life-threatening : 1. neuropsychiatric 2. Autoimmune 3. Ischemic 4. Infectious Disorders ```
35
PEG Interferon Alfa-2b adverse effects
Flu-like sx, fever, headache, chills, toxicities at higher doses
36
Elbasvir / Grazoprevir : | MOA and when it is used
Elbasvir : HCV, NS5A inhibitor ** | Grazoprevir : HCV NS3/4A protease inhibitor **
37
Elbasvir / Grazoprevir : | Contraindications
Modest to severe hepatic impairment
38
Elbasvir / Grazoprevir : warning sx to look for
ALT elevation
39
Elbasvir / Grazoprevir : adverse effects and drug interactions
1. Fatigue, headache, N 2. Co-administered with moderate CYP3A inducers NOT recommended = decrease plasma concentration of Elbasvir / Grazoprevir
40
Ledipasvir / Sofosbuvir : | MOA and when to use
Ledipasvir : HCV, NS5A inhibitor | Sofosbuvir : HCV, nucleotide analog, NS5B polymerase inhibitor + Guanosine analog
41
Ledipasvir / Sofosbuvir : | Warnings to look for
Use of other drugs with Sofosbuvir NOT recommended
42
Ledipasvir / Sofosbuvir : | Adverse effects and drug interactions
1. Fatigue, H | 2. Poly-glycoproteins inducers (Rifampin, S. John’s wort) : can alter concentration of Ledipasvir / Sofosbuvir
43
Velpatasvir / Sofosbuvir : | MOA and when to use
Velpatasvir : HCV , NS5A inhibitor Sofosbuvir : HCV nucleotide analog NS5B polymerase inhibitor + guanosine analog = HCV pt with decompensated cirrhosis (with ribavirin) = HCV pt with NO cirrhosis or compensation liver
44
Velpatasvir / Sofosbuvir : | Contraindications
Pt who can’t tolerate ribavirin*
45
Velpatasvir / Sofosbuvir | Warnings to look for
= bradycardia can get worse (co-administration of aminodarone) = beta-blocker patients, or cardiac patients, or advanced liver disease pt : caution and monitor closely
46
Boceprevir : | MOA and when to use
NS3/4A protease inhibitor Chronic HCV : with combination of PEGinterferon a + ribavirin (adults, liver compensation like cirrhosis, have failed previous interferon or ribavirin tx)
47
Velpatasvir / Sofosbuvir adverse effects
** most with Pt taking V/S or Ribavirin (cirrhosis pts) : fatigue, N, D, headache
48
Velpatasvir / Sofosbuvir drug interactions
PGP inducers * or moderate to potent CYP inducers* (st. John’s wort, rifampin,carabamazepine) = can decrease Velpatasvir / Sofosbuvir levels
49
Ribivarin : | MOA and when to use
Nucleoside analog 1. Chronic HCV with interferon Alfa-2a with compensated liver failure (over 5yo) 2. Chronic HCV with HIV adults
50
Ribivarin : | Black box warnings
= risk of serious disorders and ribavirin associated effects* 1. Birth defects , birth death 2. Dont use in pregnancy and dont get pregnant 6 months after tax
51
Ribivarin :contraindications
1. Female pregnant and male with pregnant partner | 2. Hemoglobinopathies
52
Ribivarin : adverse effects
Fatigue, fever asthenia, H
53
Boceprevir : | Contraindications
Same as Ribavirin and PEGinterferon alpha
54
Boceprevir : warnings to look for | And adverse effects
1. Ribavirin can cause birth defects, so no pregnancy or for the 6months after tx including males with partners 2. Fatigue anemia, N, H

GIGU2 Exam 2 (4 decks)

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