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What is the treatment goal for Hepatitis B (HBV)?
Reduce HBV DNA to undetectable levels
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True/false: HBV can be eradicated
False; it cannot, that’s why the goal isn’t to clear out the virus, but just to reduce the DNA level
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MOA and route of admin of antiviral agents for Hep B:
- Inhibit HBV polymerase
- Oral
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Nucleotide/nucleoside analog agents:
- Lamivudine
- Entecavir
- Tenofovir
- (these are used for HBV because HBV has DNA)
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Which HBV nucleotide analog can the virus become resistant to?
Lamivudine
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Which HBV nucleotide analog also has therapeutic effect for HIV?
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True/false: HBV resistance often seen with entecavir use
False; it’s lamivudine
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Which HBV nucleotide analog can cause GI complaints and rash?
Tenofovir
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What is the MOA of interferon alfa?
- Stimulate interferon receptors, works through JAK STAT
- Interferon helps prepare uninfected cells from virus
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What is a drug that’s indicated for both HBV and Hep C?
- Peg interferon alfa 2a/b
- Administered Subcutaneous or IM
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What are ADR for peg interferon alfa 2/ab
- Flu-like syndrome
- Neurotoxicity
- Myalgias
- Bone marrow suppression
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What is a main contraindication for peg interferon use?
Pregnancy
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Which hepatitis drug must you reduce the dosage for patients with renal insufficiency?
Peg interferon alfa 2a/b
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True/false: goal of treatment for HCV is to reduce the viral load
False; goal for HCV is to cure/ eradication
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Patient with chronic Hep C is at risk for developing which disease?
Cirrhosis
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What are agents used to treat HCV?
- Peg interferon alfa
- Ribavirin
- Simpeprevir, sofosbuvir, Harvoni (these are the new direct acting antiviral agents)
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Which hepatitis drug is a guanosine analog?
Ribavirin (used to treat HCV)
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What is the MOA of ribavirin?
- Interfere with GTP synthesis
- Inhibit capping of viral mRNA
- Inhibit RNA polymerase
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True/false: Ribavirin can also be used in treatment for influenza, RSV and HIV, in addition to HCV
True
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Pregnant patients should avoid which hepatitis drugs?
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Which hepatitis C drug can cause hemolytic anemia?
Ribavirin
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Which drug has embryocidal and teratogenic effects and should wait 6 months after use before thinking about getting pregnant?
Ribavirin (for HCV)
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Direct-acting antiviral (DAA) agents:
- Simeprevir
- Sofosbuvir
- Ledipasvir
- Harvoni (sofobuvir + ledipasvir)
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DAA that inhibit NS3 protease have _______ stem. NS5A protease inhibitor has ________ stem. And NS5B inhibitor has _______.
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What is the black box warning for Direct acting antivirals?
Can reactivate HBV, so must screen HCV patients for HCB before putting them on DAAs
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Simeprevir MOA:
Inhibit HCV NS3/4A serine protease
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Which DAA for HCV has drug interaction by modifying activity of CYP3A4?
Simeprevir
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Which DAA drug should not be used with statin? What can it be used with?
- Simeprevir should not be used with Statins,
- But can be used in combination with PEG INF, ribavirin or sofosbuvir
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Sofosbuvir can be used in combination with which drugs:
Simeprevir, ribavirin, or ribavirin + PEG INF
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Must check for negative pregnancy test before initiation of this DAA drug____:
sofosbuvir
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MOA of Sofosbuvir:
Inhibits HCV NS5B
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Harvoni is combination of ______ and ____
Sofosbuvir and ledipasvir
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