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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Identify and evaluate the clinical manifestations and laboratory parameters relevant to the assessment and treatment of chronic hepatitis C virus (HCV) infection.

  • Design a patient-specific pharmaceutical care plan for a patient with chronic HCV, including drugs, doses, and duration of therapy.

  • Develop a plan for monitoring efficacy and adverse effects of the pharmacologic agents used in the management of chronic HCV.

  • Identify and evaluate the drug interactions related to pharmacologic agents used in the treatment of chronic HCV, especially with direct-acting antivirals (DAAs).

  • Provide patient education for patients with chronic HCV regarding their medications, nonpharmacologic interventions/behaviors, and vaccinations.

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PATIENT PRESENTATION

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Chief Complaint

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“About two months ago, my internal medicine doctor informed me that my liver tests were abnormal. He referred me to your liver disease clinic for assessment and follow-up. I had my first liver clinic visit a month ago, and I’m here today to talk about treatment.”

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HPI

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Jason Corey is a 38-year-old man who has been referred by his internal medicine physician to the liver clinic for assessment of his abnormal liver enzymes. After a conversation between the internal medicine physician and the hepatologist, Mr Corey had a battery of labs drawn and a liver biopsy done last week. He returns to the clinic today for a complete physical and further workup.

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About 2 months ago, he went to his internal medicine physician for follow-up of his chronic left shoulder pain. The injury occurred 1.5 years ago from a body slam during a wrestling match with some friends. He was unable to treat the injury because he had no insurance at that time. He states that he has pain in his shoulder “all the time.” He describes it as mild intensity, but it worsens during sleep, exercise, and physical therapy. He states that the pain is better with heat, and was improving with ibuprofen. However, his internal medicine physician discontinued ibuprofen in light of his potential liver disease. Since he was about 25 years old, he has worked out with weights about 3–4 days a week, and runs a few times a week. Although he continues to maintain his regimen despite working long hours, he has noticed a progressive decline in his stamina over the few months. He reports use of recreational drugs “on and off for the past 10 years,” which included marijuana, alcohol, IV heroin, and intranasal cocaine. He states that he stopped use of these drugs around 6 months ago. He also has a history of alcohol abuse. His consumption of alcohol had gone from just an occasional social drink to drinking 8–12 drinks per day. He was treated for drug and alcohol abuse 6 months ago through an inpatient treatment program, and says he has been sober since that time. ...

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