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Hepatitis B/C
Non-antiretroviral agents
Question | Answer |
---|---|
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 |