Hepatitis Tx I

Question 1

Agents for Hep B virus

Answer 1

peginterferon alfa
adefovir
entecavir
lamivudine
telbivudine
tenofovir

Question 2

agents for Hep C virus

Answer 2

pegintergeron alfa
ribavirin
simeprevir
sofosbuvie
protease inhibitors: roceprevir and telaprevir

Question 3

how to confirm hep virus

Answer 3

serologic tests

Question 4

which hep virus is DNA

Answer 4

hep B

Question 5

Hep C is transmitted most commonly

Answer 5

injection drug users

Question 6

serologic test for HepAvirus

Answer 6

IgM Ab

Question 7

Tx HepA

Answer 7

prevention and prophylaxis
Ig for pre and post exposure prophylaxis
vaccination preferred

Question 8

Sx HepB

Answer 8

fever, anorexia, nausea, vomtiing, jaundice, dark urine, pale stools, abnominal pain

Question 9

serologic tests for Hep B

Answer 9

HBsAg- active infection
antiHBs- recovery or immunity, successful vaccination
antiHBc- previous or ongoing infection
IgM antiHBc delineates recent infection in past 6 mo
HBeAg viral replication
HBeAb clearing virus

Question 10

What serologic levels will be increased in acute infection HBV

Answer 10

HBsAg, antiHBc IgM antiHBc

Question 11

what serologic levels will be increased in chronically infected HBV

Answer 11

HBsAg, antiHBc

Question 12

patient had Hep B virus and cleared

what will titers show

Answer 12

antiHBc and anti HBs

Question 13

is HBV curable

Answer 13

no

Question 14

goals of therapy for HBV

Answer 14

suppress replication
prevent complications
seroconvert HBeAg to Ab
reduce need for liver transplantation

Question 15

when to Tx HBV

Answer 15

risk of liver related morbidity and mortality is foreseeable

Question 16

non-pharm management for HBV

Answer 16

vaccinate sexual and household contacts
avoid alcohol
vaccinate HAV

Question 17

first vaccine against major human cancer, HCC

Answer 17

HBV vaccine

Question 18

msot common blood borne pathogen

Answer 18

hep C

Question 19

85% hep c develop what

Answer 19

chronic HCV so increased risk cirrhosis, HCC and end stage liver failure

Question 20

chronic Sx HCV

Answer 20

fatigue, RUQ pain, nausea, poor appetite

Question 21

goals of HCV therapy

Answer 21

eradicate virus

absent RNA for 6 mo

Question 22

Indications for HCV Tx

Answer 22

all patients with evidence of chronic HCV in prev 6 mo

untreated patients with HCV

Question 23

patients not to Tx HCV in

Answer 23

decompensated liver disease or Hx of severe uncontrolled psychiatric disorder

Question 24

factors associated with favorable Tx response for HCV Tx

Answer 24

HCV genotype 2 or 3
absence cirrhosis
low preTx HCV RNA level

Question 25

pros and cons of Interferon alfa

Answer 25

pros: finite duration, no resistance, responses durable cons: side effects, not used in patients with decompensated disease

Question 26

MOA interferon alfa

Answer 26

inhibits viral penetration, translation, transcription, protein processing, maturation and release enhanced phagocytic activity

Question 27

how is peginterferon administered? why?

Answer 27

subcutaneoulsy because slower clearance | have to adjust for renal impairement

Question 28

adverse effects interferon alfa

Answer 28

flu like illness (resolves with cont Tx) | transient inc in hepatic enzymes

Question 29

adverse effects chronic Tx interferon alfa

Answer 29

neurotoxicity with chronic Tx with myelosuppression and profound fatigue, weight loss, rash, cough, myalgia, alopecia, tinnitus, reversible hearing loss, retinopathy, penumonitis

Question 30

contraindications interferon alfa

Answer 30

hepatic decompensation, autoimmune disease, Hx cardiac arrhythmia, pregnancy

Question 31

cautions for using interferon alfa

Answer 31

psychiatric disease, epilepsy, thyroid disease, ischemic cardiac disease, severe renal insufficiency, cytopenia

Question 32

Therapeutic uses interferon alfa

Answer 32

chronic HBV and HCV

Question 33

drug drug interactions interferon alfa

Answer 33

may increase levels of theophylline and methadone | not recommended with didanosine(inc hepatic failure) or zidoyudine (exacerbate cytopenias)

Question 34

MOA nucleoside/nucleotide analogs

Answer 34

interfere viral replication

Question 35

what are pros and cons to nucleoside analogs vs interferon

Answer 35

PO administration that is better tolerated and higher response rate, can be used chronic therapy or htose with liver disease cons: sustained response limited after discontinuation resistance, peripheral neuropathy, lactic acidosis and hepatic steatosis

Question 36

what are the nucleoside/tide analogs

Answer 36

adefovir and dipivoxil entecavir lamivudine

Question 37

MOA adefovir dipivoxil

Answer 37

inhibit HBV DNA polymerase, chain termination after incorporation into viral DNA

Question 38

adverse effects adefovir dipivoxil

Answer 38

HA, diarrhea, abdominal pain, potential nephrotoxicity

Question 39

therapeutic use adefovir and dipivoxil

Answer 39

wide range DNA RNA viruses like HBV HIV and herpes | not rec as first line HBV

Question 40

R to adefovir dipivoxil

Answer 40

adefovir-R rt233 HBV mutatns | no cross R with lamivudine

Question 41

MOA entecavir

Answer 41

inhibits DNA polymerase (base priming, reverse transcriptase and DNA synthesis)

Question 42

what to tell patient if on entecavir

Answer 42

take on empty stomach

Question 43

adverse effects entecavir

Answer 43

HA, dzziness, nausea

Question 44

Therapeutic use entecavir

Answer 44

first line HBV

Question 45

MOA lamivudine

Answer 45

inhibits DNA polymerase, competes for incoporation into viral DNA, causes chain termination

Question 46

adverse effects lamivudine

Answer 46

excellent safety profile can have HA nausea and dizziness if HIV patient inc risk pancreatitis

Question 47

what analog can you use in pregnant woman

Answer 47

lamivudine

Question 48

Therapeutic use lamivudine

Answer 48

HIV Tx rapildy suppress HBV not rec as 1st line b/c resistance cross R with entecavir

Question 49

MOA telbivudine

Answer 49

inhibits DNA polymerase (competitive) causes chain termination

Question 50

adverse effects telbivudine

Answer 50

fatigue, HA, abdominal pain, increased creatine kinase levels, nausea, vomiting

Question 51

contraindications telbivudine

Answer 51

avoid with interferon alfa b/c peripheral neuropathy

Question 52

therapeutic use telbivudine

Answer 52

rapidly suppresses HBV and causes HBeAg seroconversion not rec as 1st line b/c Resistance cross R with lamivudine

Question 53

MOA tenofovir

Answer 53

competitvely inhibits DNA polymerase, chain termination

Question 54

adverse effects tenofovir

Answer 54

nausea, diarrhea, vomiting, decreased bone mineral density (give Ca and vit D supp)

Question 55

therapeutic use tenofovir

Answer 55

first line HBV HIV Tx resistance rare