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Hepatitis B/C

Non-antiretroviral agents

QuestionAnswer
Hepatitis B/C blood borne pathogens, infects and replicates in hepatocytes of the liver
Hepatitis B 47mm DNA virus, incubation: 60-180 days, Route: parenteral, sexual; insidious onset, positive carrier, severe/prolonged/chronic; can lead to chronic hepatitis, any age affected, hygiene/HBV vaccine
Hepatitis C 30-60mm RNA virus, 35-72 days incubation, parenteral route, insidious, positive, mild to severe, any age affected, can lead to chronic hepatitis, hygiene/novaccination/screen blood/interferon alpha or combo w/ribavirin
Lamivudine, entecavir, telbivudine, adefovir, tenofovir (ALL INHIBIT HBV DNA POLYMERASE), interferon alpha treatment of hepatitis B (SUPPRESSIVE)
interferon (alpha), ribavirin, protease inhibitors treatment of hepatitis C (CURATIVE W/ COMBO THERAPY)
Lamivudine treat HBV, 17-19 hrs, inhibit HBV DNA polymerase and HIV RT, cross-resistance (high level), HA/NVD/dizziness, co-infection with HIV may increase risk of pancreatitis
All hepatitis treatment inhibit what? inhibit hepatitis (B/C) DNA polymerase
Telbivudine treat HBV, needs to be phosphylorated (activated), unaffected by food, renal excreted, 15 hrs, upper resp infection, HA, abdpain, NVD, lactic acidosis, liver problems
Tenofovir similar structure to adefovir, but significantly better rate of response treat HBV, decrease activity against adefovir-resistant strains, maintains activity against lamivudine and entecavir-resistant hepatitis virus isolates
Entecavir treat HBV, PO, decrease by food-empty stomach, kidneys excreted, 15 hrs, HA/NVD/fatigue/dizziness, decreased renal fxn and increase drug when co-administered,
Adefovir dipivoxil treat HBV, ester prodrug of adefovir, needs to be activated, active in vitro DNA/RNA viruses (HBV,HIV,HSV), unaffected by meals, 5-18 hrs, renal excreted, no cross resistance with lamivudine, HA/NVD/asthenia/abdpain,
greater the mutation of virus equals greater the resistance of virus to medication
Interferon alpha potent, protein, less side effects when produced in low levels, at high levels lots of SE, SC/IM for HBV/HCV, no PO
Pegylated interferon increase oral absorption, linked to polyethylene glycol chain covalently to reduce clearance/dosing (1x/week), increase half-life; better tolerated than interferon
Mechanism of action of Interferons inhibits: transcription, translation, post-translational processing, virus maturation, viral release causing membrane changes which blocks budding
Interferons side effects flu-like, thrombocytopenia, granulocytopenia,fatigue, NVD, HA, anorexia, rash, arthralgia, psych effects, increase serum aminotransferase levels
Interferon contraindications psychosis, depression, seizures, neutropenia, thrombocytopenia, severe cirrhosis, pregnancy-fetal loss (pts w/pysch, thyroid, cardiac, renal insuff)
Ribavirin interfere w/synthesis of GTP(guanosine triphosphate) to inhibit capping of viral mRNA (processing) and RNA polymerase; broad spectrum: influenza (A/B), HCV/HIV/RSV/parainfluenza; kidneys excreted, decrease w/antacids,high fat meals
treats RSV (respiratory syncytial virus) via nebulizer (aerosolized), PG X, combo w/interferon for HCV Ribravin
Side effects of Ribravin fatigue, HA, insomnia, hemolytic anemia, depression, rash, irritability, cough, nausea, pruritus
Contraindications to Ribravin anemia, ESRF, ischemic vascular disease, pregnancy - instruct pt not to conceive children at least 6 months after tx
Teleprevir & Boceprevir HCV Protease inhibitors
Viral Protease modify viral PRO to produce, mature, functional virus for release
HCV Protease inhibitors used as part of triple therapy (pegylated interferon + ribavirin + protease inhibitor; sustained virologic response to HCV increases w/triple therapy
HCV Protease inhibitors side effects fatigue, anemia, nausea
SVR (sustained virologic response) absence of detectable viremia for 6 months after completion of therapy
Created by: cburrows
 

 



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