Viral Hepatitis drugs Flashcards
(33 cards)
is there a treatment for acute hepatitis B
No specific treatment
most often resolves spontaneously
what are the goals of chronic HBV therapy
1.
The suppression of HBV DNA to undetectable levels
2.
Seroconversion of HBeAg(or more rarely, HBsAg) from positive to negative
3.
Reduction in elevated serum aminotransferase levels.
can chronic HBV be cured?
no it is rare
The covalently closed circular viral DNA exists in stable form indefinitely within the cell serving as a reservoir for HBV throughout the life of the cell and resulting in the capacity to reactivate
relapse is more common in patients co-infected with hepatitis D virus
MOA and BB warning of Entecavir
A hepatitis B virus nucleoside analogue reverse transcriptase
- SEVERE ACUTE EXACERBATIONS OF HEPATITIS B especially PATIENTS CO-INFECTED WITH HIV AND HBV
- LACTIC ACIDOSIS
- HEPATOMEGALY
are there any contradictions and what are the Adverse reactions of Entecavir
No contradictions
Adverse reactions:
In adults, the most common adverse reactions (≥3%, all severity grades) are
headache, fatigue, dizziness, and nausea. The adverse reactions observed in pediatric patients were consistent with those observed in adults.
MOA and BB warning of Tenofovir Disoproxil
Anucleotide analog HIV-1 reverse transcriptase inhibitor and an HBV reverse transcriptase inhibitor.
- LACTIC ACIDOSIS/SEVERE HEPATOMEGALY WITH STEATOSIS
- POST TREATMENT EXACERBATION OF HEPATITIS
what are the indications of Entecavir
Indicated for the treatment of chronic hepatitis B virus infection in adults and children at least 2 years of age with evidence of active viral replication and either evidence of persistent elevations in serum aminotransferases (ALT or AST) or histologically active disease.
what are the Indications of Tenofovir disoproxil
Used in combination with other antiretroviral agents for the treatment of HIV-1 infection in adults and
pediatric patients 2 years of age and older.
-Used the treatment of chronic hepatitis B in adults and pediatric patients 12 years of age and older. (1)
what are the warnings, precautions and adverse effects of Tenofovir disoproxil
WARNINGS AND PRECAUTIONS
New onset or worsening renal impairment: Can include acute renal failure and Fanconi syndrome
ADVERSE RXNS: In HBV-infected subjects with compensated liver disease: most common adverse
reaction (all grades) was nausea (9%).
Indications and contradictions in Adefovir
INDICATIONS: is a nucleotide analogue used for the treatment of chronic hepatitis B in patients 12 years of age and older.
CONTRAINDICATIONS: in patients with previously demonstrated hypersensitivity to any of the components of the product.
what are the warnings, adverse rxns, and drug interactions of adefovir
WARNINGS/PRECAUTIONS
Nephrotoxicity: Monitor renal function during therapy for all patients, particularly those with pre-existing or other risks for renal impairment.
-Severe acute exacerbations of hepatitis
ADVERSE RXNS: Most common adverse reaction (incidence greater than 10%) in compensated disease patients is asthenia and increased creatinine in pre and post transplantation lamivudine-resistant liver disease patients
DRUG INTERXNS: Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of adefoviror the coadministered drug.
what are the MOA and Indications of Telbivudine?
A nucleoside analogue reverse transcriptase inhibitor
Used for the treatment of chronic hepatitis B in adult patients with evidence of viral replication and either evidence of persistent elevations in serum aminotransferases (ALT or AST) or histologically active disease.
Contradictions, BB warning, and adverse reactions of Telbivudine
LACTIC ACIDOSIS
SEVERE HEPATOMEGALY WITH STEATOSIS
SEVERE ACUTE EXACERBATIONS OF HEPATITIS B
Combination of Telbivudine with PEGylated interferon alfa-2a: Increased risk of peripheral neuropathy
ADVERSE RXNS: Most common adverse reactions: fatigue, increased creatine kinase (CK), headache, cough, diarrhea, abdominal pain, nausea,arthralgia, pyrexia, rash, back pain, dizziness, myalgia, ALT increased, dyspepsia, insomnia, and abdominal distension.
what is the indications of PEG Interferon Alfa-2a
INDICATIONS: Treatment of chronic hepatitis C with compensated liver disease not previously treated with interferon alpha, in patients with histological evidence of cirrhosis and compensated liver disease,
*Treatment of patients with chronic hepatitis B infection who have compensated liver disease and evidence of viral replication and liver inflammation
what are the BB warnings, contradictions, and adverse reactions of PEG interferon Alfa-2a
ADVERSE RXNS: Most common are fatigue/asthenia, pyrexia, myalgia, and headache.
BB WARNING: RISK OF SERIOUS DISORDERS AND RIBAVIRIN-ASSOCIATED EFFECTS
CONTRAINDICATIONS:
• Autoimmune hepatitis
• Hepatic decompensation in patients with cirrhosis
• Use in neonates/infant
what are the Indications of PEG Interferon Alfa-2b
INDICATIONS: Used for the treatment of chronic hepatitis C in patients 18 years of age or older with compensated liver disease who have a history of blood or blood-product exposure and/or are HCV antibody positive.
what are the BB warnings, Contraindications, and adverse reactions of PEG Interferon Alfa-2b
BB WARNING: Can cause or aggravate fatal or life-threatening neuropsychiatric,
autoimmune, ischemic, and infectious disorders.
CONTRAINDICATIONS:• Hypersensitivity to interferon alpha or any component of the product
• Autoimmune hepatitis
• Decompensated liver disease
ADVERSE RXNS: Most frequently reported adverse reactions were “flu-like” symptoms, fever, headache, chills, myalgia, and fatigue. More severe toxicities are observed generally at higher doses and may be difficult for patients to tolerate.
when is the end point typically achieved of sustained viral response?
no detectable viremia for 24 weeks after the completion of treatment
what is the rate of clearance without treatment for patients
20-30 percent that is why some practitioners delay therapy for minimum of 6 months to see if the infection clears its self
what are the Indications of Elbasvir and Grazoprevir?
Is a fixed-dose combination product containing elbasvir, a hepatitis C virus (HCV) NS5A inhibitor,
and Grazoprevir, an HCV NS3/4A protease inhibitor used in the treatment of Hepatitis C.
what are the contradictions, warnings, adverse reactions and drug interactions of Elbasvir and Grazoprevir
Contraindications-Patients with moderate or severe hepatic impairment
WARNINGS AND PRECAUTIONS:
ALT elevations:
ADVERSE REACTIONS: The most commonly reported adverse reactions of all intensity were fatigue, headache, and nausea
DRUG INTERACTIONS: Co-administration with moderate CYP3A inducers is not
recommended as they may decrease the plasma concentration of Elbasvir/Grazoprevir.
what are the indications of Ledipasvir and Sofosbuvir
• A fixed-dose combination of ledipasvir, a hepatitis C virus (HCV) NS5A inhibitor,
and sofosbuvir, an HCV nucleotide analog NS5B polymerase inhibitor,
• Indicated for the treatment of chronic hepatitis C infection in adults
what are the warnings, adverse reactions, and drug interactions of Ledipasvir/sofosbuvir
WARNINGS/PRECAUTIONS: Only recommended with some combination of ribavirin, peginterferon-alfa, simeprevir, ledipasvir, daclatasvir, or velpatasvir
ADVERSE RXNS: Most common are fatigue and headache
DRUG INTERXNS:• Poly glycoprotein inducers (e.g., rifampin, St. John’s wort): May alter concentrations of ledipasvir and sofosbuvir»not recommended
what are the Indications of Velpatasvir/Sofosbuvir
• A fixed-dose combination of sofosbuvir, a hepatitis C virus (HCV) nucleotide analog NS5B polymerase inhibitor, and velpatasvir, an HCV NS5A inhibitor,
•
INDICATION: for the treatment of adult patients with chronic HCV infection
•
without cirrhosis or with compensated cirrhosis
•
with decompensated cirrhosis for use in combination with ribavirin
