1
Q
- Hep C is the most common ____
- Commonly associated w/ which 3 things?
A
- blood-borne pathogen
- IVDU
- Renal dialysis
- Body piercing, tattoos
2
Q
- ___ nature of acute infections
- ___ to ___ year disease progression
A
- silent
- 20-30
3
Q
What are the 2 most common genotypes of Hep C?
A
- Genotype 1a and 1b
4
Q
Treatment regimens for Hep C are usually __ to ___ weeks
A
- 6 to 24 weeks
5
Q
Hep C virus uses what to replicate?
A
Healthy cells
6
Q
What drugs are these?
- BoceprEVIR
- GlecaprEVIR
- GrazoprEVIR
A
NS3/4A Protease Inhibitors
7
Q
What drugs are these?
- DaclatASVIR
- ElbASVIR
- LedipASVIR
A
NS5A Inhibitors
8
Q
What drugs are these?
- DasaBUVIR
- SofoBUVIR
A
NS5B Polymerase Inhibitors
9
Q
What category?
- Sofosbuvir
A
NS5B Nucleoside Polymerase Inhibitor
10
Q
Which category?
- Dasabuvir
- Beclabuvir
A
NS5B Non-Nucleoside Polymerase Inhibitors
11
Q
Which category?
- Daclatasvir
- Ledipasvir
- Ombitasvir
- Elbasvir
- Velpatasvir
- Pibrentasvir
A
NS5A Inhibitors: replication complex inhibitor
12
Q
NS3/4A Protease Inhibitors: inhibits ___ replication directly binding to the NS3/4A protease that cleaves HCV - encoded polyproteins
A
HCV
13
Q
Which 2 HCV meds have been discontinued?
A
- Boceprevir
- Telaprevir
14
Q
What 2 lab tests are recommended at any time prior to starting antiviral therapy?
A
- HCV genotype and subtype
- Quantitative HCV RNA (HCV viral load)
15
Q
What 4 lab tests are recommended within 12 weeks prior to starting antiviral therapy?
A
- CBC - complete blood count
- INR - international normalized ratio
- Hepatic function panel (ALT & AST)
- Calculated glomerular filtration rate (eGFR)
16
Q
Pts w/ current or prior hx of ____ or w/ a current CTP score of 7 or greater should NOT receive tx w/ regiments that contain ____ protease inhibitors due to increased blood levels / lack of safety data
A
- decompensated liver disease
- NS3
17
Q
All patients initiating HCV direct acting antiviral (DAA) therapy should be assessed for ______ w/ HBsAg testing and for evidence of ____ w/ anti-HBs and anti-HBc testing
A
- HBV coinfection
- prior infection
18
Q
What 3 tests are recommended after 4 weeks of tx and as clinically indicated?
A
- CBC
- Creatinine level
- calculated eGFR
- Hepatic function panel
19
Q
Patients receiving _____/_____ should be monitored with a hepatic function panel at 8 weeks and again at 12 weeks if receiving 16 weeks of tx
A
Elbasvir / Grazoprevir
20
Q
A 10-fold increase in ____ activity at any time during tx should prompt discontinuation of therapy
A
alanine aminotransferase (ALT)
21
Q
An increase in ALT <10-fold that is accompanied by what 7 things should also prompt discontinution of therapy?
A
- weakness
- nausea
- vomiting
- jaundice
- significantly increased bilirubin
- increased alkaline phosphatatse
- increased INR
22
Q
Asymptomatic increases in ALT <10-fold should be closely monitored w/ repeat testing at ___ week intervals. If levels remain persistently elevated, consideration should be given to discontinue therapy
A
2
23
Q
Which part of Hep C Virus Lifecycle?
- NS5A inhibitors
- Ledipasvir
- Ombitasvir
- Daclatasvir
- Elbasvir
A
- Viral Assembly
- Transport & Release
24
Q
Which part of the Hep C Virus Lifecycle?
- NS5B Polymerase inhibitors
- Dasubuvir
- Sofosbuvir
A
RNA replication
25
**Which part of the Hep C Virus Lifecycle?**
* _NS3/4A protease inhibitors_
* Telaprevir
* Boceprevir
* Simeprevir
Polyprotein processing
26
**Which Box Warning?**
* Must not be taken by pregnant women or the male partners of pregnant women
* Teatogenic / emryocidal effects
* Extreme care must be taken to avoid pregnancy during treatment and for six months following treatment in both female patients and female partners of male patients who are taking ribavirin
* Use two forms of birth control during this period
Example, a man could use a condom and a woman could use a diaphragm or birth control pills
Ribavirin
27
**Which box warning?**
* Protease inhibitors interfere with hormonal birth control
* Birth control pills
* Uterine implants
* Depo-Provera injections
* Vaginal rings
* Use two non-hormonal forms of birth control
* Example: a condom and diaphragm plus spermicidal jelly
Simprevir (Olysio)
28
**Which drug?**
* only given with ribavirin in cases of decompensated (advanced) cirrhosis.
* Recommended dosage: One tablet (sofosbuvir 400 mg/velpatasvir 100 mg) taken orally once daily with or without food.
* Length of treatment is 12 weeks.
* The most common side effects are headache and fatigue.
* When given with ribavirin, the most common side effects include headache, fatigue, nausea, diarrhea, insomnia and anemia.
Epclusa
29
**Which drug?**
* Recommended dosage: Three tablets (glecaprevir 100 mg/pibrentasvir 40 mg) taken orally once daily with food
* Length of treatment is 8, 12 or 16 weeks depended on genotype, previous HCV treatment experience and having compensated cirrhosis.
* The most common side effects are headache and fatigue.
**Mavyret** (glecaprevir & pibrentasvir)
30
**Which drug?**
* Recommended dosage: One tablet (400 mg of sofosbuvir, 100 mg of velpatasvir, and 100 mg of voxilapresvir) taken orally once daily with food.
* Length of treatment is 12 weeks for patients without cirrhosis and patients with compensated cirrhosis.
* The common side effects for Vosevi include headache, tiredness, diarrhea, and nausea.
**Vosevi** (sofosbuvir/velpatasvir/voxilapresvir tablet)
31
What are the 3 "PAN-GENOTYPIC MEDICATIONS" which treat all genotypes?
* Epclusa
* Mavyret
* Vosevi
32
**Drug interactions of which drug?**
* Increased levels of Amiodarone --\> bradycardia\*
* Increased levels of statin medication (e.g., atorvastatin, rosuvastatin)
* Decreased efficacy with concomitant rifampin ( Rifadin, Rifamate, Rifater, Rimactane), **St. John’s wort\***
**Epclusa** (Sofosbuvir / Velpatasvir)
33
**Drug interactions of what drug?**
* AED --\> decrease level of sofosbuvir\*
* Carbamazepine, oxcarbazepine, phenobarbital, primidone
* Proton pump inhibitors of H2 blockers decrease the level of Epclusa
* Take antacids containing aluminum or magnesium hydroxide fours hours before or fours hours Epclusa.
* Drug interaction issues with some of the medications used to treat HIV\*
**Epclusa** (Sofosbuvir / Velpatasvir)
34
**Drug interactions of what drug?**
* Taking other drugs including with atazanavir or rifampin at the same time as Mavyret.
* Taking these medications can reduce the success of the medication
* Digoxin treat heartbeat irregularities, at the same time as Mavyret.
* Increased levels of statin medication (e.g., atorvastatin, rosuvastatin)
* Decreased efficacy with concomitant rifampin ( Rifadin, Rifamate, Rifater, Rimactane), St. John’s wort
**Mavyret** (Glecaprevir & Pibrentasvir)
35
**Drug interactions of what drug?**
* AED --\> decrease level of sofosbuvir
* Carbamazepine, oxcarbazepine, phenobarbital, primidone
* Oral contraceptives at the same time as Mavyret can increase ALT levels and is not recommended
* Drug interaction issues with some of the medications used to treat HIV
* Not recommended for those taking immunosuppressants such as Cyclosporine on a daily basis.
**Mavyret** (Glecaprevir & Pibrentasvir)
36
**Which drug?**
* Increased levels of Amiodarone à bradycardia
* Increased levels of statin medication (e.g., atorvastatin, rosuvastatin)
* Decreased efficacy with concomitant rifampin ( Rifadin, Rifamate, Rifater, Rimactane), St. John’s wort
* AED à decrease level of sofosbuvir
* Carbamazepine, oxcarbazepine, phenobarbital, primidone
**Vosevi** (Sofosbuvir / Velpastavir / Voxilaprevir)
37
What 6 medications are Genotype Specific for HCV Genotype 1?
* **Daklinza** w/ Sovaldi sometimes given w/ Ribavirin
* **Harvoni** sometimes given w/ Ribavirin
* **Olysio** plus Sovaldi sometimes given w/ Ribavirin
* **Kiekira Pak**
* **Viekira XR**
* **Zepatier**
38
**Which drug for HCV Genotype 1?**
_ADE:_
* fatigue
* HA
* Nausea
* anemia
Daklinza
39
**Which drug for HCV Genotype 1?**
_ADE:_
* **Tx for 8, 12, or 24 weeks:** fatigue, HA, neuromuscular/skeletal weakness
* **When given w/ ribavirin:** weakness, HA, cough
* **Harvoni**
"The breakthrough drug"
40
**Which drug for HCV Genotype 1?**
_ADE:_
* Tx for 12 weeks w/ combo therapy: fatigue, HA, nausea, insomnia, itching, rash, photosensitivity
* Tx for 24 weeks: all above + dizziness & diarrhea
Olysio plus Sovaldi
41
**ADEs of which HCV Genotype 1 drug?**
* w/o Ribavirin: nausea, itching, sleep problems
* w/ Ribavirin: tiredness, nausea, itching, sleep problems, feeling weak, skin rxns such as redness or rash
Viekira Pak
42
**ADEs of which HCV Genotype 1 drug?**
* Length of tx is 12 weeks (w/ cirrhosis)
* Lenght of tx if 24 weeks (w/ compensated cirrhosis)
* W/o ribavirin: nausea, itching, sleep problems
* W/ Ribavirin: tiredness, nausea, itching, sleep problems, feeling weak, skin rxns such as redness and rash
Viekira XR
43
**ADEs of which HCV Genotype 1 drug?**
* W/o Ribavirin: fatigue, HA, nausea
* W/ Ribavirin: anemia, HA, fatigue, SOB, rash, itching
Zepatier
44
Which medication is genotype specific for HCV Genotype 2?
**Sovaldi** (sofosbuvir + ribavirin)
45
What are the 2 ADEs of Sovaldi + Ribavirin (Genotype 2)?
* Fatigue & Headache
46
* What are the 2 medications genotype specific for HCV Genotype 3?
* What are their 2 side effects?
* Daklinza with Sovaldi
* Sovaldi + Ribavirin
* Fatigue and HA
47
What 4 medications are Genotype 4?
* Harvoni
* Sovaldi
* Technivie
* Zepatier
48
**ADEs of which HCV Genotype 4?**
* Fatigue & HA
* w/ Ribavirin: weakness, HA, cough
Harvoni
49
**ADEs of which HCV Genotype 4?**
* Fatigue & HA
Sovaldi + Ribavirin
50
**ADEs of which HCV Genotype 4?**
* w/ Ribavirin: fatigue, nausea, sleep problems, feeling weak, itching/redness/rash
Technivie
51
**ADEs of which HCV Genotype 4?**
* w/o Ribavirin: fatigue, HA, nausea
* w/ ribavirin: anemia, HA, fatigue, SOB, rash/itching
Zepatier
52
Genotype 5 drug
SE?
Harvoni
Fatigue & HA
53
Genotype 6 drug?
SE?
**Harvoni**
Fatigue & HA
54
**Hep B Vaccine prior to tx**
* New anti-viral therapies can ____ .
* Hep B vaccine prior to starting tx
* May also need ____ vaccine.
* re-activate past Hep B
* Hep A vaccine
55
Don't give _____ for Hep C related pain
Tylenol
