CSP Clinical Management: Infectious Disease 2

Question 1

A treatment-naive patient with chronic HCV genotype 3 and no cirrhosis starts glecaprevir/pibrentasvir. What is the recommended treatment duration?

Accepted Answer

8 weeks

Answer

Glecaprevir/pibrentasvir is given for 8 weeks to treatment-naive patients of any genotype, with or without compensated cirrhosis.

Question 2

A patient starting sofosbuvir/velpatasvir also takes amiodarone. What is the primary safety concern?

Accepted Answer

Serious symptomatic bradycardia

Answer

Giving sofosbuvir with amiodarone can cause serious, sometimes fatal, symptomatic bradycardia.

Question 3

Before starting direct-acting antiviral therapy for HCV, which screening is required because of a boxed warning?

Accepted Answer

HBsAg and anti-HBc to assess hepatitis B reactivation risk

Answer

HCV DAAs carry a boxed warning for HBV reactivation, so all patients need HBV screening first.

Question 4

A patient on sofosbuvir/velpatasvir needs a proton pump inhibitor. Why is this combination a concern?

Accepted Answer

Higher gastric pH lowers velpatasvir solubility and absorption

Answer

Velpatasvir solubility drops as pH rises, so if a PPI is needed, the DAA should be taken with food 4 hours before omeprazole 20 mg.

Question 5

Which HCV regimen is contraindicated in a patient with decompensated (Child-Pugh B or C) cirrhosis?

Accepted Answer

Glecaprevir/pibrentasvir

Answer

Regimens containing an NS3/4A protease inhibitor, such as glecaprevir, are contraindicated in decompensated cirrhosis because of hepatotoxicity risk.

CSP - Certified Specialty Pharmacist Practice Test