The pharmacological management of viral hepatitis has been revolutionized over the past decade, particularly with the advent of Direct-Acting Antivirals (DAAs) for Hepatitis C. These agents have transformed a chronic, debilitating disease into a curable condition. As a future pharmacist, a deep understanding of the pharmacology of these life-changing medications, a key topic in the Patient Care 4 curriculum, is essential. This quiz will test your knowledge on the mechanisms of action, drug targets, and clinical pharmacology of antivirals used to treat Hepatitis B and C, preparing you to manage these complex therapies and optimize patient outcomes.
1. Direct-Acting Antivirals (DAAs) have transformed the treatment of which type of viral hepatitis?
- a. Hepatitis A
- b. Hepatitis B
- c. Hepatitis C
- d. Hepatitis E
Answer: c. Hepatitis C
2. What is the primary goal of therapy with DAAs for Hepatitis C?
- a. Long-term viral suppression
- b. Reduction of liver enzymes to the normal range
- c. Achievement of a Sustained Virologic Response (SVR)
- d. Prevention of transmission only
Answer: c. Achievement of a Sustained Virologic Response (SVR)
3. Sofosbuvir is a highly effective DAA for Hepatitis C. What is its mechanism of action?
- a. It inhibits the NS3/4A protease.
- b. It inhibits the NS5A replication complex.
- c. It is a nucleoside analog that inhibits the NS5B RNA polymerase.
- d. It inhibits viral entry into hepatocytes.
Answer: c. It is a nucleoside analog that inhibits the NS5B RNA polymerase.
4. The “-previr” suffix in a DAA name, such as glecaprevir, indicates that the drug is a(n):
- a. NS5B Polymerase Inhibitor
- b. NS5A Replication Complex Inhibitor
- c. NS3/4A Protease Inhibitor
- d. Host-targeting agent
Answer: c. NS3/4A Protease Inhibitor
5. The “-asvir” suffix in a DAA name, such as velpatasvir, indicates that the drug is a(n):
- a. NS5B Polymerase Inhibitor
- b. NS5A Replication Complex Inhibitor
- c. NS3/4A Protease Inhibitor
- d. Cyclophilin inhibitor
Answer: b. NS5A Replication Complex Inhibitor
6. The “Pharmacology of Hepatitis Antivirals” is a specific learning module in which course?
- a. PHA5784C Patient Care 4
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5784C Patient Care 4
7. Why are DAAs for Hepatitis C always used in combination regimens?
- a. To reduce the cost of therapy.
- b. To target multiple steps in the viral lifecycle, which increases efficacy and provides a high barrier to resistance.
- c. To improve the taste of the medications.
- d. One drug is for the virus and the other is for liver protection.
Answer: b. To target multiple steps in the viral lifecycle, which increases efficacy and provides a high barrier to resistance.
8. Which of the following is a first-line class of medication for the treatment of chronic Hepatitis B?
- a. Direct-Acting Antivirals (DAAs)
- b. Monoclonal antibodies
- c. Nucleos(t)ide Reverse Transcriptase Inhibitors (NRTIs)
- d. Interferon-gamma
Answer: c. Nucleos(t)ide Reverse Transcriptase Inhibitors (NRTIs)
9. Entecavir and tenofovir are used for chronic Hepatitis B. What is their mechanism of action?
- a. They inhibit the viral protease.
- b. They inhibit the HBV DNA polymerase enzyme.
- c. They block viral entry.
- d. They modulate the host immune system.
Answer: b. They inhibit the HBV DNA polymerase enzyme.
10. What is the goal of therapy for chronic Hepatitis B?
- a. A cure, defined as eradication of the virus.
- b. Long-term suppression of HBV DNA to undetectable levels to prevent disease progression.
- c. A 12-week course of treatment.
- d. To increase liver enzymes.
Answer: b. Long-term suppression of HBV DNA to undetectable levels to prevent disease progression.
11. The virology of Hepatitis A, B, and C is a topic in the Patient Care 2 curriculum.
- a. True
- b. False
Answer: a. True
12. A patient being treated with a DAA regimen containing sofosbuvir should be warned about a serious drug interaction causing bradycardia if they are also taking:
- a. Amlodipine
- b. Amiodarone
- c. Atorvastatin
- d. Allopurinol
Answer: b. Amiodarone
13. Ribavirin, an older antiviral sometimes used with DAAs, carries a significant black box warning for which two adverse effects?
- a. Nephrotoxicity and Ototoxicity
- b. Hemolytic anemia and Teratogenicity
- c. Hepatotoxicity and Pancreatitis
- d. Severe rash and Myopathy
Answer: b. Hemolytic anemia and Teratogenicity
14. What does “SVR12” signify in Hepatitis C management?
- a. The patient has been treated for 12 months.
- b. The patient has a virus that is resistant to 12 drugs.
- c. Undetectable HCV RNA at 12 weeks after completion of therapy.
- d. The patient’s liver enzymes have normalized for 12 weeks.
Answer: c. Undetectable HCV RNA at 12 weeks after completion of therapy.
15. Many DAA regimens can be affected by acid-suppressing therapy (e.g., PPIs). This is because:
- a. The absorption of some DAAs (like ledipasvir and velpatasvir) is pH-dependent.
- b. PPIs induce the metabolism of all DAAs.
- c. The combination increases the risk of QTc prolongation.
- d. There is no such interaction.
Answer: a. The absorption of some DAAs (like ledipasvir and velpatasvir) is pH-dependent.
16. Which of the following is a “pan-genotypic” DAA regimen, effective against all major HCV genotypes?
- a. Elbasvir/grazoprevir
- b. Sofosbuvir/velpatasvir
- c. Ledipasvir/sofosbuvir
- d. Paritaprevir/ritonavir/ombitasvir + dasabuvir
Answer: b. Sofosbuvir/velpatasvir
17. The management of viral hepatitis is a specific topic within the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
18. Tenofovir alafenamide (TAF) is a prodrug of tenofovir that differs from tenofovir disoproxil fumarate (TDF) in that it:
- a. Has lower rates of renal and bone mineral density-related side effects.
- b. Is less potent against Hepatitis B.
- c. Requires twice-daily dosing.
- d. Is not effective for HIV.
Answer: a. Has lower rates of renal and bone mineral density-related side effects.
19. Which hepatitis virus is an RNA virus?
- a. Hepatitis A
- b. Hepatitis C
- c. Hepatitis E
- d. All of the above
Answer: d. All of the above
20. Which hepatitis virus is a DNA virus?
- a. Hepatitis A
- b. Hepatitis B
- c. Hepatitis C
- d. All are RNA viruses.
Answer: b. Hepatitis B
21. The “-buvir” suffix in a DAA name, such as sofosbuvir, indicates that the drug is a(n):
- a. NS5B Polymerase Inhibitor
- b. NS5A Replication Complex Inhibitor
- c. NS3/4A Protease Inhibitor
- d. Host-targeting agent
Answer: a. NS5B Polymerase Inhibitor
22. Which older hepatitis therapy was known for causing significant psychiatric side effects, including depression and suicidal ideation?
- a. Ribavirin
- b. Lamivudine
- c. Entecavir
- d. Pegylated interferon-alfa
Answer: d. Pegylated interferon-alfa
23. Many DAAs are substrates of CYP3A4 and/or P-glycoprotein. Therefore, co-administration with a potent inducer like rifampin is:
- a. Recommended to boost DAA levels.
- b. Contraindicated due to the risk of therapeutic failure of the DAA.
- c. Contraindicated due to the risk of rifampin toxicity.
- d. Allowed with careful monitoring.
Answer: b. Contraindicated due to the risk of therapeutic failure of the DAA.
24. The active site of the HCV NS3/4A protease is a target for which class of DAAs?
- a. NS5A inhibitors
- b. Polymerase inhibitors
- c. Protease inhibitors
- d. Entry inhibitors
Answer: c. Protease inhibitors
25. A pharmacist dispensing a DAA regimen must counsel the patient on:
- a. The importance of 100% adherence for the full duration of therapy.
- b. Potential drug-drug interactions.
- c. The need for follow-up testing to confirm SVR.
- d. All of the above.
Answer: d. All of the above.
26. Why is ribavirin a teratogen?
- a. It inhibits DNA polymerase.
- b. It is a nucleoside analog that can be incorporated into DNA and RNA, causing mutations.
- c. It depletes red blood cells.
- d. It is a potent immunosuppressant.
Answer: b. It is a nucleoside analog that can be incorporated into DNA and RNA, causing mutations.
27. Before starting a patient on treatment for chronic Hepatitis B, it is essential to:
- a. Test the patient for HIV, as some HBV drugs also treat HIV and can induce resistance if used as monotherapy.
- b. Ensure the patient has a high fiber diet.
- c. Check their blood pressure.
- d. Obtain a chest x-ray.
Answer: a. Test the patient for HIV, as some HBV drugs also treat HIV and can induce resistance if used as monotherapy.
28. An active learning session on the management of hepatitis is part of the Patient Care 4 course.
- a. True
- b. False
Answer: a. True
29. The NS5A protein of HCV is critical for:
- a. Viral entry into the cell.
- b. Viral RNA replication and virion assembly.
- c. Cleavage of the viral polyprotein.
- d. Egress of the new virus particles.
Answer: b. Viral RNA replication and virion assembly.
30. Hepatitis A is typically a(n):
- a. Chronic infection requiring lifelong therapy.
- b. Acute, self-limiting infection that does not become chronic.
- c. DNA virus.
- d. Infection treated with DAAs.
Answer: b. Acute, self-limiting infection that does not become chronic.
31. What is a key counseling point for a patient taking tenofovir (TDF or TAF)?
- a. The medication can be stopped as soon as symptoms improve.
- b. There is a risk of an acute exacerbation of Hepatitis B if the medication is stopped abruptly.
- c. The medication should be taken on an empty stomach.
- d. This medication will cure their Hepatitis B infection.
Answer: b. There is a risk of an acute exacerbation of Hepatitis B if the medication is stopped abruptly.
32. The mechanism of action of NRTIs like entecavir involves:
- a. Acting as a chain terminator after being incorporated into the growing viral DNA strand.
- b. Blocking the viral protease enzyme.
- c. Inhibiting the NS5A protein.
- d. Modulating the immune system.
Answer: a. Acting as a chain terminator after being incorporated into the growing viral DNA strand.
33. Patients with cirrhosis starting DAA therapy have a black box warning regarding the risk of:
- a. Hepatitis B reactivation.
- b. Severe hypertension.
- c. Acute pancreatitis.
- d. Worsening ascites.
Answer: a. Hepatitis B reactivation.
34. What is the primary route of transmission for Hepatitis C?
- a. Fecal-oral route
- b. Contaminated food and water
- c. Parenteral (blood-borne) route
- d. Respiratory droplets
Answer: c. Parenteral (blood-borne) route
35. A significant drug-drug interaction exists between ledipasvir/sofosbuvir and which class of medications?
- a. Beta-blockers
- b. Statins (e.g., rosuvastatin)
- c. ACE inhibitors
- d. Metformin
Answer: b. Statins (e.g., rosuvastatin)
36. The pharmacology of hepatitis antivirals is a lecture within the Hepatic Disease module.
- a. True
- b. False
Answer: a. True
37. Which of the following is NOT a class of Direct-Acting Antivirals for HCV?
- a. NS3/4A Protease Inhibitors
- a. NS5A Inhibitors
- c. NS5B Polymerase Inhibitors
- d. Integrase Strand Transfer Inhibitors
Answer: d. Integrase Strand Transfer Inhibitors
38. The goal of using pegylated interferon was to:
- a. Reduce the side effects of interferon.
- b. Increase the half-life of interferon, allowing for less frequent dosing.
- c. Improve the taste of interferon.
- d. Make the interferon an oral medication.
Answer: b. Increase the half-life of interferon, allowing for less frequent dosing.
39. A pharmacist’s role in HCV management includes:
- a. Screening for drug-drug interactions with the DAA regimen.
- b. Counseling on the importance of adherence.
- c. Assisting with prior authorizations.
- d. All of the above.
Answer: d. All of the above.
40. Hepatitis A and B are both preventable through:
- a. Antiviral therapy
- b. Vaccination
- c. Diet and exercise
- d. Probiotics
Answer: b. Vaccination
41. Sofosbuvir is a nucleotide analog, which means it is a prodrug that:
- a. Is active immediately upon administration.
- b. Must be metabolized inside the host cell to its active triphosphate form.
- c. Is only active against DNA viruses.
- d. Is not absorbed orally.
Answer: b. Must be metabolized inside the host cell to its active triphosphate form.
42. A patient with decompensated cirrhosis (e.g., Child-Pugh B or C) should not receive a DAA regimen that contains what?
- a. An NS5B inhibitor
- b. An NS5A inhibitor
- c. A protease inhibitor
- d. Any DAA is safe.
Answer: c. A protease inhibitor
43. The development of pan-genotypic DAA regimens was a major advance because:
- a. They are cheaper than genotype-specific regimens.
- b. They eliminated the need for HCV genotyping prior to treatment in many patients.
- c. They have fewer side effects.
- d. They require a shorter duration of therapy.
Answer: b. They eliminated the need for HCV genotyping prior to treatment in many patients.
44. What is the primary reason for the high cost of DAA therapies?
- a. The raw materials are very expensive.
- b. The manufacturing process is extremely complex.
- c. The cost reflects the research and development investment and the value of providing a cure.
- d. The tablets are made of gold.
Answer: c. The cost reflects the research and development investment and the value of providing a cure.
45. A patient on entecavir for Hepatitis B should be counseled to take the medication:
- a. With a high-fat meal.
- b. On an empty stomach.
- c. At bedtime to reduce side effects.
- d. Only when they have symptoms.
Answer: b. On an empty stomach.
46. A patient who achieves SVR after HCV treatment:
- a. Is immune to reinfection with HCV.
- b. Can still be reinfected with a different HCV genotype or the same one.
- c. Must continue DAA therapy for life.
- d. No longer needs to be screened for liver cancer.
Answer: b. Can still be reinfected with a different HCV genotype or the same one.
47. The introduction of DAAs has largely replaced which older, poorly tolerated therapy for HCV?
- a. Lamivudine
- b. Acyclovir
- c. Interferon-based regimens
- d. Tenofovir
Answer: c. Interferon-based regimens
48. What is the role of a pharmacist in preventing viral hepatitis?
- a. Identifying at-risk patients and strongly advocating for Hepatitis A and B vaccination.
- b. Providing sterile syringes through needle-exchange programs.
- c. Counseling patients on safe practices to avoid transmission.
- d. All of the above.
Answer: d. All of the above.
49. The typical duration of therapy for most modern DAA regimens for Hepatitis C is:
- a. 4 weeks
- b. 8-12 weeks
- c. 24-48 weeks
- d. Lifelong
Answer: b. 8-12 weeks
50. The ultimate goal of understanding the pharmacology of hepatitis antivirals is to:
- a. Memorize all the brand and generic names.
- b. Ensure the safe and effective use of these complex medications to cure HCV and suppress HBV, thereby improving patient lives.
- c. Pass the pharmacology exam.
- d. Be able to explain the viral lifecycle in detail.
Answer: b. Ensure the safe and effective use of these complex medications to cure HCV and suppress HBV, thereby improving patient lives.
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