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PT3 ID 2 > HEP B and C therapeutics > Flashcards

HEP B and C therapeutics Flashcards

(62 cards)

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1
Q

risk factors for Hep B transmission

A
  • IV drug use
  • contact with blood
  • multiple sexual partners
  • mother to infant
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2
Q

Hep B anti-HBc+ indicates

A

prior exposure

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3
Q

HBsAg+ indicates

A

current hep B infection

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4
Q

Hep B anti-HBs+ indicates

A

immunity from vaccine or previous infection

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5
Q

hep B HBeAg+ indicates

A

active Hep B replication

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6
Q

hep B HBV DNA+ indicates

A

active Hep B replication

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7
Q

immediate prophylaxis for Hep B

A

hepatitis B immune globulin IM injection

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8
Q

Hep B vaccine scedule

A

at 0, 1 month, 6 months

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9
Q

which hep B tests to do first when checking for status

A

anti-HBc and HBsAg

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10
Q

if initial hep B tests come out positive what tests to follow up with

A

HBeAg
HBV DNA
ALTs

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11
Q

when to vaccinate adults for hep B

A

when all tests come up negative

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12
Q

how to test for efficacy to hep B vaccine

A

have antiHBs+ (immunity)
antiHBc-
HBsAg-
(not from past exposure or infection)

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13
Q

phases of chronic HBV

A
  • immune tolerant
  • HBeAg-positive immune active
  • inactive chronic hep B
  • HBeAg-negative immune reactivation
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14
Q

HBV immune tolerant phase lab values

A
  • ALT normal
  • HBV DNA >1 million
  • HBeAg positive
  • minimal liver fibrosis
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15
Q

Inactive chronic hep B phase lab values

A
  • ALT normal
  • HBV DNA <2,000 (low or undetectable)
  • HBeAg negative
  • variable fibrosis
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16
Q

HBeAg positive immune active phase labs

A
  • ALT elevated
  • HBV DNA >20,000
  • HBeAg positive
  • moderate to severe inflammation/fibrosis
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17
Q

HBeAg-negative immune reactivation phase labs

A
  • ALT elevated
  • HBV DNA >2,000
  • HBeAG negative
  • mod-severe inflammation/fibrosis
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18
Q

why is HBV not curable

A

gets incorporated into the nucleus of the cell

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19
Q

lab goals of treatment in HBV

A
  • HBV DNA -
  • convert HBeAg- to anti-HBe+
  • convert HBsAg- to anti-HBs+ (rarely done)
  • normalize ALT and AST
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20
Q

secondary goal of HBV treatment

A

reduce progression to cirrhosis, liver cancer

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21
Q

indications for treatment of HBV

A

-HBeAg-positive/negative immune active phase

elevated ALT, HBV DNA, liver damage

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22
Q

treatment options in HBV

A 
interferon
lamivudine
adefovir
entecavir
telbivudine
tenofovir
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23
Q

Interferon alfa regimen

A

sc weekly for 48 weeks

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24
Q

interferon alfa adverse effects

A 
flu like symptoms
depression
alopecia
thrombocytopenia
leukopenia
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25
patients best suited for interferon alfa treatment
- low baseline HBV DNA - short disease duration - HBeAg+
26
patients least suited for interferon alfa treatment
HIV coinfection
27
regimen for nucleotide/side analogs
all oral once daily
28
telbivudine adverse effect
myopathy w/ CK elevation
29
adefovir adverse effect
nephrotoxicity, especially in decomp cirrhosis | not used much
30
TDF adverse effects
nephrotoxicity | reduced bone mineral density
31
TAF adverse effects
low risk nephrotoxicity
32
clearance of HBsAg by drug groups
interferon - good | nucleotide/sides - bad
33
in HBV if nucleotide/side resistance what are pts at risk of
acute hepatitis | increased ALT and DNA
34
HBV drugs with low drug resistance
entecavir | tenofovir
35
treatment criteria for chronic HBV
- if ALT is >2x or significant histology | - normal ALT with some fibrosis/inflammation and over 40 years old
36
treatment drugs for chronic HBV
entecavir tenofovir peg-inf
37
treatment drugs for chronic HBV with cirrhosis
compensated: entecavir tenofovir decompensated: combo therapy
38
term for hep C cure
sustained virologic response
39
sustained virologic response
no detectable HCV in the blood at 12 or more weeks after therapy is complete
40
3 drug classes used in HCV regimens
NS3/5 NS5B NS5A +/- ribavirin
41
duration of HCV regimens
8-24 weeks | typically 12
42
HCV drugs to avoid in liver disease | aka use these in renal insufficiency
PrOD/PrO +/- RBV Grazoprevier/elbasvir +/- RBV Glecaprevir + pibrentasvir
43
challenges of HCV treatment
- hepatic failure/decompensation - many DDIs (amiodarone big one) - reactivation of hep B
44
HCV drugs recommended for decompensated cirrhosis
``` sofosbuvir velpatasvir ledipasvir daclatasvir +/- RBV ```
45
protease inhibitor regimens are not recommended when in HCV
decompensated cirrhosis
46
most common drug interactions with HCV drugs
``` st. john's wort rifampin phenobarbital carbamazepine phenytoin amiodarone ```
47
other drug classes to consider avoiding or adjusting when using HCV drugs
statins PPIs H2RAs antacids
48
main cyp and transporters to be worried about in DDIs for HCV drugs
pgp BCRP 3A4
49
antivirals that have pH dependent absorption
ledipasvir | velpatasvir
50
ledipasvir and PPI use
take simultaneously
51
velpatasvir and PPI use
not recommended | if necessary take 4 hours prior to omeprazole
52
H2RA instructions with DAA
take together or 12 hours apart
53
antacids instructions with DAA
separate by 4 hours
54
if reactivation of hep B occurs in HCV treatment when does it usually occur
4-8 weeks
55
for genotype 1a a positive RAS test treatment
GRZ+EBR add RBV 16 week duration
56
for genotype 1a a negative RAS test treatment
GRZ+EBR no RBV 12 week duration
57
for genotype 3 a positive RAS test treatment
VEL+SOF or DCV+SOF | add RBV
58
for genotype 3 a negative RAS test treatment
VEL+SOF or DCV+SOF only
59
RBV adverse effects
``` nausea insomnia cough rash anemia (get tested q2wk until stable) teratogen ```
60
DAAs tolerability
mild side effects when used without RBV headache fatigue nausea
61
labs to consider for DAAs
CBC q2wk with RBV creatinine hepatic function HCV genotype
62
tests to assess efficacy of HCV drugs
HCV PCR at week 4 and week 12 after treatment

PT3 ID 2 (6 decks)

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