Management of Viral Hepatitis: Hepatitis C

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Questions and Answers

What is the primary characteristic of Glecaprevir/pibrentasvir for treating Hepatitis C?

It has no known drug interactions.

It should be taken on an empty stomach for optimal absorption.

It is effective for all Hepatitis C genotypes. (correct)

It is available in a liquid form for easy ingestion.

Which of the following statements about Hepatitis C treatment is accurate?

Treatment does not require monitoring of liver function.

Direct acting antivirals are the preferred treatment option. (correct)

There is a vaccine available for Hepatitis C prevention.

Chronic Hepatitis C can be treated effectively with vaccine therapy.

What is the recommended dosing regimen for Glecaprevir/pibrentasvir?

Twice daily on an empty stomach for 12 weeks.

Once weekly with fluid intake for hydration.

Three times a day regardless of food.

Once daily with food for 8 weeks. (correct)

In which scenario should Glecaprevir/pibrentasvir be contraindicated?

In patients with moderate-severe hepatic impairment. Signup and view all the answers

What is a common adverse drug reaction (ADR) associated with Glecaprevir/pibrentasvir?

Headache and fatigue. Signup and view all the answers

Which Hepatitis type is known to have a vaccine available?

Hepatitis A and Hepatitis B. Signup and view all the answers

How is Hepatitis C primarily transmitted?

Through permucosal and percutaneous exposure. Signup and view all the answers

What parameter is crucial for monitoring during Hepatitis C treatment?

Liver function tests and patient symptoms. Signup and view all the answers

What is the estimated cost of therapy for Mavyret over an 8-week duration?

$26,400 Signup and view all the answers

Which HCV medication has the highest estimated cost for its treatment duration?

Harvoni Signup and view all the answers

What ICD-10 code is associated with the prior-authorization process for HCV?

B18.2 Signup and view all the answers

Which of the following therapies costs the same as Epclusa?

Vosevi Signup and view all the answers

What is a critical aspect of the HCV treatment process indicated in the document?

Insurance verification Signup and view all the answers

Which statement about the prior-authorization process is accurate?

It can be very time-consuming and involves multiple forms. Signup and view all the answers

What is the estimated cost of therapy for Zepatier over 12 weeks?

$54,600 Signup and view all the answers

In which month and year was the Rebetol package insert published?

August 2011 Signup and view all the answers

Which of the following is true regarding Sofosbuvir/velpatasvir (Epclusa)?

It is a two-part regimen consisting of an NS5B inhibitor and an NS5A inhibitor. Signup and view all the answers

What is the appropriate dosing schedule for Sofosbuvir/velpatasvir/voxilaprevir (Vosevi) for the treatment of HCV?

Once daily with food for 12 weeks. Signup and view all the answers

What common adverse drug reactions (ADRs) are associated with Sofosbuvir/velpatasvir (Epclusa)?

Headache and fatigue. Signup and view all the answers

In which patient population is Sofosbuvir/velpatasvir/voxilaprevir (Vosevi) preferred treatment?

For patients with decompensated cirrhosis. Signup and view all the answers

What is the significance of the FDA warning regarding Sofosbuvir/velpatasvir (Epclusa) and other therapies?

It can lead to liver failure and death in severe liver disease cases. Signup and view all the answers

What is the role of ribavirin (RBV) when used with Sofosbuvir/velpatasvir (Epclusa) in specific conditions?

It is added in cases of decompensated cirrhosis. Signup and view all the answers

Which of the following statements correctly identifies a difference between Sofosbuvir and Sofosbuvir/velpatasvir?

Sofosbuvir is used in combination mainly with DAAs. Signup and view all the answers

What precaution should be taken with acid suppressive therapy in patients receiving Sofosbuvir/velpatasvir (Epclusa)?

It should be avoided or minimized. Signup and view all the answers

What is the primary mechanism of action for Ribavirin?

Inhibits HCV RNA-dependent RNA polymerase Signup and view all the answers

Which of the following patient conditions does NOT warrant a dosage adjustment for Ribavirin?

Stable cardiac disease Signup and view all the answers

For a patient weighing 80 kg, what would be the appropriate daily dosage of Ribavirin?

1200 mg/day Signup and view all the answers

Which of the following is a contraindication for Ribavirin use?

Chronic obstructive pulmonary disease (COPD) Signup and view all the answers

Under which circumstance should Ribavirin be discontinued according to dosing guidelines?

Hemoglobin level drops below 8.5 g/dL Signup and view all the answers

What is a black box warning associated with Ribavirin?

Risk of teratogenic effects Signup and view all the answers

What is the recommended dosing schedule for a patient who weighs 70 kg?

400 mg AM and 600 mg PM Signup and view all the answers

What is the half-life of Ribavirin when used in treating HCV?

24 hours Signup and view all the answers

What characterized the historical response rates of co-infected patients treated with DAAs compared to previous treatments?

They have diminished over time. Signup and view all the answers

Which factor could contribute to greater liver-related mortality in HIV patients?

The use of HAART. Signup and view all the answers

What effect do acid reducers have on the absorption of Ledipasvir and Velpatasvir?

They decrease absorption/concentration. Signup and view all the answers

What is the recommended separation time for taking antacids with Harvoni?

Separate by 4 hours. Signup and view all the answers

Which of the following drug classes is NOT associated with clinically important interactions with DAAs?

Antihistamines Signup and view all the answers

How should H2 antagonists be administered when taken with LDV/VEL?

Administer WITH LDV/VEL or separate by 12 hours. Signup and view all the answers

What is a notable complication of HCV co-infection in relation to HIV progression?

More rapid progression of HIV. Signup and view all the answers

Which of the following is a recommendation for administering proton pump inhibitors with LDV?

Administer on an empty stomach. Signup and view all the answers

Study Notes

Objectives of Hepatitis C Management

Understand characteristics of direct-acting antivirals (DAAs) for Hepatitis C (HCV).
Monitor parameters before, during, and after treatment.
Select preferred treatment regimens based on patient history and cost.
Adapt treatment strategies for special populations with HCV.

Types of Viral Hepatitis Infections

Hepatitis A: Transmitted via fecal/oral route, no treatment, vaccine available, no chronicity.
Hepatitis B: Transmitted through permucosal/percutaneous methods, treated, vaccine available, can lead to chronic infection in neonates.
Hepatitis C: Transmitted via permucosal/percutaneous routes, treatable, no vaccine, potential for chronic infection in neonates.
Hepatitis D: Requires Hepatitis B for transmission; leads to chronicity when co-infected.
Hepatitis E: Transmitted via fecal/oral route, no treatment or vaccine available, no chronicity.

Direct Acting Antivirals (DAAs) for HCV

Glecaprevir/Pibrentasvir (Mavyret):
- Pangenotypic, dosed once daily with food for 8 weeks.
- Common side effects include headache and fatigue (10%).
- Contraindicated in moderate-severe hepatic impairment.
Sofosbuvir/Velpatasvir (Epclusa):
- Pangenotypic, preferred for decompensated cirrhosis, taken daily for 12 weeks.
- Common side effects include headache and fatigue (10%).
- Should avoid acid suppressive therapy.
Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi):
- Pangenotypic, used for patients with decompensated cirrhosis, dosed once daily for 12 weeks.
- Common side effects: headache, diarrhea, nausea (10%); includes use as salvage therapy.
Sofosbuvir (Sovaldi):
- Used in combination with other DAAs; effective for various genotypes.
- Common side effects: fatigue, headache, nausea.

Ribavirin

Directly inhibits HCV RNA polymerase, minimal effect when used alone.
Dosing varies based on weight, with specific adjustments for hemoglobin levels.
Contraindications include pregnancy, unstable cardiac disease, and renal dysfunction.

Drug Interactions

Significant interactions with various medications: statins, anticonvulsants, and estrogens noted.
Acid reducers decrease absorption of specific DAAs; dosing guidelines provided for antacids, H2 antagonists, and PPIs.

Special Considerations

HCV screening recommended for all HIV patients due to co-infection risks.
Challenges in drug access and prior authorization involve time-consuming paperwork.

Cost of HCV Treatments

Estimated costs for various therapies (2019 estimates):
- Mavyret: $26,400 for 8 weeks
- Harvoni: $94,500 for 12 weeks
- Epclusa and Vosevi: $74,760 for 12 weeks
- Zepatier: $54,600 for 12 weeks.

Safety Warnings

Ribavirin carries black box warnings for hemolytic anemia and teratogenicity, necessitating caution in certain populations.

Monitoring and Adjustments

Pre-treatment evaluations and ongoing monitoring are crucial to ensure safety and efficacy during therapy.
Adjust medication regimens based on patient response and side effects throughout treatment.

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Description

This quiz focuses on the management of Hepatitis C, emphasizing the characteristics of direct acting antivirals. Participants will learn about pre-treatment, on-treatment, and post-treatment monitoring parameters, as well as how to select preferred treatment regimens based on patient history and other factors.