Flashcards in Hepatitis Tx Deck (29)
What are the preferred antivirals?
Tenofovir and Entacavir
HBV resistance occurs when?
WHen mutations occur in the HBV polymerase.
Tends to be structure specific.
Which drug does not inhibit HBV polymerase
All of the antivirals are Triphosphates except
Adefovir and Tenofovir
Why are the oral antiviral drugs first line therapy over Interferon?
Because they are better tolerated and suppres the virus better
Lamivudine is what type of drug?
Nucleoside/tide structural analog
Prodrug adenosine analog
GFR and RTS
Adefovir is what type of structural analog
Adenosine analog (not a prodrug like lamivudine)
GFR and RTS, Also may cause lactic acidosis and steatorrhea (hepatotoxic)
Tenofovir os what type of structural analog
What can yo do to increase the bioavailability of tenofovir?
Take with a high fat meal
Important AE of TENOFOVIR
Renal toxicity in pts with renal dz. Make sure t test serum creatinine and BUN.
- MAKE SURE to ask pts about bone pain or muscle pain as this may be a sign of renal tubolopathy
- Tenofovir ( a retroviral) Has also been shown to cause osteoporosis. Give with calcium and Vit d
Avoid taking Tenofovir with other nephrotoxic agents like
can be used for co-infections....its a cytosine analog
Interferon 2a used against
IFN 2b used for
AE of IFN
flu like, neuropsych (depression and seizures), myelosuppresion, high LFTs, Transient thyroid disturbance
How the fuck do IFNs work
They agonize IFN receptors (JAK/STAT) that upregulate enzymes like adenosine deaminase, PKR, and oligoadenylate cyclase----all of which are endonucleases which cleave viral DNA , Inh dsRNA, Inh Viral penetration, uncoating, and release
HCV genotype 1
Pegylated IFN 2B + Ribavirin + Telaprevir
What does Ribavirin do?
Increases immune clearance, lowers GTP, Mutates RNA. transiently decreases HCV RNA but normalizes ALT
Ribavirin absorption increased with
high fat meal
AE of Ribavirin
Hemolytic anemia, MI, difficulty breathing
Telepravir and Boceprevir mech
When are telepravir and boceprevir added?
after four weeks of Interferon + Ribavirin