Active Learning: Hepatitis B

Asal Ardalan Course Name: Infectious Diseases II Course Number: PHAR 839 asdfasfdasfdasfdas dffdasdffdsfdfdEEv iCapstone Active Learning: Hepatitis B Use the case “Hepatitis B Case” to answer the following questions. 1. What subjective information may be experienced by patients presenting with chronic hepatitis B? fatigue, jaundice, dark urine, white stool, abdominal pain, loss of appetite, fever, and chills. In this case, the patient reports feeling depressed but denies any symptoms such as jaundice or gastrointestinal issues 2. Common: Fever, jaundice, scleral icterus, hepatomegaly • Less common: splenomegaly, skin rash, arthralgia What objective information indicates the presence of chronic hepatitis B? • Positive HBsAg: The patient has an active hepatitis B infection, confirmed by the positive HBsAg test result. • HBeAg positivity: The patient is HBeAg positive, indicating viral replication. • Elevated HBV DNA levels: The patient’s HBV DNA level is greater than 6 million IU/mL. • Elevated AST and ALT: The patient has elevated liver enzymes (AST 57 IU/L and ALT 59 IU/L). • Ultrasound findings: The ultrasound shows a coarsened liver texture, suggesting liver disease, and mildsplenomegaly. Mother also had HTC 3. Is this patient a candidate for treatment of her hepatitis B infection? What criteria support your answer? Yes, she is a candidate for treatment. 4. - treatment is recommended for patients with HBV DNA levels over 2,000 IU/mL and evidence of liver damage and elevated ALT and AST. The patient’s viral load and liver enzyme levels exceed these thresholds Also Family history of HTC What are the goals of pharmacotherapy for hepatitis B infection in this case - The goals of therapy are to suppress HBV replication (achieve undetectable HBV DNA levels) - normalize liver enzyme levels (AST/ALT) West Coast University PHAR 839: Infectious Diseases II—Fall 2024 Page 1 - achieve seroconversion from HBeAg to HBeAb, prevent progression to cirrhosis or hepatocellular carcinoma, and prevent reactivation of HBV -prevent disease progression -prevent transmission -decrease morbidity and mortality 5. What pharmacotherapeutic options are available for treating hepatitis B infection? - Entecavir - tenofovir disoproxil fumarate (TDF) - tenofovir alafenamide (TAF) -interferon in this patient has to be avoided because of it’s needles and depression 6. Provide a pharmacotherapeutic regimen for this patient’s chronic hepatitis B infection. Include drug name, dose, route, frequency, and duration if applicable. Tenofovir disoproxil fumarate (TDF) 300 mg orally once daily OR Entecavir 0.5 mg orally once daily( take on empty stomach) 48 weeks duration of all the meds 7. What patient counseling information should be provided to this patient to ensure successful therapy, minimize adverse effects, and prevent morbidity and spread of hepatitis B infection? Nonpharmacologic recommendations: • Counsel patients on prevention of disease transmission • Vaccinate sexual and household contacts against HBV • Barrier protection methods for sex partners who have not completed vaccination series • Lifestyle modifications: avoid alcohol use and smoking (potentiates liver disease) • Herbal medicines (e.g. milk thistle): Limited data demonstrating efficacy 8. What laboratory parameters should be monitored to determine efficacy of treatment for hepatitis B infection? • ALT levels, monthly* • HBV DNA levels, every 3 months* • HBeAg after HBV DNA level is undetectable • HBsAg after HBeAg is lost or seroconverted • Abdominal ultrasound to rule out HCC, every 6 months Continually take serological test West Coast University PHAR 839: Infectious Diseases II—Fall 2024 Page 2