Please enable JavaScript.

Coggle requires JavaScript to display documents.

chronic viral hepatitis (Hepatitis C (Extrahepatic Manifestations (HCV and…

- - - - Cytidine nucleoside analogue
        
        Inhibits first-strand DNA synthesis
        
        dosing: Oral
        100 mg/day, Adjust for renal dysfunction
    - - Adenosine nucleotide analogue
        
        MOA:
        Inhibitor of HBV DNA polymerase
        Not dependent on intracellular kinases for first phosphorylation step
        
        Effective against wild-type and lamivudine-resistant HBV
        
        Dosing (oral):
        10 mg/day, Adjust for renal dysfunction
    - - Deoxyguanine nucleoside analogue
        
        MOA: Inhibits HBV replication in 3 ways
        Priming of HBV DNA polymerase
        Reverse transcription of the negative DNA strand from pregenomic RNA
        Synthesis of the positive DNA strand
        
        Effective against wild-type and lamivudine-resistant HBV
        
        Dosing (oral):
        0.5 mg (wild type) or 1 mg (lam-R) daily, Adjust for renal dysfunction
    - - Nucleotide analogue
        
        Single table regime – 1x1 tab/day 245mg
        Selective inhibitor HBV polymerase
        
        Strong viral replication inhibitor (suppression about 7 log)
        
        Drug resistance
        Not register in immunocompetent patients
        tolerance profile similar to entecawir
        Kidney function and osteoporosis monitoring monthly first year of therapy
        
        Doses reduction in kidney impairment
    - - Sustained suppression of HBV DNA replication
        HBeAg seroconversion
        Improvement in liver histology
        Reduced rates of liver complications
      - HBeAg-
        Treat indefinitely
        
        HBeAg+
        -Seroconversion: Stop 6–12 months later
        -No seroconversion: Continue
    - - Recombinant interferon immune modulator
        
        Injection
        
        MOA:
        Dual immunomodulatory and antiviral mode  of action
        Exact target against HBV replication  unknown
- - - - Manifestations
        
        Dermatitis (dependent areas), Vasculitis
        
        Myalgias (fibromyalgia?), Arthralgias (RA and/or ANA positive)
        
        Membranoproliferative glomerulonephritis, Neuropathy
        
        Chronic fatigue syndrome
    - - 10%-30% of patients with chronic HCV
        
        Appearance
        Flat topped, violaceous, pruritic papules
        Throughout body
        Oral mucosa
        
        Histology
        Dense infiltration of dermis with T lymphocytes
  - - - Confirmation HCV infection
        Detection quantitative test HCVRNA (real time PCR)
        Detection HCV genotype
        
        Confirmation liver disease
        Liver biopsy, Elastography (Fibroscan), Fibrotest
        
        Polymorphism IL-28B – not obligatory for IFN-free
        CC –predictor of good therapy response
        CT –predictor of worse therapy response
        TT –predictor of bad therapy response
    - - Autoimmune disorders (only interferon based-therapy)
        Immunosuppressive therapy autoimmune diseases
        Autoimmune diseases in remission stage
        Immunocompromised patients (facultative)
        
        Lack of patients cooperation
        Mental disorders, Active addiction, Refuse of therapy
        
        Active neoplastic disorder (facultative, IFN based therapy)
        
        Decompensation other disorders (facultative)
  - - - False positives
        Autoimmune disorders
        Spontaneous resolution of viral infection
        
        False negatives
        Chronically immune suppressed
        Transplant recipients
        Chronic renal failure on dialysis
        HIV positive
    - - Confirm HCV infection:
        Persistently normal serum ALT, No risk factors
        HCV antibody positive, Antinuclear antibodies
        Prior to initiating therapy
        
        Assess effectiveness of treatment
        Predict likelihood of response before and during therapy
        Confirm response after therapy completed