University:
University of North Carolina at Chapel Hill
Course:
NURS 312 | Pharmacology
Academic year:

2020
Views:

412

Pages:

1
Author:

esfredint7qo

7.2 – “Dr Liver Liver--stone, I presume?”: Hep-C treatment (Ribavirin, sofosbuvir, simeprevir) • Hep C can cause acute and chronic hepatitis. Acute infection is often self-limited and commonly causes chronic infection. Decision of treatment regimen, dosing, and duration of therapy depends on stage & state of infection as well as infecting genotype (sketch of yellow hippo with genotype? highlighted). Fibrosis stage usually assessed as well, usually by history and exam; biopsy is not necessarily standard of care (stony “fibrosed” liver under microscope). • Treatment causes ↓M&M and improved quality of life in all patients with virologic evidence of chronic HCV infection (photographic evidence on board). Standard of care is to treat all HCV⊕ ⊕ patients except those with limited life expectancy. Goal of treatment is the eradication of viral RNA which is predicted by a sustained virologic response (i.e. HCV RNA not detected by PCR for 6 months after stopping treatment) (6 mos. sustained search for Sea Hippo). Achieving SVR means 99% change of sustained seronegativity on long term follow-up. • Treatment: Once weekly pegylated-IFN-α (α-antenna) + daily oral ribavirin (ribs) is traditional therapy. Several newer therapies with fewer adverse effects are available. • Ribavirin o Given oral daily as part of combination therapy along with pegylated-IFN-α o Guanosine nucleoside analog (purine shaped stakes). Needs Ⓟ by intracellular enzymes into active nucleotide form (3 pepper shakers) o Inhibits RNA production (RNA ropes) o Also used in RSV (though has largely been replaced with palivizumab) (RSV tombstone) o Adverse effects ▪ Dose dependent hemolytic anemia (tomatoes) ▪ Teratogenic – category X (enormous tarantula). Not to be used in M or F of childbearing age not on birth control. • Polymerase inhibitors: sofosbuvir (sofa with nucleoside pattern) o Nucleoside analog that inhibits the NS5B RNA-dependent RNApol inpatients infected by genotypes 1,2,3,4 (nucleotide pattern on sofa). o Direct polymerase inhibitor that disrupts RNA production (disrupted ssRNA rope) o May be part of a regimen with ribavirin, IFN-α, or the newer ones that are all oral; latter regimens highly effective & welltolerated, without interferon toxicities. o Adverse effects (tired Dr Livingstone) ▪ Fatigue ▪ Nausea • Protease inhibitors (NS3/4A inhibitors) (machete) o Simeprevir (and other protease inhibitors) work with HCV genotype 1 (simmering food over the fire). o Cleave HCV-encoded polyproteins o Adverse effects ▪ Photosensitivity & rash (flashing camera) ▪ Substrate & inhibitor of CYP450 system (broken down truck in the background) • New investigational drugs (North Sea investigative map) nd o 2 gen NS3/NS4A protease inhibitors o NS5A inhibitors o None require ribavirin & INF administration