Treatment of Chronic Hepatitis Flashcards Preview

DEMS: Unit 1 > Treatment of Chronic Hepatitis > Flashcards

Flashcards in Treatment of Chronic Hepatitis Deck (13):
1

Indications for tx of chronic HBV infection

  1. HBsAg(+) > 6 months*
  2. Serum HBV DNA >105 copies/mL
  3. Persistent or intermittent elevation in ALT and AST levels
  4. tx patients w/advanced liver disease


 

2

Tx options for HBV

  • Interferon
    • Finite duration of therapy (1 year)
    • Absence of resistant mutations
    • More durable response
  • Nucleoside/tide analoges
    • Fewer side effects
    • Resistant mutations
  • Goals:
    • serocoversion of HBeAg ==> HBeAb
    • negative HBV DNA 
       

3

Types of HCV drugs & MOA

  • NS3 Protease Inhibitors ==> prevent HCV protein production
    • Simeprevir
    • Telaprevir
    • Boceprevir
  • Non-NUC/NUC NS5B inhibitors ==> prevent RNA replication
    • Sofosbuvir
  • NS5A inhibitors ==> prevents RNA replication/assembly
    • Ledipasvir

4

Tx for genotype 2/genotype 3 HCV

  • NS5B Polymerase (NUC) Inhibitor (Sofosbuvir) + Ribavirin

5

Tx of genotype 1 HCV + tx duration

  • NS5B Polymerase (NUC) Inhibitor + NS5A Protein Inhibitor
    • = Sofosbuvir + Ledipasvir
  • Tx-naive w/ or w/out cirrhosis = 12 weeks
  • Tx-experienced w/cirrhosis = 24 weeks

6

Goal of HCV tx

  • Goal = clear HCV RNA such that remain HCV RNA negative 12 weeks after stopping therapy
  • Sustained virological response (SVR) = cure
     

7

Tx for hereditary hemochromatosis

•Treatment is therapeutic phlebotomy
–500 mL of whole blood = 200-250 mg iron
–Endpoint is serum ferritin 50 ng/mL
–Maintenance phlebotomy to keep ferritin 50-100 ng/mL
•For anemic patients not able to tolerate phlebotomy, chelation therapy with desfuroxamine
 

8

Tx for autoimmune hepatitis

•Treatment based on immune suppression
–Corticosteroids
–Azathioprine
•Relapse typically occurs if treatment stopped after liver enzymes normalized
 

9

Tx of Primary Biliary Cirrhosis

•Therapy is ursodeoxycolic acid (UDCA)
–Secondary bile acid, metabolic byproduct of intestinal bacteria
–Improves bile acid transport, “detoxifies” bile and providing cytoprotection
 

10

Indications for Primary Biliary Cirrhosis

–Improved liver biochemistries
–Improve survival
–Reduce need for liver transplantation
 

11

Tx of Primary Sclerosing Cholangitis

  • No effective medical therapy
  • Treatment focused on management of complications of bile duct obstruction
    • Stenting strictures
    • Antibiotics for cholangitis
       

12

Tx for Wilson's Disease

•Treatment is copper chelation
–D-penicillamine
–Trientine
•Maintenance therapy with zinc
 

13

Tx of Non-alcoholic steatohepatitis

•Treatment focused on modifying risk factors
–Obesity
–Diabetes mellitus type 2
–Dyslipidemia
•Investigational therapies
–Diabetes medications – even if not diabetic
–Vitamin E - antioxidant