HBV and HCV Pharm Flashcards by Liz Pennington

What are the goals of chronic HBV therapy?

supression of HBV DNA to undetectable levels
seroconversion of HBeAg from positive to negative
Reduction in elevated serum aminotransferase levels

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What are the endpoints of HBV supression?

improved necro-inflammatory disease

decreased risk for hepatocellular carcinoma and cirrhosis

decreased need for liver transplant

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What is the MOA for Entecavir?

HBV nucleoside analogue reverse transcriptase

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What is the BB warning for Entecavir?

severe acute exacerbation of Hep B

Coinfection with HIV and HBV

lactic acidosis

hepatomegaly

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What are the indications for Entecavir?

Tx chronic HBV in adults and kids ages 2+ with persistent elevated ALT/AST or histologically active disease and evidence of active viral replication

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What are the contraindications for Entecavir?

None

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What are the AE of Entecavir?

Adults and kids-HA, dizziness, nausea

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What is the MOA for Tenofovir Disoproxil?

HBV reverse transcriptase inhibitor (also for HIV-1)

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What is the BB warning for Tenofovir Disoproxil?

Lactic acidosis

severe hepatomegaly with steatosis

post-treatment exacerbation of hepatitis

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What are the indications for Tenofovir Disoproxil?

Use in combo for HIV-1 in adults and kids 2+

Use for HBV in adults and kids 12+

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What are the contraindications for Tenofovir Disoproxil?

New onset or worsening renal impairment (ARF or Fanconi)

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What are the AE for Tenofovir Disoproxil?

Pt’s with compensated liver disease most commonly experience is Nausea

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What is the MOA and indication for Adefovir?

Nucleotide analogue for HBV in pt’s ages 12+

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What are the contraindications for Adefovir?

Don’t use in any pt with a hx of hypersensitivity to any of the ingredients

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What is the main warning/precaution of Adefovir?

nephrotoxicity

monitor renal fxn!!

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What are the adverse effects of Adefovir?

asthenia and increased creatinine

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What are the drug interactions for Adefovir?

coadministration with drugs that reduce renal function may increase concentrations of adefovir or the coadministered drug

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What is the MOA for Lamivudine?

nucleoside analogue RT inhibitor for HBV

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What is the BB warning for Lamivudine?

Lactic Acidosis

Severe Hepatomegaly

Exaceration of Hep B

Different formulations

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What are the indications of Lamivudine?

What are the contraindications for Lamivudine?

Used in combination with other antiretroviral agents for the treatment of HIV1

Don’t use in pt’s with previous hypersensitivity rxn to any ingredient

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What are the warnings/precautions for Lamivudine?

In co-infected pt’s with HBV/HIV-1: Lamivudine resistant HBV strains

Pancreatitis

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What are the AE for Lamivudine?

HA, nausea, malaise, fatigue

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What is the MOA for Telbivudine?

nucleoside analogue RT inhibitor for HBV

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What are the BB warnings for Telbivudine?

Lactic Acidosis

Severe Hepatomegaly with steatosis

severe acute exacerbations of Hep B

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What are the indications for Telbivudine?

Used for chronic HBV with evidence of viral replication, and either elevated ALT/AST or histological evidence

What are the contraindications for Telbivudine?

combination of telbivudine with **PEGylated interferon alfa-2a** increases risk of **peripheral neuropathy**

What are the AE of Telbivudine?

fatigue, increased CK, HA

What is the indication for PEG Interferon Alfa-2a?

**Treat HCV** in pt's not previously treated with this agent **Treat HBV** in those with compensated liver dz and evidence of viral replication and liver inflammation

What is the BB warning for PEG interferon alfa-2a?

risk of serious disorders Ribavirin associated effects

What are the contraindications for PEG interferon alfa-2A?

autoimmune hepatitis hepatic decompensation in pt's with cirrhosis use in neonates/infants

What are the adverse reactions to PEG interferon alfa 2a?

fatigue, asthenia, pyrexia, HA "flu-like sx"

What are the indications for PEG interferon alfa-2**b**

Treat HCV in pt's 18+ with hx of blood exposure and/or are HCV positive

What is the BB warning for PEG inteferon alfa-2**b**

cause or aggrevate fatal neuropsych, autoimmune, ischemic, and infectious disorders

What are the contraindications for PEG interferon alfa-2**b?**

HSN rxn to interferon alpha or other ingredients autoimmune hepatitis decompensated liver dz

What are the adverse effects of PEG interferon alfa-2b?

flu-like sx

What is the main goal of HCV treatment?

eradication of the virus

Sustained viral response is defined as the absence of decetable viremia ___ after completion of therapy.

24 weeks

What is the MOA and indication of Elbasvir/Grazoprevir?

**Elbasvir: HCV NS5A inhibitor** **Grazoprevir: NS3/4A protease inhibitor**

What are the contraindications for Elbasvir/Grazoprevir?

Pt's with moderate to severe hepatic impairment

What are the warnings/precautions of Elbasvir/Grazoprevir?

ALT elevations

What are the AE of Elbasvir/Grazoprevir?

fatigue, HA, nausea

What are the drug interactions for Elbasvir/Grazoprevir?

Co-administration with moderate CYP3A inducers is NOT recommended as it may decrease drug concentrations

What is the MOA and indication for Ledipasvir/Sofosbuvir?

Ledipasvir: NS5A inhibitor Sofosbuvir: NS5B polymerase inhibitor Indicated for use of chronic HCV in adults

What are the warnings/precautions for Ledipasvir/Sofosbuvir?

Do not combine with other Sofosbuvir containing products

What are the AE of Ledipasvir/sofosbuvir?

Fatigue and HA

What are the drug interactions with Ledipasvir/Sofosbuvir?

poly glycoprotein inducers (rifampin, St. John's Wort) may alter concentrations of drug-not recommended

What is the MOA for Velpatasvir/Sofosbuvir?

Velpastasvir: HCV NS5A inhibitor Sofosbuvir: NS5B polymerase inhibitor

What is the indication for Velpatasvir/Sofosbuvir?

adults with HCV without cirrhosis or with compensated cirrhosis or with decompensated cirrhosis in combo with ribavirin

What are the contraindications for Velpatasivir/Sofosbuvir?

do not use in pt's in whom ribavirin is contraindicated

What are the warnings/precautions for Velpatasvir/Sofosbuvir?

bradycardia with amiodarone co-administration cardiac and liver issues with co-admin of beta blockers

What are the adverse reactions for Velpatasvir/Sofosbuvir?

HA and fatigue

What are the drug interactions with Velpatasvir/Sofosbuvir?

PGP inducers and/or moderate CYP inducers may decease drug concentrations-not recommended

What are the BB warnings for Ribivarin?

Serious birth defects and fetal death Do not use in pregnancy (and don't get pregnant within 6 months after treatment)

What are the indications and MOA for Ribivarin?

nucleoside analogue for HCV with Interferon alfa-2a in patients ages 5+ adults with HIV coninfection

What are the contraindications for Ribavirin?

pregnant women and men whose female partners are pregnant hemoglobinopathies

What are the AE of Ribivarin?

fatigue, asthenia, HA

What is the MOA and indication for Boceprevir?

HCV NS3/4A protease inhibitor indicated for chronic HCV with PEG alfa and Ribavirin in adults with compensated liver dz/cirrhosis previously untreated or failed interferon/ribavirin therapy

What are the contraindications for Boceprevir?

any contraindications for PEG alfa and ribavirin apply since Boceprevir is co-administered with them

What are the warnings/precautions for Boceprevir?

same as for Ribavirin/Peg alfa | (birth defects being major)

What are the AE for Boceprevir?

fatigue, anemia, HA, dysguesia

What drugs are the NS3/4A protease inhibitors?

**"Previr"** Telaprevir Boceprevir Simeprevir Paritaprevir Grazoprevir

What drugs are the NS5A inhibitors?

**"Asvir"** Daclastasvir Ledipasvir Velpatasvir Ombitasvir Elbasvir

What drugs are the NS5B RNA polymerase inhibitors?

**"Buvir"** Nucleosides: Sofosbuvir Nonnucleosides: Dasabuvir

HBV and HCV Pharm Flashcards

(63 cards)