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GI Final 3
Long Hep-C
| Question | Answer |
|---|---|
| Which OTC medications are frequently used in combo for mush and push and prevent OIC | Docucase (colace) and Senna (ex-lax) |
| which of the following meds is most likely to cause electrolyte abnormalities? A) methotrexate B) colace C) dulcolax D) vedolizumab | C) dulcolax (bisacodyl) --> remember that it's a stimulant and will push things through quickly, not allowing things to get absorbed. *remember that MTX causes hepatotoxicity; B is wrong bc its just a stool softener and won't cuase electrolyte abnormalities (but causes benzyl alohol toxicity in children <2) |
| T/F: When giving Cholestyramine, only give it to a pt not on any other medication due to DDI | True |
| HCV is dynamic meaning its always _______ | changing |
| What is one difference b/w Hepatitis C and Hepatitis B virus? | Hepatitis B has a vaccine whereas Hep C does not |
| How HCV transmitted? Other forms of transmission? | Via the blood, from mother to child or sexual transmission) |
| Hep C is a? | (blood borne RNA flavivirus; -targest hepatocytes --> acute +/- chronic inflammation that can lead to cirrhosis; *chronic inflammatio and fibrossis, you got cirrhosis |
| What are the risk factors for transmission of HCV? | IV drug use (makes up 60%); was a misnomer and thought to be 100% of the cause. Not everyone with the infection was via IV drug use. |
| Prior to 1992, there was a lack of _________ of medical equipment(i.e. dialysis machine, syringes); *no longer a risk | Sterilization (these werer uns-screened and pts would receivie bloood transfusions as well w/o being screened for pathogens or viruses and pts would freely contract HCV :)) |
| What is the most prevealent genotype in the US? | Genotype 1 (subtypes 1a, 1b, 2a, 2b, 3a) but genotype 1 for testing purposes |
| What is the disease course of HCV? | ***Exposure and incubation period (2 weeks to 6 months)***--> acute infection--> pt may be cured (15-25% of pts) OR acute leads to CHRONIC infection (75-85% of pts)--> Stable diseae (90% of chornicially infected pts) OR Cirrhosis (10% of chronically infected pts)--> Slow progression (75% of pts) OR HCC (Hepatocellular-carcinoma), death, liver transplant (25% of cirrhosis) |
| If a pt gets tested during the incubation period (prior to 6 months), will the test be (+) or (-)? | NEGATIVE *too soon to rule out or give comfort to pt; definite answer after 6 months if you have it or not |
| What is the recommendation for testing for HCV? | One-time routine, opt out HCV testing is recommended for ALL individuals aged 18 years or older; annual HCV testing is recommended for all persons who inject drugs, for HIV infected men who have unprotexted sex with men, and men who have sex with med taking pre-exposure prophylaxis (PrEP) |
| Which HCV medication class works at the inital part of the HCV life cycle? | NS3/4A inhibitors (rmemeber that 3 classes are organized numerically and alphabetically (NS3A/4A--> NS5A--> NS5B |
| Risk activities for HCV are? | IV and intranasal drugs use; Male engagement in sex with men, Engagement in chem sex |
| Risk Conditions for HCV are? | HIV or HBV infection sexually active and about to start PrEP for HIV unexplained chronic liver disease or hepatitis solid organ transplant donation and receipt |
| receipt of blood or an organ transplant before ____________ ______________ is considered a risk exposure | July 1992 -bc remember before this date, they didn't screen the blood to check for HCV |
| Risk of exposure to HCV include? | Hx of long-term Hemo-dialysis; parenteral exposures, Needlesticks, sharps, or mucosal exposure to HCV-infected blood; Birth by an HCV-infected woman; Receipt of blood from a donor who tested (+) fir HCV, received blood or organ transplant PRIOR to JULY 1992; receipt of clotting factor conc. before 1987; hx o f incarceration |
| Which of the following is the primary model of transmission of the Hep C virus? | BLOOD |
| how long could the time be b//w expsure to HCV and signs of an acute infection? | 6 months (maximum amount of time); remember that the minimal amount of time is 2 weeks |
| which of the following pts is LEAST at risk for transmission of the Hep C virus? -Frank (blood transfusion this morning) -Shannon (dialysis from a michine not sterilized) -Erick (just received a transplant from an HCV donor) -Bill (ilicict drug user) | Frank (who received a blood transfusion this morning) |
| What scenario would you see an antibody (+) but a (-) RNA negative? There is a difference to having antibiodies for hepatitis C and having active hepatitis C RNA, which is? | virus was cured but presence of antibodies that remember the virus; Hepatitis C RNA means you have active replicating particles; antibody means that your body has seen Hepatitis C in the past. |
| Testing for HCV: We test for the antibody and if it's negative, do we need to do anything | No, bc they don't have HCV and never have |
| Testing for HCV: If we test their antibody and it's positive, what does that mean | that person has seen HCV before and we need to check to see if they have it right now or was this something in the past *if we see it now, we see that it's RNA positive, that means we have a current infection and we need to treat them -if they don't have RNA (so it would say "hepatitis C RNA negative" --> that means they don't have a current infection |
| among persons with a negative HCV-antibody test who were exposed to HCV within the prior ______ months, HCV-RNA or follow-up HCV antibody testing 6 months or longer after exposure is recommended. HCV-RNA testing can also be considered for immunocompromised persons | 6 months |
| JJ is a 20 year old IV drug user that was determined to be HCV (-) and HIV (-) a little over 1 year ago. Should he be re-tested? | yes, if JJ is still using IV drugs, he should be tested on an annual basis |
| MM is a 60 year old female who is at her PCP's office for her annual checkup. She has never been tested for HCV before and has not yet been asked about her risk behaviors. Should she be tested for HCV | yes, all adults qualify for one-time HCV testing regardless of risk behavior |
| what are the goal of treatment for HCV? | cure (reduce all-cause mortality, ESLD, and HCC by achievement of virologic cure |
| when we say virologic cure, what are we referring to? | sustained virologic response (SVR) |
| what does sustained virologic response (SVR) mean? | you gave the pt a drug, the virus responded well to the drug (aka the virus died) and it was sustained/undetectable for 12 weeks following treatment cessation. 12 weeks starts after you treat them *sustained for12 weeks after tx stops to be considered sustained/undetectable--. after 12 weeks, we will test again, and if not seen, they are CURED |
| What are the major factors that affect Tx response? | Genotype; Commorbidities; Viral load; Mutations genotype 1 is the most difficult to treat and the strongest form of the virus (most prevalent in the US); viral load (amount of virus in the body); mutations are associated with resistance to tx (i.e. RAS( |
| major factors of Tx response with HCV: Comorbidities? | mainly talking about if the patient already has cirrhosis and if the cirrhosis is compensated or decompensated --> you will know if it's decompensated bc decompensation by definition is when they have the presence of at least one complication (ex: hepatic encephalopathy, ascites, hepatorenal syndrome, variceal bleeding, etc.) |
| Genotype 1 is the most ______ to tx and most ______ in the US | difficult; common |
| A lower viral load means better? | chance of tx response |
| What is considered ot be a "LOW VIRAL LOAD?" | <800,000 copies |
| Factors affecting Tx response: RAS stands for? | Resistance-Associated Substitution (its a mutation); there are substitutions in its genes that is a RAS mutation -this is bad if they have this bc it makes it harder to treat with certain medications |
| if we are going to use a drug that is impacted by RAS, what must we first do before using the drug | Test for RAS |
| if we are going to choose a different treatment where the RAS substitution doesn't make a difference, do we need to do the RAS test | NO (so only conducting the RAS test for drugs that are affected by RAS); mainly test for RAS with NS5A drugs* |
| Importance of testing for RAS: G1a + NS5A RAS leads to a ___-____ decrease in specific NS5A inhibitor activity | 5-fold (10-15% pf Gq tx naivie pts have detectable NS5A RASs |
| If we are not going to be using an NS5A inhibitor medication, do we still test for RAS? | No |
| how do we recommend treatment for hepatitis C | For ANYONE WHO IS HCV, acute or chronic unless they have an exception -If they have HCV, we are going to treat it unless they have an exception |
| What are the excetions to treating Hep C in a infected pt? | patients with short life expectancies not able to be remedied --> aka they will not survive OR if it's not a good time to treat them --> ie, if they are going to keep using IV drugs or if they are incarcerated |
| What are the benefits of cure (Hep C)? | decreased (inflammation of the liver--> improvement in complications of cirrhosis; decreaed progression rate of liver firbosis; decreased rate of hepatoceullar carcinoa, decreased need for liver transplantl liver-related mortality; insulin resistance; and increased QOL |
| when should pts be counseled about antiviral therapy initiation | Prior to initiation |
| Treatment initiation: Pts should be counseled prior to antiviral therapy initiation: | -importance of medication adherence and informing healthcare providers about medication changes |
| Treatment initiation: Recommended assessments PRIOR to antiviral therapy initaiton: let them know about? | Hepatic fibrosis staging AND potential drug interactions *we need to look at the liver before we start treatment bc some treatments cannot be used in liver impairment; and decompensated vs compensated cirrhosis will change treatment course) |
| AST, ALT, alkaline phosphatase, albumin, total and direct bilirubin lab tests should be done within ______ months prior to antiviral initiation | 6 months *want to get a CBC, INR, eGFR 6 months prior to initiation as well |
| which drug class should be avoided if the pt has decompensated liver disease | protease inhibitors --> the NS3/4 inhibitors; -the brown drugs; -no brown drugs in liver impairment |
| which of the following is not a factor that could affect treatment response? A) adherence B) RASs C) CM812G genetic polymorphism D) genotype E) viral load | CM812G genetic polymorphism |
| what are the 3 classes of direct-acting antiviral agents | NS3/4A inhibitors NS5A inhibitors NS5B inhibitors |
| which medications are NS3/4A inhibitors | "previr"; Grazoprevir; Glecaprevir; Voxilaprevir *These are the brown drugs; and CANNOT BE USED INN DECOMPENSATED CIRRHOSIS |
| Which medications are NS5A inhibitors? | "-asvir" Ledipasvir; Elbasvir; Velpatasvir ; Pibrentasvir *TEST for RAS with these medications |
| which medication is a NS5B inhibitor? | "buvir" Sofosbuvir (only medication in this class) |
| What is RAS? | Resistance associated substitution |
| A treatment-naive pt is? | they have never seen an HCV treatment before; this is the first time we are treating HCV; they have never been treated before |
| What would make pts ineligible for SIMPLIFIED tx for treatment-naive w/o cirrhosis? | -prior HCV treatment; -HBsAG+ ; -known or suspected HCC; -prior liver transplantation; -current pregnancy |
| For SIMPLIFIED treatment for treatment-naive patients without cirrhosis, what pre-treatment assessment needs to be done? | cirrhosis evaluation; -medication reconciliation; -DDI assessment; -pt education ; -lab testing |
| For SIMPLIFIED treatment for treatment-naive patients without cirrhosis, what are the 2 regimen options available and what is their duration | -Glecaprevir/Pibrentasvir --> 8 wks; -Sofosbuvir/Velpatasvir --> 12 weeks; ***remember that pts with decompensated cirrhosis cannot take Glecaprevir/Pibrentasvir --> 8 wks due to the Glecaprevir (brown drug) |
| For SIMPLIFIED treatment for treatment-naive patients with compensated cirrhosis, what would make them ineligible for this tx? | current/prior episode of decompensated cirrhosis (CTP score > 7); -ESRD (eGFR < 30) |
| For SIMPLIFIED treatment for treatment-naive patients with Compensated Cirrhosis? | Cirrhosis evaluation/CTP score; medication reconciliation; drug-drug interaction assessment; pt education; laboratory testing |
| or SIMPLIFIED treatment for treatment-naive patients with compensated cirrhosis, what are the 2 regimen options available and what is their duration? | Genotype 1-6: *Glecaprevir/Pibrentasvir --> 8 wks; Genotype 1, 2, 4, 5, or 6 or 3 if w/o Y93H RAS: *Sofosbuvir/Velpatasvir --> 12 weeks |
| which of the following medications is an NS5B inhibitor? A) Ledipasvir B) Glecaprevir C) Sofosbuvir D) Velpatasvir | Sofosbuvir |
| which of the following is a "simplified treatment regimen"? A) Elbasvir/grazoprevir x 8 weeks B) ledipasvir/sofosbuvir x 8 weeks C) sofosbuvir/velpatasvir x 8 weeks D) glecaprevir/pibrentasvir x 8 weeks E) None | glecaprevir/pibrentasvir x 8 weeks |
| for patients that are treatment-naive G1a with NO cirrhosis, what are the treatments options | Glecaprevir/pibrentasvir x 8 weeks; Sofosbuvir/velpatasvir x 12 weeks; Ledipasvir/sofosbuvir x 12 weeks; Ledipasvir/sofosbuvir x 8 weeks; **for pts who are HIV-unaffected and whose HCV RNA level is < 6 million (aka very low). If a pt has HIB, they will need Ledipasvir/Sofosbuvir x 12 weeks |
| for patients that are treatment-naive G1a with COMPENSATED cirrhosis, what are the treatments options: | Glecaprevir/pibrentasvir x 8 weeks; Sofosbuvir/velpatasvir x 12 weeks; Ledipasvir/sofosbuvir x 12 weeks; *no option for an 8 wk treatment of Ledipasvir/Sofosbuvir like how it is for treatment-naive G1a with NO cirrhosis pts |
| Besides glecaprevir/pibrentasvar, how long should most treatment-naive G1a patients receive treatment? A) 8 weeks B) 12 weeks C) 16 weeks D) 24 weeks E) none of the above | 12 weeks |
| for patients that are treatment-naive G1b with NO cirrhosis, what are the treatments options? | Glecaprevir/pibrentasvir x 8 weeks; Sofosbuvir/velpatasvir x 12 weeks; Ledipasvir/sofosbuvir x 12 weeks; Ledipasvir/sofosbuvir x 8 weeks; *for pts who are HIV-unaffected and whose HCV RNA level is < 6 million (aka very low); **Elbasvir/grazoprevir x 12 weeks; **same as treatment-naive G1a with NO cirrhosis just adding on the last line |
| for patients that are treatment-naive G1b with COMPENSATED cirrhosis, what are the treatments options | Glecaprevir/pibrentasvir x 8 weeks; Sofosbuvir/velpatasvir x 12 weeks; Ledipasvir/sofosbuvir x 12 weeks; ***no option for an 8 week treatment of Ledipasvir/sofosbuvir like how it is for treatment-naive G1a with NO cirrhosis patients Elbasvir/grazoprevir x 12 weeks; -the top 3 are the same as treatment-naive G1a with COMPENSATED cirrhosis but here we are just adding in Elbasvir/grazoprevir x 12 weeks |
| for patients with decompensated cirrhosis that can tolerate ribavirin, what do we give | sofosbuvir/velpatasvir/ribavirin x 12 weeks or ledipasvir/sofosbuvir/ribavirin x 12 weeks **ie, with decompensated cirrhosis, they have a lot of damage and the virus is strong so we need to add a 3rd drug |
| for patients with decompensated cirrhosis that cannot tolerate ribavirin, what do we give | sofosbuvir/velpatasvir x 24 weeks or ledipasvir/sofosbuvir x 24 weeks ***basically same as those that can tolerate ribavirin but just removing ribavirin from the combo and doubling the duration |
| patients with decompensated cirrhosis should not receive what 2 things | 1. any protease inhibitor-containing regimen (eg, glecaprevir, grazoprevir, and voxilaprevir); 2. interferon-based regimens bc they can't tolerate the ADRs -we wouldn't do this anyone bc we don't give interferon to anyone ever |
| in which of the following pts would you want to avoid NS5A inhibitors? A) melanie: genotype 5 and CC IL28C polymorphism B) nick: genotype 1 and NS5A RAS C) john: genotype 2 and a high viral load D) joe: genotype 3 and african american | B) nick: genotype 1 and NS5A RAS -this means they have NS5A resistance so we are not going to an NS5A inhibitor -remember that NS5A drugs end in -asvir |
| for treatment experienced: if a patient has ever had anything sofosbuvir based or elbasvir/grazoprevir, what will they get **ie, treatment failure of these meds above | Sofosbuvir/Velpatsavir/Voxilaprevir x 12 weeks |
| for treatment experienced: if a pt had glecaprevir/pibrentasvir treatment failure, what are the options | glecaprevir/pibrentasvir/ribavirin x 16 weeks sofosbuvir/velpatasvir/voxilaprevir x 12 weeks **for pts with compensated cirrhosis, addition of ribavirin is recommended x 12 weeks |
| for treatment experienced: for pts with decompensated cirrhosis and genotype 1-6 infection in whom prior sofosbuvir or NS5A inhibitor treatment failed, what are the options | 1. prior sofosbuvir/based treatment failure: ledipasvir/sofosbuvir/ribavirin x 24 weeks 2. sofosbuvir/velpatasvir/ribavirin x 24 weeks |
| which of the following patients can receive HCV treatment for 8 weeks? -paulo: tx naive pt with G1a and no cirrhosis who is prescribed sofo/velpat -Rhea: tx naive pt with G1a and compensated cirrhosis who is prescribed ledipasvir/sofosbuvir -Christina, a tx naive pt with G1b and no cirrhosis who is prescribed glecaprevir/pibrentasvir -Sarah, a tx naive pt with G1b and decompensated cirrhosis who is prescribed glecaprevir/pibrentasvir | C) christina, a treatment-naive patient with G1b and no cirrhosis who is prescribed glecaprevir/pibrentasvir |
| testing for acutely infected patients: if you have a patient that is acutely infected (is not a chronic HCV case; recently got HCV) what do we not do | we do not give them pre-exposure or post-exposure prophylaxis with antiviral therapy in HCV (this is only in HIV) |
| recommendations for medical management and monitoring of acute HCV infection: 1. after the initial diagnosis of acute HCV with viremia (defined as quantifiable RNA), HCV treatment should or should not be initiated? | SHOULD be initiated w/o awaiting spontaneous resolution |
| recommendations for medical management and monitoring of acute HCV infection: 2 counseling is recommended for pts with acute HCV infection to avoid ___________________ insults, including hepatotoxic drugs | 2. hepatotoxic -ex: methotrexate -so while we are waiting, we will not give them hepatotoxic drugs |
| what is the generic of Mavyret? | Glecaprevir and Pibrentasivr |
| what are the contraindications of Mavyret (Glecaprevir and Pibrentasivr)? | Contraindicated: in hepatic dysfunction (child pugh class B or C) or history of decompensation (bc it contains a -previr in the combo) Contraindicated: When administered with azataznavir or rifampin |
| can we use mavyret in compensated? MUST test for NS5A _____ | yes; resistance; -remember we used it for peach and yoshi |
| are there a little or lot of DDIs with Mavyret? | a lot (p-Gp, OATP1B1/3, UGT1A1) |
| what are the ADRs of Mavyret (glevaprevir andpibrentasvir)? | elevated LFTs HA fatigue nasea |
| what is the brand name of elbasvir and grazoprevir? | zepatier |
| what are the contraindications of zepatier? | Contraindicated: in hepatic dysfunction (child pugh class B or C) or history of decompensation (bc it contains a -previr in the combo) Contraindicated: When administered with azataznavir or rifampin (bc it contains a brown drug); AE: includes elevated LFts, HA, fatigue, and nausea |
| what is the brand name of sofosbuvir and velpatasvir? *this drug can be chosen with someone with liver problems (no brown drug) | Epclusa |
| what are the interactions of epclusa? | Amiodarone: increased risk of bradycardia; -Antacids: decrease velpatasvir concentration (separate administration by > 4 hrs)*** |
| what testing should be done prior to use of (Sofosbuvir and Velpatasvir) epclusa | NS5A resistance testing prior to initiation |
| what are the adverse effects of epclusa | HA; fatigue; irritability; insomnia; increased lipase; weakness |
| what is the brand name of Ledipasvir and Sofosbuvir? | Harvoni |
| what are the drug interaction of (Ledipasvir and Sofosbuvir) Harvoni? | Amiodarone: increased risk of bradycardia; -Antacids: decrease Ledipasvir concentration (separate administration by > 4 hrs)**** |
| what kind of testing is done prior to initiation of (Ledipasvir and Sofosbuvir) Harvoni? | NS5A resistance testing due to the -asvir component |
| what are the ADRs of harvoni | HA; fatigue; irritability; insomnia; increased lipase; weakness |
| what is the brand name of Sofosbuvir + Velpatasvir + voxilaprevir? | Vosevi *only drug that has Voxilaprevir |
| what are the DDIs of vosevi? | Amiodarone: increased risk of bradycardia; Antacids: decrease velpatasvir concentration (separate administration by > 4 hrs)*** |
| what is vosevi contraindicated with? | Rifampin; NS5A resistance so testing required prior to initiation of Vosevi (Sofosbuvir/Velpatasvir/Voxilaprevir) |
| what are the ADRs of vosevi | HA; Fatigue; Diarrhea; Nausea; Insomnia; Avoid use in hepatic dysfunction (Child Pugh classes B or C) or hx of decompensation |
| which of the following is FALSE about zepatier? A) it interacts with many medications B) it should be taken with food C) it is contraindicated in hepatic dysfunction D) it can cause elevated LFTs and HA | should be taken with food |
| which medication do you AVOID USING MONOTHERAPY? | Ribaverin *nucleoside analog: inhibis replication of RNA and DNA viruses) and has poor tolerability. Must be added to regiment to increase SVR if high risk of tx failure (Avoid using as monotherapy) |
| What is the brand name of Ribaverin? | Copegus |
| who can you NOT use ribavirin (copegus) in? | renal dysfunction (CrCl < 50); significant cardiac disease; pulmonary diesease; autoimmune disease/severe infection; psychiatric history; elderly and pediatric pts; elderly and pediatric pts |
| what do you avoid using ribavirin with? | Azathioprine****; *nned to know to give eye exams, and this drug can cause dental, periodontal disorder, severe dermatologic rxns |
| What are the BBW of Ribaverin? | not effective monotherapy for HCV; hemolytic anemia; **teratogenic (contraception during and for 6 months after tx) hemolytic anemia teratogenic ("contraception during ad for 6 months after treatment") |
| what is the dosing of Ribaverin? | Start at a low dose to see if they can tolerate it. 600 mg daily. *increase as tolerated to max of weight-based dose |
| 60 mg daily for Ribaverin should be increased to tolerable max of WEIGHT-BASED dosing. If <75 kg dose? If >75kg? | <75 kg--> 1000 mg daily in 2 divided doses >/=75 kg--> 1200 mg daily in 2 divided doses *dosed adjustment for toxicity; *can re-trial at 600 mg daily in divded doses of 200 mg/ 400mg; can increase to 800 mg daily, but avoid increasing to original dose; ***permanently DC if WBC <1000, platelets <25, and Hgb < 8.5 |
| Which meds must be taken with food? | Ribavirin; Mavyret; and Vosevi |
| When do you permanently D/c ribavirin? | permanently d/c if WBC < 1000; platelets < 25; Hgb < 8.5 *can be any of these to D/C |
| When would we use Ribavirin (RBV;Copegus)? | Baseline NS5A RAS; Decompensated cirrhosis; Prior DAA treatment failure |
| Sonic the Hedgehog has HTN and class C cirrhosis from HCV. Which of the following tx is the best option for him? -Gleaprevir/Pibrentasvir -Sofosbuvir/ledipasvir -Sofosbuvir/velpatasvir/voxilaprevir -Elbasvir/Grazoprevir -none | Class C--> decompensated (cant get anything with -previr |
| Boxed warning for anyone that las latent Hepatitis B, when we treat their Hepatitis C, theres a high liklihood that the Hep B will? | start to cause problems; So before they start HCV treament with DAAs (direct acting antiviral), assess for HBV co-infection so we monitor for viral load |
| February 2020: DAA safety alert: When we treated pts for HCV--> we saw mainly _________ | hypoglycemia (liver helps to balance glucose (stores as glycogen) *must counsel pt on glucose checks |
| Which of the following pts should have ribavirin as part of their HCV treatment regimen? | Gonzo muppet, who has HCV and an NS5A RAS *can't give if CrCl <50; CI with Azathiprine and CI in pediatrics and elderly |
| Monitor during Antiviral Therapy: ALT--> If >/= 10-fold increase in ALT? <10-fold increase + symptoms--> d/c therapy; if <10-fold increase _ asymptommatic --> repeat testing every ___ _____ | discontinue therapy; 2 weeks |
| Monitoring during Antiviral therapy: HCV viral load(>/= 12 weeks after completion to document _______ | SVR (Sustained Viral response for CURE) |
| Monitoring during Antiviral therapy: Hepatic functuion panel if receiving what drug? CBC if receiving ______ (as clinically indicated) | Zepatier (elbasvir/grazoprevir) (weeks 8 and 12); Ribavirin (check for WBC, Platelet, Hgb) |
| Monitoring during Antiviral therapy: HBV DNA levels check _____. If low/undetectable--> prophylaxis until 12 weeks after DAA _____. If greater than 10-fold increase above baseline or to >1000 IU/mL from undetectable--> _____ ______ | monthly; completed; HBV treatment *educate on pt adherence, AE (hypoglycemia); and medication interactions (subtherapeutic INR if taking Warfarin |
| Monitor if Achieve SVR (pt is cured)--> If cirrhotic, we still check for? | HCC screening with ultrasound; upper endoscopic screening for varices |
| Monitor if Achieve SVR (pt is cured)--> If unexplained hepatic dysfunction or persistently abnormal liver tests--> | -Quantitative HCV RNA to assess for recurrence; -Assessment of other causes of liver disease *make sure it hasn't reoccurred |
| Monitor if Achieve SVR (pt is cured)-->If ongoing risk for HCV infection--> | Quantitative HCV RNA (annually) |
| Monitor if Achieve SVR (pt is cured)--> If not cirrhotic and no hepatic dysfunction-->then | No additonal follow up |
| Monitoring IF DO NOT ACHIEVE SVR--> Assessment of disease progression every ___-_____ months | 6-12 *check Hepatic functional panel, CBC, INR |
| Monitoring IF DO NOT ACHIEVE SVR--> | -HCC screening with liver ultrasound every 6 months -Upper endoscopic screening for varices |
| which of the following pts would you want to get a CBC? | treatment naive pt receving Epclusa and ribavirin |
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