Active Learning: Hepatitis C

Asal Ardalan Course Name: Infectious Diseases II asdfasfdasfdasfdasdff Course Number: PHAR 839 dasdffdsfdfdEEviCaps tone Active Learning: Hepatitis C Case 1: Diagnosis and Initial Assessment Patient A.W. is a 38-year-old male presenting with unexplained fatigue. He has a history of intravenous drug use and unprotected sexual intercourse with multiple partners. His father was diagnosed with hepatitis C in the past. What is the most appropriate initial diagnostic test for this patient? A) Complete Blood Count (CBC) B) Liver Biopsy C) HCV Antibody Test D) Serum Creatinine Test E) HCV RNA Test Case 2: Treatment Selection Patient B.P is a 55-year-old female with genotype 3 hepatitis C infection. She also has past medical history of asthma, hypertension, and hyperlipidemia. She has a history of alcohol abuse but has been abstinent for the past two years. Her mother also had hepatitis C. Which direct-acting antiviral (DAA) medication is most suitable for this patient? A) Ledipasvir/Sofosbuvir B) Elbasvir/Grazoprevir C) Glecaprevir/Pibrentasvir D) Ribavirin monotherapy E) Interferon-alpha Case 3: Monitoring and Adverse Effects Select the appropriate medication and adverse effect pair. What lab(s) should be monitored for the selected pair? A) Ledipasvir/Sofosbuvir – Photosensitivity B) Elbasvir/Grazoprevir – Bradycardia C) Glecaprevir/Pibrentasvir - Leukopenia D) Ribavirin – Hemolytic Anemia E) Sofosbuvir/Velpatasvir – Rhabdomyolysis Case 4: Patient Counseling Patient S.P., a 30-year-old female, is about to start hepatitis C treatment with a DAA regimen. She is currently taking several over-the-counter supplements, including Vitamin D, Vitamin E, Fish Oil, and St. John's Wort. What is the pharmacist's most important counseling point for this patient? A) Potential drug interactions with Fish Oil B) Potential drug interactions with St. John's Wort C) Maintaining a low-fat diet D) The importance of limiting alcohol consumption E) Staying well-hydrated during treatment West Coast University PHAR 839: Infectious Diseases II—Fall 2024 Page 1 Case 5: Preventive Measures Patient E.P. is a 21-year-old college student with a history of recreational drug use and unprotected sexual activity. He has not been vaccinated against hepatitis A or B. What is the most appropriate recommendation for this patient to reduce his risk of hepatitis C infection? Select all that apply. A) Hepatitis C vaccination B) Condom use during sexual activity C) Hepatitis A and B vaccination D) Regular liver function tests E) No preventive measures are necessary Case 6: Drug-Drug Interactions Patient C.O. is on a hepatitis C treatment regimen that includes ledipasvir/sofosbuvir. He is prescribed amiodarone for a cardiac condition. What potential severe drug interaction should the pharmacist warn the patient about? A) Hypertension B) Hepatotoxicity C) Pulmonary Toxicity D) Peripheral Neuropathy E) Bradycardia Case 7: Putting it all together Patient N.K., a 60-year-old male, presents to the hospital with a recent diagnosis of hepatitis C. PMH: - Hypertension for 10 years, managed with amlodipine 10 mg daily - Type 2 diabetes for 15 years, treated with metformin 500 mg BID - GERD for 6 years, treated with esomeprazole 40 mg daily - Chronic obstructive pulmonary disease (COPD) for 5 years, using albuterol inhaler as needed. - Former intravenous drug user, but he has been clean for 20 years. - History of alcohol abuse, but he has been abstinent for 5 years. SH: - Lives alone in a small apartment. - Retired, used to work as a construction worker. - Limited family support. Medical History: - Recently diagnosed with hepatitis C after routine blood work showed elevated liver enzymes. HCV RNA confirms active infection. - Liver function tests show elevated ALT (120 U/L) and AST (110 U/L) levels - CTP Score: 5 - Hemoglobin A1c: 7.5% - Blood pressure: 148/90 mm Hg - Respiratory rate: 20 breaths per minute - Heart rate: 82 beats per minute - Temperature: 98.6°F (37°C) West Coast University PHAR 839: Infectious Diseases II—Fall 2024 Page 2 1. Given the patient's significant past medical history and current medical conditions, which comorbidities could impact the choice of initial hepatitis C antiviral therapy? Select all that apply A) Hypertension B) Type 2 diabetes C) COPD D) Former drug use history E) Alcohol abuse history 2. The patient's liver function tests show elevated ALT and AST levels, along with a CTP Score of 5. How should these elevations impact the choice of hepatitis C therapy? A) No impact on therapy choice B) Consider alternative therapy options C) Increase the dose of antiviral medication D) Decrease the dose of antiviral medication E) Discontinue hepatitis C treatment 3. Considering the patient's medical history and medications, which hepatitis C treatment regimen is most suitable for him? A) Sofosbuvir/Velpatasvir B) Glecaprevir/Sofosbuvir C) Elbasvir/Grazoprevir D) Ribavirin monotherapy E) Interferon-alpha 4. After careful consideration you decide to start the patient on Epclusa. Which potential drug-drug interactions should be assessed and managed when initiating a patient with hepatitis C antiviral therapy for this patient? A) Interactions with amlodipine B) Interactions with metformin C) Interactions with albuterol inhaler D) Interactions with esomeprazole E) Interactions with alcohol history 5. The patient's social history and limited family support may impact his adherence to antiviral therapy. How can a pharmacist assist in addressing adherence issues? Select all that apply. A) Refer the patient to a social worker B) Educate the patient on the importance of adherence C) Consider directly observed therapy (DOT) D) Assist the patient in finding a new place to live E) Encourage the patient to return to drug use for a support system 6. Patient N.K. presents to your pharmacy with their prescription for Epclusa. Which of the following are counseling points for N.K? Select all that apply. A) This medication should always be taken with food B) This medication should be taken daily for a total of 12 weeks C) This medication can cause nausea, headaches, and fatigue West Coast University PHAR 839: Infectious Diseases II—Fall 2024 Page 3 D) This medication can be safely be taken with amiodarone E) This medication should be separated from acid reducing agents West Coast University PHAR 839: Infectious Diseases II—Fall 2024 Page 4