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

Drugs To Treat Viral Hepatits - Dr. Izard Flashcards

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

A

Headache, N D, C

23
Q

Telbivudine

MOA and when

A
  1. Nucleotide anaglog reverse transcriptase inhibitor

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

24
Q

Telbivudine 3 black box warnings

A
  1. Lactic acidosis
  2. Severe hepatomegaly + steatosis = jaundice
  3. Severe exacerbation of HBV
25
Q

Telbivudine

Contraindications

A

If combined with PEGylated Alfa-2a : high risk of peripheral neuropathy

26
Q

Telbivudine adverse reactions

A

Fatigue, high Cr, headache, cough, abd pain, rash, pyrexia (Fever), ALT increase,

27
Q

PEGylated interfernon alfa-2a (poly-ethyl-glycal interfernon)
Used when

A
  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
Q

PEGylated interfernon alfa-2a black box warnings

A

Serious disorders and ribavirin- associated effects (anemia, SOB)

29
Q

PEGylated interfernon alfa-2a contraindications and adverse effects

A
  1. Autoimmune hepatitis
  2. Hepatic decompensation in cirrhosis pt (alcoholism can cause this)
  3. Neonates or infants
    = fatigue, asthenia, fever, headache (FLU-LIKE)
30
Q

Goal or HCV drugs

A

Eradicate the drug , some also regress the cirrhosis and HCC lowered risk
= undetectable for 24 weeks

31
Q

HCV spontaneous clearance

A

20%-35% on its own, so you can delay tax until you seen need to help body resolve it

32
Q

PEG Interferon Alfa-2b

when to use

A

Chronic HCV in 18yo older, with compensated liver disease + history of blood exposure and / or HCV Ab +

33
Q

PEG Interferon Alfa-2b

Contraindications

A

Hypersensitivity to interferon -a
Autoimmune hepatitis
Decompensation liver disease (cirrhosis, fibrosis, alcoholism)

34
Q

PEG Interferon Alfa-2b

Black box warnings

A 
Aggregate fatal to life-threatening : 
1. neuropsychiatric 
2. Autoimmune
3. Ischemic
4. Infectious 
Disorders
35
Q

PEG Interferon Alfa-2b adverse effects

A

Flu-like sx, fever, headache, chills, toxicities at higher doses

36
Q

Elbasvir / Grazoprevir :

MOA and when it is used

A

Elbasvir : HCV, NS5A inhibitor **

Grazoprevir : HCV NS3/4A protease inhibitor **

37
Q

Elbasvir / Grazoprevir :

Contraindications

A

Modest to severe hepatic impairment

38
Q

Elbasvir / Grazoprevir : warning sx to look for

A

ALT elevation

39
Q

Elbasvir / Grazoprevir : adverse effects and drug interactions

A
  1. Fatigue, headache, N
  2. Co-administered with moderate CYP3A inducers NOT recommended = decrease plasma concentration of Elbasvir / Grazoprevir
40
Q

Ledipasvir / Sofosbuvir :

MOA and when to use

A

Ledipasvir : HCV, NS5A inhibitor

Sofosbuvir : HCV, nucleotide analog, NS5B polymerase inhibitor + Guanosine analog

41
Q

Ledipasvir / Sofosbuvir :

Warnings to look for

A

Use of other drugs with Sofosbuvir NOT recommended

42
Q

Ledipasvir / Sofosbuvir :

Adverse effects and drug interactions

A
  1. Fatigue, H

2. Poly-glycoproteins inducers (Rifampin, S. John’s wort) : can alter concentration of Ledipasvir / Sofosbuvir

43
Q

Velpatasvir / Sofosbuvir :

MOA and when to use

A

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
Q

Velpatasvir / Sofosbuvir :

Contraindications

A

Pt who can’t tolerate ribavirin*

45
Q

Velpatasvir / Sofosbuvir

Warnings to look for

A

= bradycardia can get worse (co-administration of aminodarone)
= beta-blocker patients, or cardiac patients, or advanced liver disease pt : caution and monitor closely

46
Q

Boceprevir :

MOA and when to use

A

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
Q

Velpatasvir / Sofosbuvir adverse effects

A

** most with Pt taking V/S or Ribavirin (cirrhosis pts) : fatigue, N, D, headache

48
Q

Velpatasvir / Sofosbuvir drug interactions

A

PGP inducers * or moderate to potent CYP inducers* (st. John’s wort, rifampin,carabamazepine)
= can decrease Velpatasvir / Sofosbuvir levels

49
Q

Ribivarin :

MOA and when to use

A

Nucleoside analog

  1. Chronic HCV with interferon Alfa-2a with compensated liver failure (over 5yo)
  2. Chronic HCV with HIV adults
50
Q

Ribivarin :

Black box warnings

A

= 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
Q

Ribivarin :contraindications

A
  1. Female pregnant and male with pregnant partner

2. Hemoglobinopathies

52
Q

Ribivarin : adverse effects

A

Fatigue, fever asthenia, H

53
Q

Boceprevir :

Contraindications

A

Same as Ribavirin and PEGinterferon alpha

54
Q

Boceprevir : warnings to look for

And adverse effects

A
  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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