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Therapeutics > Hep B & C > Flashcards

Hep B & C Flashcards

1
Q

What are the 5 at risk populations for Hep C?

A

IV drug users, received blood before 7/1992, chronic HD, HIV+ individuals, persons with known exposure (healthcare workers)

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2
Q

What is the pathophysiology of Hep C?

A

Hep C redirects your immune system. Hidden in hepatocytes. Slow transition to cirrhosis/liver cancer. What kills you is susceptibility to another disease.

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3
Q

Name the 4 HCV drug targets.

A

NS3/NS4A, NS5A, NS5B (polymerase)

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4
Q

Which HCV genotype is the worst one and has a faster rate of fibrosis?

A

Genotype 3

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5
Q

Which HCV genotype has a higher likelihood for resistance mutations and a lower cure rate?

A

Genotype 1a

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6
Q

A positive HCV infection requires which testing results…

A

+ HCV antibody and + HCV RNA

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7
Q

What is the biggest interacting drug with HCV options?

A

PPIs

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8
Q

What FIB-4 score indicates that cirrhosis is likely present?

A

FIB-4 >3.25

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9
Q

Child-Pugh A indicates

A

compensated cirrhosis

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10
Q

Child-Pugh B or C indicates

A

decompensated cirrhosis

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11
Q

Increased bilirubin, decreased albumin, increased INR indicate

A

more points for a higher Child-Pugh score

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12
Q

Decreased bilirubin, increased albumin, decreased INR indicate

A

lesser points for a lower Child-Pugh score

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13
Q

When is HCV urgent to treat?

A

3 factors: HIV coinfection, genotype 3, chronic Hep B coinfection

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14
Q

-previr medications target which HCV drug targets

A

NS3/NS4A

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15
Q

-asvir medications target which HCV drug targets

A

NS5A

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16
Q

-buvir medications target which HCV drug targets

A

NS5B

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17
Q

Which HCV medication is notorious for its considerable toxicity?

A

Ribavirin

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18
Q

Which HCV medication should be used in all decompensated cirrhotic patients unless ineligible?

A

Ribavirin

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19
Q

Ribavirin should be discontinued permanently if…

A

WBC <1,000 cells/mm3, ANC <500 cells/mm3, Hgb <8.5 g/dL, Plts <25 x 10*9 cells/L

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20
Q

Which HCV medication should you AVOID if heart disease is unstable of significant?

A

Ribavirin

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21
Q

What are common ADE for HCV meds?

A

HA, fatigue, dizziness, insomnia, memory impairment

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22
Q

Which medication requires men and women to avoid becoming pregnant for 6 months after treatment cessation?

A

Ribavirin

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23
Q

Harvoni is approved for which genotypes?

A

1, 4, 5, 6

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24
Q

Which HCV medications are efficacious in patients with and without cirrhosis?

A

Harvoni (add ribavirin for decompensated)

Epclusa (add ribavirin for decompensated)

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25
Q

When should you complete NS5A resistance testing for Harvoni?

A

If patient is treatment experienced and has genotype 1a

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26
Q

What is the standard duration for Harvoni?

A

12 weeks (however, may be eligible for 8 weeks)1

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27
Q

If Harvoni patients have decompensated cirrhosis and are ineligible for ribavirin, what is the duration of treatment?

A

24 weeks [need extended therapy]

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28
Q

Does Harvoni require renal adjustments?

A

No!

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29
Q

When can you initiate 8 week treatments for Harvoni?

A

Viral load <6 million
Non-cirrhotic
[if pt is HIV coinfected, ineligible for 8 week treatment]

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30
Q

Which HCV medication hits every genotype?

A

Epclusa

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31
Q

When should you complete resistance testing for Epclusa?

A

Genotype 3, experienced or cirrhotic patients

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32
Q

What is the standard duration for Epclusa?

A

12 weeks (NO 8-WK OPTION)

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33
Q

Epclusa patients with decompensated cirrhosis should have a treatment duration of…

A

24 weeks

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34
Q

Does Epclusa require renal adjustments?

A

No!

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35
Q

What is the max dose of omeprazole a patient can take while on Epclusa or Harvoni?

A

omeprazole 20 mg once per day

36
Q

Which HCV med requires you to take your PPI 4 hours afterwards? Epclusa or Harvoni?

A

Epclusa

37
Q

Which HCV med requires you to take your PPI together in the AM after fasting overnight? Epclusa or Harvoni?

A

Harvoni

38
Q

Which HCV medication is the biggest gun and has all three drug classes in one tablet?

A

Vosevi

39
Q

Which HCV meds should you AVOID in decompensated cirrhosis?

A

Vosevi, Mavyret, Zepatier

40
Q

Which side effect is slightly worse in Vosevi than Epclusa?

A

Diarrhea

41
Q

What kind of DDI does atazanavir have with voxilaprevir in Vosevi?

A

Quadruples the AUC, should be avoided

42
Q

Does Vosevi require renal adjustments?

A

No!

43
Q

Which HCV med is the most popular because of its low cost option and shortest duration?

A

Mavyret

44
Q

What is the duration of treatment for Mavyret in all naive, non-cirrhotic, or compensated patients?

A

8 weeks (HIV+ with compensated cirrhosis should receive 12 weeks)

45
Q

Which HCV med is not recommended for Child-Pugh class B or C?

A

Mavyret

46
Q

Does Mavyret need any ESRD or HD adjustment?

A

No!

47
Q

Why is Zepatier not as good of a HCV med as the rest?

A

Hits the liver a little harder

48
Q

Which genotypes are Zepatier indicated for?

A

1 & 4

49
Q

Zepatier is recommended for patients with compensated cirrhosis unless they have genotype…

A

1a

50
Q

What is the standard duration of treatment for Zepatier?

A

12 weeks (just do not use)

51
Q

If doses are missed in HCV therapy, what should you do?

A

Add them to the end of therapy - do not stop exactly at 12 weeks if tablets are remaining

52
Q

What can happen if patients are admitted for GIB and given high-dose PPIs…

A

High-dose PPIs can overcome Harvoni/Epclusa/Vosevi

53
Q

If PPIs are absolutely necessary, you should

A

negotiate lower PPI doses

54
Q

If no compromise can be reached regarding PPIs, you should

A

Stop HCV therapy (may be able to restart in 2-3 days if situation improves)

55
Q

Which HCV med requires a repeated hepatic functional panel every 4 weeks?

A

Zepatier

56
Q

Which HCV med requires constant CBC monitoring?

A

Ribavirin

57
Q

What are the two instances you should stop HCV treatment for ADRs?

A
  1. ALT increases 10-fold from baseline

2. ALT increases <10x but patient is symptomatic (nausea, weakness, jaundice, vomiting)

58
Q

What happens if HCV treatment fails?

A
  1. CBC, hepatic function panel, INR check every 6-12 months

2. Hepatocellular carcinoma screening every 6 months

59
Q

Which Hepatitis is easier to transmit sexually?

A

Hep B

60
Q

When is HBV considered a chronic infection?

A

HBsAg (Hep B antigen) persists for ≥6 months

61
Q

HbsAg+ (positive surface antigen) means

A

you actively have Hep B

62
Q

anti-HBs+ (positive surface antibodies) means

A

you have the antibody and you are IMMUNE

63
Q

anti-HBc+ (positive core antibody) means

A

you were exposed to Hep B at one point, you may still have it

64
Q

Which two HBV medications are NOT PREFERRED?

  1. Entecavir
  2. Lamivudine
  3. Tenofovir disoproxil
  4. Adefovir
A

Lamivudine & Adefovir

65
Q

Which HBV med works well but only if the patient is willing to suffer every day?

A

Peginterferon alfa-2a

66
Q

Match which tenofovir works where (blood, tissues).

  1. tenofovir disoproxil fumarate (TDF)
  2. tenofovir alafenamide (TAF)
A 
tenofovir disoproxil fumarate (TDF) -> blood
tenofovir alafenamide (TAF) -> tissues
67
Q

Which HBV med can improve fibrosis/cirrhosis, reduce risk of hepatocellular carcinoma, and can work despite HBV resistance?

A

Tenofovir

68
Q

Which tenofovir is easier to tolerate and has a high likelihood of success?

A

TDF

69
Q

TDF should be avoided if CrCl is…

a. <40 mL/min
b. <50 mL/min
c. <60 mL/min
d. <70 mL/min

A

<60 mL/min

70
Q

TAF is safe for patient with CrCl down to at least…

A

15 mL/min and also HD patients

71
Q

When should you avoid TAF?

A

Pregnancy

Anti-epileptic therapy

72
Q

Does entecavir require renal adjustments?

A

Yes, if CrCl <50 mL/min

73
Q

The oddball but good HBV medication (has same benefits as tenofovir)

A

Entecavir

74
Q

When would you dose 0.5 mg of entecavir vs. 1 mg?

A

0.5 mg for treatment naive patients

1 mg for lamivudine-experienced or decompensated cirrhosis

75
Q

Entecavir has what cross-resistance

A

Lamivudine (but tenofovir is advantageous)

76
Q

Which HBV med has very high rates of resistance and a very high likelihood of generating resistance within 5 years?

A

Lamivudine

77
Q

Which HBV med is less active and slower-acting than TFV?

A

Adefovir

78
Q

Which HBV med is more likely to be part of a dual drug regimen for HIV/HBV?

A

Lamivudine

79
Q

When is emtricitabine recommended?

A

Treating HBV when HIV/HBV coinfection

80
Q

HIV/HBV requires two HBV agents which are

A

emtricitabine and TFV

81
Q

This HBV med has shortened therapy but is contraindicated in decompensated cirrhosis

A

PegIFN

82
Q

What are the goals of therapy for Hep B?

A
  1. Achieve HBeAg seroconversion
  2. Loss of HBsAg (lose the surface antigen)
  3. Minimize or halt progression of liver damage
  4. Reduce risk of developing HCC
83
Q

For Immune-active CHB (liver is getting irritated), which HBV medications are recommended?

A

PegIFN, TFV, or entecavir (PegIFN has high rates of success)

84
Q

Immune-active HBeAg+ that seroconverts to HBeAg- should continue treatment for at least ____ after seroconversion

A

1 year

85
Q

Immune-active HBeAg- likely requires ____ treatment

A

indefinite

86
Q

This hepatitis needs Hep B to survive

A

Hep D

87
Q

The only approved agent for Hep D is

A

IFN

Therapeutics (10 decks)

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