hepatitis tx

Question 1

Peginterferon alfa

Answer 1

HBV agent/HCV agent

MOA: inhibits viral penetration, tln, txn, protein processing, maturation and release
- must be given subq: but has slower clearance, 1x/week injections

ADR’s: experience flu-like illness w/in first week
- increase in hepatic enzymes

• neurotoxicity, meylosupression, fatigue

CI’s: hepatic decomposition, psychiatric disease

Question 2

Adefovir

Answer 2

HBV agent

Nucleoside/NT analogs (NA’s): interfere w/ viral replication- inhibit HBV DNA pol, chain termination after incorporation into viral DNA

ADR’s: h/a, diarrhea, ab. pain; nephrotoxicity

Question 3

Entecavir

Answer 3

HBV agent

Nucleoside/NT analogs (NA’s): interfere w/ viral replication-
MOA: inhibits DNA polymerase

ADR’s: welll- tolerated
** first line therapy for HBV

Question 4

Lamivudine

Answer 4

(3TC) HBV agent

Nucleoside/NT analogs (NA’s): interfere w/ viral replication-
MOA: inhibits DNA pol

ADR’s: excellent safety profile, including use during pregnancy

USE: has high amount of resistnace, not first line therapy

Question 5

Telbivudine

Answer 5

HBV agent

Nucleoside/NT analogs (NA’s): interfere w/ viral replication
MOA- inhibits DNA pol via competitive inhibition, causing chain termination

CIS’s: concurrent use w/ interferon alfa can cause peripheral neuropathy

not recommended first line

Question 6

Tenofovir

Answer 6

HBV agent

Nucleoside/NT analogs (NA’s): interfere w/ viral replication-
MOA: comp. inhibits DNA pol, causing chain termination

ADR’s: nausea, diarrhea, vomiting, decreased bone mineral density

Use: recommended first-line therapy for HBV
resistance is rare

Question 7

Ribavarin

Answer 7

HCV agent

MOA: inhibits initiation/elongation of RNA –> inhibition of viral protein synth (inhibits RNA pol)

ADR’s: dose dependent hemolytic anemia , teratogenic, oncogenic

Used for Chronic HCV

CI’s: anemia, ESRF, ischemic vascular disease, pregnancy

Question 8

simeprevir

Answer 8

(OLYSIO) HCV agent

MOA: direct acting antiviral

ADR’s: skin rash/puritis

DDI’s: avoid with CYP inducers (rifampin) – super expensive tx

Question 9

Sofosbuvir

Answer 9

(Sovaldi) HCV agent

MOA: direct acting antiviral - inhibits RNA pol

ADR’s: fatigue, h/a, insomnia

expensive!!!

Question 10

Boceprevir

Answer 10

(Incivek) HCV agent = protease inhibitor

no longer recommended

Question 11

Telaprevir

Answer 11

(Victrelis) HCV agent = protease inhibitor

no longer recommended

Question 12

+ HBsAG

Answer 12

HBV surface protein; high level occur during acute/chronic infection - means pt. is infectious

Question 13

+ anti-HBs

Answer 13

interpreted as recovery or immunity from HBV - also arise after succesful vaccination

Question 14

+ anti-HBc

Answer 14

total hepatitis B core Ab - appears at onset of infection (will persist for life) and indicates previous or ongoing infection

Question 15

IgM anti-HBc

Answer 15

delineates recent infection with HBV w/in 6 mos

Question 16

HBeAg

Answer 16

indicates high levels of HBV - found during acute and chronic infection, indicating viral replication

Question 17

HBeAB

Answer 17

indicates lower levels of HBV - spontaneous Ag to AB conversion is a good predictor of viral clearance

Question 18

which of following is NOT a tx goal for HBV?

Answer 18

Viral cure

three risks if not cured? cirrhoisis, HCC, hepatic failure

seroconversion is a good predictor of viral clearance

Question 19

which drug class would be preferred if pt. has decompensated liver disease

Answer 19

nucleoside/nucleotide analogs

Question 20

first line tx for HBV?

Answer 20

tenofovir and entecavir

Question 21

high resistance for HBV?

Answer 21

lamuvidine, telbivudine

Question 22

favorable response to tx of HCV?

Answer 22

genotype 2
low baseline HCV-RNA
no cirrhosis

Question 23

what is an SVR?

Answer 23

sustained virologic response - absence of HCV RNA by polymerase chain reaction for 6 mos. after completion of therapy -

assoc/ w/ improved liver histology, decrease risk of cancer….

Question 24

HCV tx?

Answer 24

Peginterferon, ribavirin, sofosbuvir

Question 25

pregnancy category x?

Answer 25

ribavirin - must have negative pregnancy test at baseline and up to six months after tx - needs two forms of barrier tx.

Question 26

mechanism of action of sofosbuvir?

Answer 26

directing acting antiviral- inhibits RNA polymerase (incorporated into HCV RNA and causes chain termination of RNA)

Question 27

ribavirin adverse effect?

Answer 27

hemolytic anemia | - pregnancy X drug

Question 28

IFN contraindicated/use with caution?

Answer 28

hepatic decomposition, AI disease, cardiac arrythmia, pregnancy caution: psychiatric disease, epilepsy, thyroid disease, renal insufficiency

Question 29

inhibits DNA pol?

Answer 29

adefovir, entecavir, lamivudine, telbivudine, tenofovir

Question 30

inhibits RNA pol?

Answer 30

ribavirin, sofosbuvir

Question 31

inhibits viral penetration, tln, maturation?

Answer 31

peginterferon

Question 32

inhibits viral protease?

Answer 32

semeprevir, boceprevir, teleprever

Question 33

common side effect of peginterferon?

Answer 33

flu like illness

Question 34

psych problems?

Answer 34

peginterferon

Question 35

first-line tx for HBV?

Answer 35

entecavir, tenofovir

Question 36

HCV tx?

Answer 36

peginterferon, ribavirin + (sofusbuvir also, but its expensive! )

Question 37

Fatigue, scleral icterus, | and pallor.

Answer 37

ribavirin

Question 38

when is IFN ineligible?

Answer 38

``` Hepatic decomposition Autoimmune disease Cardiac arrhythmia Pregnancy (Category C?) Caution Psychiatric disease Epilepsy Thyroid disease Renal insufficiency ```