Hepatitis B

Question 1

Hepatitis B Virus

Answer 1

DNA virus (partially double stranded)
viral replication by reverse transcriptase
susceptible to bile acid lysis

Question 2

HBsAg (surface antigen)

Answer 2

small particle found circulating in bloodstream of infected patients

Question 3

HBcAg (core antigen)

Answer 3

single partially double stranded DNA
IgM - acute infection
IgG - persists for life

Question 4

HBeAg (e antigen)

Answer 4

DNA polymerase viral peptide found in viral core

clearance of HBV dependent on expression of HBeAg

Question 5

HBV Lab values of chronically infected patient?

Answer 5

HBsAg +
Anti-HBc +
IgM anti-HBC -
Anti-HBs -

Question 6

HBV Lab values of vaccinated patient?

Answer 6

HBsAg -
Anti-HBc -
Anti-HBs +

Question 7

Interferon (IFN) (MOA)

Answer 7

Acts as host cytokine (antiviral, anti-proliferative, and immunomodulatory effects)

Question 8

Interferon (IFN) (adverse effects)

Answer 8

intense mood disturbances (psychological effects)
cytopenia
autoimmuno disorders

Question 9

Interferon (IFN) (profile)

Answer 9

Drug of last resort. interferon is no longer used for Hep B. you only use this drug once things have gotten really bad. usually have to tact on anti-depressants b/c of the intense psychological effects.

Question 10

Lamivudine (LMV, Epivir) (MOA)

Answer 10

inhibitory effects on DNA polymerase

Question 11

Lamivudine (LMV, Epivir) (profile)

Answer 11

side effects comparable to acyclovir (both have good side effects)
resistance can develop with prolonged treatment

Question 12

Lamivudine (LMV, Epivir) (adverse effects)

Answer 12

(less toxic than interferon)

fatigue, N/V/D, headache

Question 13

Adefovir Dipivoxil (ADV, Hepsera) (MOA)

Answer 13

inhibitory effects on DNA polymerase

nucleoside analog converted to diphosphate intracellularly

Question 14

Adefovir Dipivoxil (ADV, Hepsera) (profile)

Answer 14

Has HIV activity (this is Hep B drug)

this drug is “grandfather” of tenofovir (the HIV drug with bone and kidney issues)

Question 15

Adefovir Dipivoxil (ADV, Hepsera) (adverse effects)

Answer 15

nephrotoxicity

gradual increase in serum creatinine

Question 16

Entecavir (ETV - Baraclude) (MOA)

Answer 16

inhibits Hep B at 3 steps:
priming of Hep B DNA polymerase
reverse transcriptase
Hep B DNA synthesis

Question 17

Entecavir (ETV - Baraclude) (adverse effects)

Answer 17

(similar to that of lamivudine)
(less toxic than interferon)
fatigue, N/V/D, headache

Question 18

Entecavir (ETV - Baraclude) (profile)

Answer 18

first line therapy for chronic Hep B

patients on this drug don’t tend to develop resistance

Question 19

Telbivudine (LdT, Tyzeka) (MOA)

Answer 19

L-nucleoside analogue with potent anti-Hep B activity

Question 20

Telbivudine (LdT, Tyzeka) (adverse effects)

Answer 20

(similar to that of lamivudine)
(less toxic than interferon)
fatigue, N/V/D, headache

Question 21

Telbivudine (LdT, Tyzeka) (profile)

Answer 21

more potent than lamivudine
high rate of resistance
if someone was on lamivudine and that didn’t work, this drug wont have an effect either (cross-resistance)

Question 22

Tenofovir (TDF, Viread) (MOA)

Answer 22

Nucleoside analogue with inhibitory effects on DNA polymerase of Hep B

Question 23

Tenofovir (TDF, Viread) (profile)

Answer 23

first line therapy for chronic Hep B

effective but not as effective as Entecavir in terms of Hep B

Question 24

Tenofovir (TDF, Viread) (adverse effects)

Answer 24

superior to adefovir, less nephrotoxicity

monitor renal function (serum creatinine)