P3 Therapeutics Test 2 Hep B Treatment

Front 1

what are the goals of HBV therapy

Back 1

suppress HBV replication and increase chances of seroconversion

prevent progression to cirrhosis, hepatocellular carcinoma

minimize further liver damage in pt with ongoing liver damage

Front 2

what therapeutic response are we looking for in HBV therapty

Back 2

normalized AST/ALT levels (means no viral turnover)
undetectable serum HBV-DNA
seroconversion (HBeAg negative, HBeAb positive)

Front 3

why is it difficult to treat a pt that does not have HBeAg

Back 3

can no longer use seroconversion as a response to treatment

Front 4

what are the treatment goals in pt that are HBeAg negative

Back 4

normalization of ALT/AST
suppression of HBV-DNA
delay or improvement in degree of liver injury

Front 5

****what are two situation in which HBV treatment would be indicated

Back 5

elevated ALT/AST (2x upper limit of normal)

normal AST/ALT but pt has known histologic disease

Front 6

what do you do if pt is HBeAg negative

Back 6

monitor for increase in AST/ALT levels

Front 7

what do you do if pt is HBeAg positive

Back 7

check HBV-DNA

IF INCREASED (>2000) - do liver biopsy > TREAT IF HISTORY OF HISTOLOGIC DISEASE (even in AST/ALT normal)

if decreased (<2000) - monitor

Front 8

what is the MOA of interferon

Back 8

acts as host cytokine, antiproliferative, antiviral effects

Front 9

why are you able to tx pt over and over with IFN a2b

Back 9

no resistance

Front 10

what are factors associated with improved response w/ interferon a2b use

Back 10

elevated ALT/AST
higher HBV-DNA levels
non asian (asians tend to have normal AST/ALT levels)

Front 11

what are AE of IFN a2b

Back 11

flu like symptoms
bone marrow suppression
depression, anxiety
thyroid dysfunction
MAY PROVOKE HEPATIC FLARES AND PRECIPITATE HEPATIC DECOMPENSATION

Front 12

what must you screen a pt for first before giving the IFN a2b

Back 12

depression

Front 13

who can IFN a2b/Peg-IFN NEVER be given to

Back 13

pt with decompensated cirrhosis (hepatic encephalopathy, severe ascites, etc)

Front 14

what is the advantages of Peg-IFN over IFN a2b

Back 14

PEG IFN
-longer half life (given weekly instead of triweekly)
-increased viral clearance

Front 15

what are AE of Peg-IFN

Back 15

flu like symptoms
risk of bone marrow depression
depression

Front 16

what drug can treat HBV and HIV

Back 16

lamivudine (3TC)

Front 17

how long is the duration of therapy of Lamivudine (3TC)

Back 17

1 year minimum

Front 18

what is the MOA of limivudine (3TC)

Back 18

cytodine analog that inserts into viral DNA and causes chain termination

Front 19

what is a major draw back of lamivudine

Back 19

RAPID DEVELOPMENT OF RESISTANCE (increases with each year of therapy)

Front 20

what can be given to decrease the resistance to Lamivudine

Back 20

Peg-IFN

Front 21

what kind of analog is Adefovir

Back 21

adenosine

Front 22

what kind of analog is Tenofovir

Back 22

adenosine

Front 23

what kind of analog is Entecavir

Back 23

guanosine

Front 24

what kind of analog is Telbivudine

Back 24

thymidine

Front 25

what are the general AE of the DNA polymerase inhibitors

Back 25

lactic acidosis

Front 26

what is the MOA of tenofovir, adefovir, entecavir, telbivudine

Back 26

inhibit DNA polymerase

Front 27

what are AE of adofovir, tenofovir

Back 27

renal toxicity

Front 28

what drug can't be given to pt with renal failure

Back 28

tenofovir
adefovir

Front 29

what are AE of entecavir

Back 29

anaphylactoid reaction

Front 30

what are AE of Telbivudine

Back 30

peripheral neuropathy
increased number of upper respiratory infection

Front 31

if pt is resistant to adofovir what can we NOT give them

Back 31

tenofovir

Front 32

if pt is resistance to entecavir what can we NOT give them

Back 32

lamivudine (3TC)

Front 33

if pt is resistant to telbivudine what can we NOT give them

Back 33

lamivudine (highly resistant)

Front 34

if pt is resistant to tenofovir what can we not give them

Back 34

adefovir

Front 35

what is preferred 1st line treatment for HBV

Back 35

tenofovir
entacavir

decrease HBV-DNA the best

Front 36

what is the duration of nucleoside therapy

Back 36

at least (whichever is longer)
-1 year
-add 6 months following seroconversion
-if no seroconversion, but HBV-DNA suppression, CONTINUE TX

Front 37

why would HBeAg negative pt require indefinite treatment with nucleosides

Back 37

not sure how long to treat for since no marker for seroconversion, but continue tx as long as suppressing viral load (HBV-DNA)