Flashcards in Pharm-Viral Hepatitis Deck (29):
treatment of acute HBV infection
95% resolve, little need for intervention unless fulminant (lamivudine?, nRTI)
goal with tx of chronic HBV
suppress virus (prevent flare, prevent progression to cirrhosis and HCC)
treatment of HBeAg+ disease is based on level of ____ and ____
HBV DNA; ALT
if HBV DNA is less than 2K, you should?
if HBV DNA is more than 2K and ALT is normal you should?
monitor ALT or consider biopsy (treat if significant dz)
if HBV DNA is more than 2K and ALT is elevated you should?
begin long-term treatment
treatment of HBV+ compensated cirrhosis should be initiated when?
HBV DNA is >2000
all patients with decompensated cirrhosis should be ______; patients with _____ should be treated with _____ medications
put on a waitlist for transplant; oral tx (NO interferon)
there is a ____ threshhold for treatment of patients who are HBeAg+ and a ____ threshhold for tx of patients who are anti-Hbe+
first line agents for chronic HBV in US are?
entecavir, tenofovir, PegIFN
these HIV medications are also active against HBV
emtricitabine, truvada (emtric/tenofovir)
these should not be used to treat HBV infection because they have a black box warning for lactic acidosis
oral nucleosides (adefovir, lamivudine)
patients with HBeAg are monitored every 3-4 months to check for?
seroconversion to anti-HBeA
the goal of HCV tx is to?
CURE the disease (when tx is deemed necessary)
how long and how severe are the side effects for HCV tx?
6-12 months of therapy with lots of side effects
current recommendations for dose and duration of PEG-IFN + ribaviron depend on _____
genotype of HCV (G1/4 have longer, stronger tx)
conjunction tx for HCV genotype 1 includes ____, which improves SVR rates and can decrease duration of tx
protease inhibitor (telaprevir, boceprevir)
major side effects of interferon
depression, blood dyscrasias, thyroid disorders, fatigue/flue-like sx
major side effect of ribavirin
side effects of telaprevir
rash, anorectal sx
side effects of boceprevir
neutropenia is worse with (interferon/peg-interferon)
peg-interferon (for severe forms)
relationship between interferon and thrombocytopenia
minimal, not much risk of TCP
what are three major causes of depression in HCV
interferon-induced, baseline mental illness, and substance abuse (occurs in 30-60% of pts)
thyroid dysfunction occurs in ___% of pts receiving INF, and up to ___% of those become thyroid antibody positive (IIT)
15%, 40% (IRREVERSIBLE)
most frequently reported extrahepatic sx in pts with HCV
fatigue (could be related to depression and therapy)
flu-like sx from interferon tx are worse (early/late) in therapy (what do you tx it with?)
early (tx with acetaminophen)
genotic polymorphisms in the IL28B gene confer SVR advantage to what races?