This document provides information on hepatitis C, including its types, sources of infection, epidemiology, treatment options, and key details about specific medications used to treat hepatitis C. It discusses the types of hepatitis C as acute or chronic. It notes that the WHO estimates that around 3% of the world's population has been infected with hepatitis C virus (HCV) and over 170 million people have chronic hepatitis C infection. The document discusses classes of antiviral medications used to treat hepatitis C including protease inhibitors, polymerase inhibitors, NS5A inhibitors, and interferons. It provides details on particular protease inhibitors like simeprevir and daclatasvir, the polymerase inhibitor sofosbuvir, and combination treatments containing sofosbuvir
A power point presentation on Hepatitis C virus on epidemiology, presentation, diagnosis and current treatment strategies we are practicing in BSMMU at a international standerd.
This lecture is about Spectrum of HCV infection presented by Dr. Muhammad Mostafa Abdel Ghaffar, Head of Tropical Medicine Department, Ahmed Maher Teaching Hospital.
The lecture was presented in the scientific meeting of Internal and Tropical Medicine departments, Ahmed Maher Teaching Hospital titled (Towards Eradication of HCV in Egypt) in celebration of World Hepatitis Day on July 28, 2016.
https://www.facebook.com/AMTH.IM
https://www.facebook.com/events/1072758396145209/
http://www.no4c.com
A power point presentation on Hepatitis C virus on epidemiology, presentation, diagnosis and current treatment strategies we are practicing in BSMMU at a international standerd.
This lecture is about Spectrum of HCV infection presented by Dr. Muhammad Mostafa Abdel Ghaffar, Head of Tropical Medicine Department, Ahmed Maher Teaching Hospital.
The lecture was presented in the scientific meeting of Internal and Tropical Medicine departments, Ahmed Maher Teaching Hospital titled (Towards Eradication of HCV in Egypt) in celebration of World Hepatitis Day on July 28, 2016.
https://www.facebook.com/AMTH.IM
https://www.facebook.com/events/1072758396145209/
http://www.no4c.com
The Slide covers for the- Hepatitis B Virus and Infection. INTRODUCTION, MODES OF TRANSMISSION, HIGH RISK GROUPS, PATHOGENESIS, CLINICAL MANIFESTATION, DIAGNOSIS, PROPHYLAXIS, PREVENTION.
Transmission risk factors, symptoms, diagnosis and treatment of hepatitis B. This is a deliberate presentation made to be easily understood by lay persons to appreciate the thinking of the doctors when it comes to treatment for hepatitis B
The primary treatment goals for patients with hepatitis B (HBV) infection are to prevent progression of the disease, particularly to cirrhosis, liver failure, and hepatocellular carcinoma (HCC).
Risk factors for progression of chronic HBV include the following :
Persistently elevated levels of HBV DNA and, in some patients, alanine aminotransferase (ALT), as well as the presence of core and precore mutations seen most commonly in HBV genotype C and D infections
Male sex
Older age
Family history of HCC
Alcohol use
Elevated alpha-fetoprotein (AFP)
Coinfection with hepatitis D (delta) virus (HDV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV)
A synergistic approach of suppressing viral load and boosting the patient’s immune response with immunotherapeutic interventions is needed for the best prognosis. The prevention of HCC often includes the use of antiviral treatment using pegylated interferon (PEG-IFN) or nucleos(t)ide analogues.
HBV infection can be self-limited or chronic. No specific therapy is available for persons with acute hepatitis B; treatment is supportive.
O modelo de gestão tradicional é baseado na divisão da empresa entre pensadores e executores e tenta garantir a realização do trabalho através da estratégia de comando e controle.
Consequentemente, relações hierárquicas são criadas e a avaliação de desempenho busca melhorar cada vez mais a produtividade das pessoas determinando como eficiente tudo que estiver em conformidade com as políticas, padrões e diretrizes de qualidade.
Por outro lado, estamos vivendo em um mundo onde é a inovação que gera riqueza e o pré-requisito fundamental para a inovação é a diversidade de pensamento e de ação, além da capacidade de adaptação às mudanças do mercado e da economia.
Nesse sentido, abordagens de gestão como Management 3.0, Beyond Budgeting e Radical Management estão redefinindo a maneira como as empresas e as pessoas trabalham. Novo modelos de gestão baseados em autonomia, colaboração, trabalho em equipe e sem relações hierárquicas estão emergindo em empresas inovadoras como Zappos, Valve, Morning Star, Google e outras. Algumas empresas brasileiras, com a Webgoal e a Lambda3, já fazem a gestão dos seus negócios sem os cargos de gerente ou coordenador.
Entretanto, essa mudança de paradigma na gestão empresarial tem criado muitos questionamentos nas empresas que estão adotando uma gestão moderna: É possível fazer a gestão de uma empresa sem ter gerentes ou coordenadores? Como as decisões são tomadas em uma empresa que não possui hierarquia formal? Como são feitas as definições sobre salários e planos de carreira numa gestão mais orgânica?
Essa palestra teve como objetivo responder essas e outras perguntas, além de apresentar práticas e ferramentas que estão ajudando equipes e empresas na adoção de novos modelos de gestão.
The Slide covers for the- Hepatitis B Virus and Infection. INTRODUCTION, MODES OF TRANSMISSION, HIGH RISK GROUPS, PATHOGENESIS, CLINICAL MANIFESTATION, DIAGNOSIS, PROPHYLAXIS, PREVENTION.
Transmission risk factors, symptoms, diagnosis and treatment of hepatitis B. This is a deliberate presentation made to be easily understood by lay persons to appreciate the thinking of the doctors when it comes to treatment for hepatitis B
The primary treatment goals for patients with hepatitis B (HBV) infection are to prevent progression of the disease, particularly to cirrhosis, liver failure, and hepatocellular carcinoma (HCC).
Risk factors for progression of chronic HBV include the following :
Persistently elevated levels of HBV DNA and, in some patients, alanine aminotransferase (ALT), as well as the presence of core and precore mutations seen most commonly in HBV genotype C and D infections
Male sex
Older age
Family history of HCC
Alcohol use
Elevated alpha-fetoprotein (AFP)
Coinfection with hepatitis D (delta) virus (HDV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV)
A synergistic approach of suppressing viral load and boosting the patient’s immune response with immunotherapeutic interventions is needed for the best prognosis. The prevention of HCC often includes the use of antiviral treatment using pegylated interferon (PEG-IFN) or nucleos(t)ide analogues.
HBV infection can be self-limited or chronic. No specific therapy is available for persons with acute hepatitis B; treatment is supportive.
O modelo de gestão tradicional é baseado na divisão da empresa entre pensadores e executores e tenta garantir a realização do trabalho através da estratégia de comando e controle.
Consequentemente, relações hierárquicas são criadas e a avaliação de desempenho busca melhorar cada vez mais a produtividade das pessoas determinando como eficiente tudo que estiver em conformidade com as políticas, padrões e diretrizes de qualidade.
Por outro lado, estamos vivendo em um mundo onde é a inovação que gera riqueza e o pré-requisito fundamental para a inovação é a diversidade de pensamento e de ação, além da capacidade de adaptação às mudanças do mercado e da economia.
Nesse sentido, abordagens de gestão como Management 3.0, Beyond Budgeting e Radical Management estão redefinindo a maneira como as empresas e as pessoas trabalham. Novo modelos de gestão baseados em autonomia, colaboração, trabalho em equipe e sem relações hierárquicas estão emergindo em empresas inovadoras como Zappos, Valve, Morning Star, Google e outras. Algumas empresas brasileiras, com a Webgoal e a Lambda3, já fazem a gestão dos seus negócios sem os cargos de gerente ou coordenador.
Entretanto, essa mudança de paradigma na gestão empresarial tem criado muitos questionamentos nas empresas que estão adotando uma gestão moderna: É possível fazer a gestão de uma empresa sem ter gerentes ou coordenadores? Como as decisões são tomadas em uma empresa que não possui hierarquia formal? Como são feitas as definições sobre salários e planos de carreira numa gestão mais orgânica?
Essa palestra teve como objetivo responder essas e outras perguntas, além de apresentar práticas e ferramentas que estão ajudando equipes e empresas na adoção de novos modelos de gestão.
Risk data sheet - a template to collect risk data attributes Dhawal Thakkar PMP
This is a data sheet ( template) used to collected the attributes related to risk , this data is further combined into the organizations risk register.
For free download /purchase of such similar data please visit our website
www.ProjectSupportTools.com
Risk register or Risk log - A template to list down all the indentified Risk Dhawal Thakkar PMP
A Risk Register, also referred to as a Risk Log, is a master document which is created during the early stages of your project. It is a tool that plays an important part in your Risk Management Plan, helping you to track issues and address problems as they arise.
For similar such templates and support on Risk management contact www.ProjectSupportTools.com
Here are 40 scary stats about endpoint data at risk that we've compiled -- and turning a blind eye won't make them go away. Go to wild.druva.com to learn more!
Think network forensics is just for security? Not with today’s 10G (and tomorrow’s 40G/100G) traffic, not to mention new 802.11ac wireless networks with multi-gigabit data rates. Data is traversing these networks so quickly that detailed, real-time analysis is at best a challenge. Network forensics provides key real-time statistics while saving a complete, packet-level recording of all network activity. You don’t need to worry about capturing the problem – your network forensics solution already has, allowing you to go back in time and analyze any network, application, or security condition.
This presentation deals with the various non-steroidal antiinflammatory drugs used in day-to-day practice enumerating their mechanism of action, uses, adverse effects, etc.
HIV AIDS is one of the most dreadful of all diseases. Newer drugs and drug combination are coming quite frequently. Attempts to design an HIV vaccine is also underway.
This seminar is my attempt this interesting topic with all the latest data I could collect on the internet.
Antiretroviral therapy Reloaded in view of updated PPTCT guidelinesDr Kamal Sundar
Updated PPTCT guidelines of NACO are new for OBG practitioners. Pharmacotherapy can be explained in a less complex manner to meet a busy practitioner's need.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. • “Hepa” means Liver
• “Titis” means Inflammation
• Hepatitis is an inflammation of
the liver.
• Infectious (i.e. viral, bacterial,
fungal, and parasitic organisms)
• Non-infectious (e.g. alcohol).
INTRODUCTION
4. • Hepatitis C is a contagious liver disease that results from infection with the Hepatitis
C virus (HCV).
• Two types:
1 Acute
Short-term illness
Occurs within the first 6 months after someone is exposed to the HCV.
2 Chronic:
Acute infection leads to chronic infection.
Long-term health problems, or even death.
HEPATITIS C
5. SOURCES OF INFECTION FOR
PERSONS WITH HEPATITIS C
*Nosocomial; Health-care work; Perinatal
Source: Centers for Disease Control and Prevention
Dr.T.V.Rao MD
6. EPIDEMIOLOGY
• The WHO estimates about 3% of the world’s population has been
infected with HCV.
• More than 170 million chronic carriers who are at risk of developing
liver cirrhosis and/or liver cancer.
• Severe morbidity in 20-30% of infected persons.
11. SIMEPREVIR
Brand Names Olysio Galexos
Pharmacokinetics
Absorption:
Food increases
systemic exposure
by 60-70%
Distribution:
Protein bound
>99.9%
Metabolism:
Liver
Excretion:
Hepatobiliary
t1/2 : 41 hr (HCV+);
10-13 hr (HCV-)
Pharmacodynamics
Inhibit the proteolytic activity of recombinant genotype 1a and 1b HCV NS3/4A
proteases.
Dosing forms &
strengths:
Capsule 150mg.
Indications and Dosing
Chronic Hepatitis C
(genotype 1)
Treatment-naïve and
prior relapsed patients
150 mg PO qD for 12 weeks of treatment with simeprevir,
peginterferon alfa, and ribavirin FOLLOWED by an
additional 12 weeks of peginterferon alfa and ribavirin( with
cirrhosis).
Treatment-naïve or 150 mg PO qD plus sofosbuvir 400 mg for 12 weeks (without
12. Administration Oral
• Administer with food.
• Maintain adequate fluid intake.
• Swallow capsules whole.
Dosing
Considerations
Must not be used as monotherapy; if sofosbuvir, peginterferon alfa, or ribavirin is
discontinued for any reason, simeprevir must also be discontinued.
Adverse Effects Fatigue, headache ,dizziness, insomnia, Skin rash, pruritus, Nausea , diarrhea, Increased
serum bilirubin, Myalgia, Dyspnea
Contraindications Hypersensitivity, Pregnancy
Drug Interactions • Simeprevir may increase the serum concentration of Atorvastatin, Cisapride, CYP3A4
Substrates, Cyclosporine (Systemic).
• CYP3A4 Inducers may decrease the serum concentration of Simeprevir.
• Atazanavir and CYP3A4 Inhibitors may increase the serum concentration of
Simeprevir.
Storage Store below 30°C (86°F). Store in the original bottle. Protect from light.
14. SOFOSBUVIR
Brand Names Sovaldi
Pharmacokinetics
Absorption:
Well absorbed
Distribution:
Plasma bound
61-65%
Metabolism:
Hepatic
Excretion:
Urine
t1/2 : 0.4hr
Pharmacodynamics
Inhibitor of HCV NS5B RNA-dependent polymerase; hence suppresses viral
replication.
Dosing forms &
strengths
Tablet 400mg.
Indications and Dosing
Chronic Hepatitis C
Genotype 1 or 4
400 mg PO qDay plus ribavirin and peginterferon alfa for 12
weeks.
Genotype 2 400 mg PO qDay plus ribavirin for 12 weeks.
Genotype 3 400 mg PO qDay plus ribavirin for 24 weeks.
15. Administration Oral Take with or without food.
Dosing
Considerations
Must not be used as monotherapy; if peginterferon alfa, or ribavirin is discontinued for
any reason, sovaldi must also be discontinued.
Adverse Effects Fatigue, headache, dizziness, insomnia, Skin rash, pruritus, Nausea , diarrhea, chills,
anemia, Myalgia, Dyspnea, asthenia
Contraindications Hypersensitivity, Pregnancy or planning pregnancy, CrCl < 50 mL/min, pancreatitis,
hemoglobinopathy.
Drug Interactions Modafinil, Oxcarbazepine, P-glycoprotein/ABCB1 Inducers, Rifabutin, Rifapentine may
decrease the serum concentration of Sofosbuvir.
Storage Store below 30°C (86°F). Dispense only in original container.
17. LEDIPASVIR/SOFOSBUVIR
Brand Names Harvoni
Pharmacokinetics
Absorption:
Well absorbed
Distribution:
Protein binding
Ledipasvir:>99.8%;
Metabolism:
Ledipasvir: 47 h
Sofosbuvir: ~0.5 h
Excretion:
•Feces
•Urine
Pharmacodynamics
• Ledipasvir: Inhibits HCV NS5A protein, which is required for viral replication.
• Sofosbuvir: Inhibitor of HCV NS5B RNA-dependent polymerase; hence
suppresses viral replication.
Dosing forms &
strengths
Tablet 90mg/400mg.
Indications and Dosing
Chronic
Hepatitis C
(Genotype 1)
Treatment-naïve
1 tablet (90mg/400mg) PO qDay for 12 weeks (with or
without cirrhosis)
Treatment-experienced
1 tablet (90mg/400mg) PO qDay for 12 weeks (without
cirrhosis)
Treatment-experienced 1 tablet (90mg/400mg) PO qDay for 24 weeks (with cirrhosis)
18. Administration Oral
May take with or without food.
Dosing
Considerations
8 weeks can be considered in treatment-naïve patients without cirrhosis who have
pretreatment HCV RNA <6 million IU/mL.
Adverse Effects Fatigue, headache, dizziness, insomnia, Increased bilirubin, Increased lipase.
Cautions Do not use with other products that contain sofosbuvir (Sovaldi).
Drug
Interactions
• Sofosbuvir may enhance the bradycardic effect of Amiodarone.
• Antacids, H2-Antagonist & PPIs may decrease the serum concentration of Ledipasvir.
• Sofosbuvir may increase the serum concentration of Topotecan, Vincristine, rifaximin &
rosuvastatin.
Storage Store below 30°C (86°F). Dispense in original container.
20. DACLATASVIR
Brand Names Daklinza
Pharmacokinetics
Absorption:
Bioavailability
67%
Distribution:
Protein binding
99%
Metabolism:
Hepatic by CYP3A
Excretion:
•Feces
•Urine
Pharmacodynamics Inhibits NS5A, a nonstructural protein encoded by HCV, suppress viral replication.
Dosing forms &
strengths
Tablet 30mg/60mg.
Indications and Dosing
Chronic Hepatitis
C (Genotype 3)
60 mg (plus sofosbuvir 400 mg) PO qDay for 12 weeks.
21. Administration Oral May take with or without food.
Dosing
Considerations
If sofosbuvir is permanently discontinued in a patient receiving daclatasvir with
sofosbuvir, then daclatasvir should also be discontinued.
Adverse Effects Headache , Fatigue , Nausea , Diarrhea , Elevated lipase.
Contraindications Coadministration with drugs that strongly induce CYP3A and, thus, may lead to lower
exposure and loss of daclatasvir efficacy.
Drug Interactions • Daclatasvir may enhance the bradycardic effect of Amiodarone.
• CYP3A4 inducers may decrease the serum concentration of Daclatasvir.
• CYP3A4 inducers may increase the serum concentration of Daclatasvir.
• Daclatasvir may increase the serum concentration of HMG-CoA Reductase Inhibitors.
Storage Store at 25°C (77°F); excursions permitted between 15°C and 30°C (59°F and 86°F).
23. INTERFERON ALFA-2B
Brand Names Intron-A
Pharmacokinetics
Absorption:
Bioavailability
•IM: 83%
•SC: 90%
Distribution:
•Vd: 31 L
•IFN does not
penetrate the CSF
Metabolism:
Renal
Excretion:
Elimination H.L
•IV: 2 hours
•IM: 2-3 hours
•SC: 2-3 hours
Pharmacodynamics
Inhibits HBV replication; immunomodulatory actions; may induce gene
transcription; interferes with oncogene expression, may change cell surface antigen
expression; cytotoxic activity of macrophages increases.
Dosing forms &
strengths
• Injectable solution 6 / 10 million International Units/mL (3.8 / 3.2 mL vial
respectively)
• Multi dose pen; 6 doses each; (22.5 / 37.5 / 75 million International
Units/1.5mL)
• Powder for injection (10 / 18 / 50 million International Units/vial)
Indications and Dosing
Chronic Hepatitis C 3 million units IM/SC 3 times/wk for16 wk.
Acute Hepatitis C 5 million Units SC/IM qd for 4 wk, then 3 times/wk for 20 wk.
24. Administration IV, IM, SC OR Intralesional.
Dosing
Considerations
For chronic hepatitis:
•If ALT normalized after 16 wk, continue treatment for 18-24 mo.
•If ALT not normalized or high levels of HCV RNA after 16 wk, consider discontinuing
treatment.
For acute hepatitis:
•If severe adverse reactions develop reduce dose by 50% or temporarily withhold until
adverse reactions abate.
•If intolerance persists discontinue permanently.
Adverse Effects Fatigue, Fever, Neutropenia, Flu-like syndrome, Myalgia, anorexia, nausea, weakness.
Contraindications Hypersensitivity, Autoimmune hepatitis, Decompensated liver disease
Drug Interactions • may increase the serum concentration of Methadone.
• may enhance the adverse/toxic effect of Ribavirin. Hemolytic anemia has been
observed.
Storage • Refrigerate intact vials.
• Powder & premixed solutions are stable at room temp for 7 d & for 30 d if
refrigerated.
25. INTERFERON ALFACON 1
Brand Names Infergen
Pharmacokinetics
• Pharmacokinetic studies have not been conducted on patients with chronic
hepatitis C.
• Time to peak: Healthy volunteers: 24-36 hours.
Pharmacodynamics
Release immunomodulatory cytokine that enhances phagocytic activity of
macrophages and cytotoxic activity of lymphocytes for target cells.
Dosing forms &
strengths:
Injectable solution : 9mcg/0.3mL & 15mcg/0.5mL.
Indications and Dosing
Chronic Hepatitis
C (Genotype 3)
• 9 mcg SC 3 times/week for 24 wk.
• 15 mcg SC with ribavirin qDay for up to 48 weeks.
<75 kg: ribavirin 1 g PO divided q12hr.
≥75 kg: ribavirin 1.2 g PO divided q12hr.
26. Administration
• SC, 3 times/week, with at least 48 hours between doses.
• Allow to reach room temperature just prior to administration.
Dosing
Considerations
• If severe toxicity occurs: Reduce to 7.5 mcg SC 3 times/week or discontinue.
• Monitor: Hgb, WBC, Plt, LFTs, creatinine, thyroid.
Adverse Effects Headache, Fatigue, Fever, Rigors, Myalgia, Body pain, Back pain, Arthalagia.
Contraindications • Hypersensitivity
• Decompensated liver disease
• Autoimmune hepatitis
Drug Interactions • Interferons may decrease the metabolism of Theophylline Derivatives.
• Interferons may enhance the adverse/toxic effect of Zidovudine.
• Interferons may decrease the metabolism of Zidovudine.
Storage • Store in refrigerator 2°C to 8°C. Do not freeze.
• Avoid exposure to direct sunlight.
• Do not shake vigorously.
27. PEGYLATED INTERFERON ALFA-
2A
Brand Names Pegasys
Pharmacokinetics
• Elimination Half-life:160 hours
• Time to peak serum: 72 to 96 hours
Pharmacodynamics
Release immunomodulatory cytokine that enhances phagocytic activity of
macrophages and cytotoxic activity of lymphocytes for target cells.
Dosing forms &
strengths
• Vial for single use: 180mcg/ml
• Prefilled syringe for single use: 180mcg/0.5ml
• Autoinjector for single use: 135 or 180 mcg/0.5ml
Indications and Dosing
C H C
• With other anti viral drugs:
180 mcg SC once weekly
• Without other anti viral drugs:
Genotypes 1, 4: 48 weeks
Genotypes 2, 3: 24 weeks
Genotypes 5, 6: Insufficient data to recommend use
28. Administration
• SC. Abdomen or thigh. Rotate injection site.
• Administration should be done on the same day and at approximately the same time
each week.
Dosing
Considerations
• Only indicated for the treatment of patients with CHC with compensated liver disease if
there are contraindications or significant intolerance to other HCV antiviral drugs.
• Not recommended for treatment of patients with CHC who previously failed therapy
with an interferon-alfa.
• Not recommended for treatment of patients with CHC who have had solid organ
transplantation.
Adverse Effects Headache, Fatigue, Rigors, Insomnia, Anxiety, Alopecia, Pruritis.
Contraindications Pregnancy, Autoimmune hepatitis, Hypersensitivity, Decompensated liver disease.
Drug Interactions • may diminish the therapeutic effect of BCG (Intravesical).
• may enhance the adverse/toxic effect of CloZAPine. Agranulocytosis may be
increased.
Storage • Store in refrigerator at 2°C to 8°C. Do not freeze. Do not leave out of the refrigerator
for more than 24 hours.
• Do not shake.
• Discard any unused portion. Protect from light.
29.
30. RIBAVIRIN
Brand Names Rebetol, Virazole, Copegus, Moderiba, Ribasphere
Pharmacokinetics
Absorption:
Bioavailability
Oral: 64%
Distribution:
Protein binding
Oral: None
Metabolism:
•Hepatically
•Intracellularly
Excretion:
•Inhalation:
Urine (40%)
•Oral capsule:
Urine (61%)
Pharmacodynamics
May inhibit the initiation and elongation of RNA fragments by inhibiting
polymerase activity, which in turn results in the inhibition of viral protein
synthesis.
Dosing forms &
strengths:
• Tablet (200mg 400mg 600mg).
• Inhalation solution (6g/vial).
• Oral solution (40mg/mL).
Indications and Dosing
C H C
(Genotype 1 to 6)
• Body weight dependent dosing. Varied.
• Period: 24 to 48 hours.
31. Administration
Oral Administer with food.
Inhalation In well ventilated rooms.
Dosing
Considerations
Dose reductions/interruptions recommended if Hgb falls.
Adverse Effects Headache, Fatigue, Fever, Rigors, Myalgia, Body pain, Back pain, Arthalagia.
Contraindications Pregnancy, Autoimmune hepatitis, Hypersensitivity, Decompensated liver disease.
Drug Interactions • Ribavirin may enhance the hepatotoxic effect of Reverse Transcriptase Inhibitors.
Lactic acidosis may occur.
• Diminish the therapeutic effect of Influenza Virus Vaccine.
Storage • Store vials in a dry place at 15°C to 30°C.
• Store tablets at 25°C.
• Solution are refrigerated at 2°C to 8°C.
33. ELTROMBOPAG
Brand Names Promacta
Pharmacokinetics
Absorption:
Bioavailability
•Tablets: 52%
•Suspension:
increased by 22 %
Distribution:
Protein binding:
> 99%
Metabolism:
In liver
Excretion:
•In feces
•In urine
Pharmacodynamics
Interacts with transmembrane domain of human TPO receptor and induces
megakaryocyte proliferation and differentiation from bone marrow progenitor cells.
Dosing forms &
strengths
Tablet: 12.5 mg 25 mg 50 mg 75 mg
Indications and Dosing
Chronic Hepatitis C-
Associated
Thrombocytopenia
25 mg PO QD
34. Administration: Oral 1 hour before or 2 hours after a meal.
Dosing
Considerations
• Used in patients whose degree of thrombocytopenia prevents the initiation of interferon-
based therapy.
• Monitor CBCs with differentials (including platelet counts) qWeek.
• Not safe in combination with direct-acting antiviral agents.
• Used without interferons.
Adverse Effects Influenza-like symptoms, Headache, Rigor, Fatigue, Nausea, Arthralgia, Myalgia.
Contraindications Not documented.
Drug Interactions Aluminium hydroxide, Fe salts, Mg salts & calcium salts may decrease its serum
concentration.
Storage • Store oral suspension at 20°C to 25°C.
• Store oral tablets at 20°C to 25°C.