Download Drug Induced Liver Disease Tutoring

HEPATITIS TUTORING PART 2
BY ALAINA DARBY
BK is a 62 yo WM who presents to you complaining of abdominal
pain and dark urine. He is determined to have HCV genotype 1
and is started on peginterferon + ribavirin. When should you
assess therapy?
a.
b.
c.
d.
4 weeks
12 weeks
24 weeks
48 weeks
BK is a 62 yo WM who presents to you complaining of abdominal
pain and dark urine. He is determined to have HCV genotype 1
and is started on peginterferon + ribavirin. At 12 weeks, he has the
targeted virological response. What is the shortest duration for
therapy to be continued?
a.
b.
c.
d.
4 weeks
12 weeks
24 weeks
48 weeks
BK is a 62 yo WM who presents to you complaining of abdominal
pain and dark urine. He is determined to have HCV genotype 1
and is started on peginterferon + ribavirin. Which of the following
DAA’s would be most likely included with this regimen?
a.
b.
c.
d.
Dasabuvir
Ombitasvir
Grazoprevir
Sofosbuvir
BK is a 62 yo WM who presents to you complaining of abdominal
pain and dark urine. He is determined to have HCV genotype 1.
For DAA treatment, which of the following classes would be best if
you expect resistance to be an issue?
a.
b.
c.
d.
PI’s
NS5Ai’s
NS5B NUCi’s
NS5B non-NUCi’s
BK is a 62 yo WM who presents to you complaining of abdominal
pain and dark urine. He is determined to have HCV genotype 1.
For DAA treatment, which of the following drugs would be best if
you expect resistance to be an issue?
a.
b.
c.
d.
Dasabuvir
Ombitasvir
Grazoprevir
Sofosbuvir
AGENTS
PI’s
NS5Ai’s
NS5B NUCi’s
NS5B non-NUCi’s
MOA
Protein transport/
processing
Potency
High
High
Intermediate
Intermediate
GT coverage
Limited
Multiple
High
Low
Barrier to
resistance
Low
Low
High
High
RNA replication and assembly
BK is a 62 yo WM who presents to you complaining of abdominal
pain and dark urine. He is determined to have HCV genotype 1.
For DAA treatment, which of the following drugs would be most
likely to complicate treatment if he also has HIV?
a.
b.
c.
d.
Dasabuvir
Ombitasvir
Grazoprevir
Sofosbuvir
BK is a 62 yo WM who presents to you complaining of abdominal
pain and dark urine. He is determined to have HCV genotype 1.
Assuming that he is taking all of the following medications, which
would you change/discontinue should you start Harvoni?
a.
b.
c.
d.
Omeprazole
Clopidogrel
Metformin
Lisinopril
Your patient is a heavy drinker who has an elevated INR, AST/ALT
are within normal limits, SCr is 2.4, and he has also been diagnosed
with HCV. Which of the following would be preferred?
a.
b.
c.
d.
Ledipasvir/sofosbuvir
Paritaprevir/ritonavir/ombitasvir + dasabuvir
Daclatasvir/sofosbuvir
Elbasvir/grazoprevir
Your patient has been diagnosed with GT 2. Which of the following
should he receive?
a.
b.
c.
d.
Ledipasvir/sofosbuvir
Paritaprevir/ritonavir/ombitasvir + dasabuvir
Daclatasvir/sofosbuvir
Elbasvir/grazoprevir
APPROVED REGIMENS BY GENOTYPE/DAA
1
Lepidasvir/sofosbuvir
X
Daclatasvir/sofosbuvir
X
Paritaprevir/ritonavir/
ombitasvir
Paritaprevir/ritonavir/
ombitasvir + dasabuvir
2
X
3
4
5/6
X
X
X
X
X
Your patient has recently had a cardiac stent placed and is taking
clopidogrel. Which of the following should be avoided?
a.
b.
c.
d.
Ledipasvir/sofosbuvir
Paritaprevir/ritonavir/ombitasvir + dasabuvir
Daclatasvir/sofosbuvir
Elbasvir/grazoprevir
WATCH OUT! … FOR DRUG INTERACTIONS
 CYP & pgp… Daclatasvir, Elbasvir, Grazoprevir
 Pgp only… Ledipasvir, Sofosbuvir