RT Book, Section A1 Deming, Paulina A2 DiPiro, Joseph T. A2 Talbert, Robert L. A2 Yee, Gary C. A2 Matzke, Gary R. A2 Wells, Barbara G. A2 Posey, L. Michael SR Print(0) ID 1148574107 T1 Viral Hepatitis T2 Pharmacotherapy: A Pathophysiologic Approach, 10e YR 2017 FD 2017 PB McGraw-Hill Education PP New York, NY SN 9781259587481 LK accesspharmacy.mhmedical.com/content.aspx?aid=1148574107 RD 2024/03/28 AB Patient Care Process: Management of Hepatitis C InfectionCollectPatient characteristics (e.g., age, sex, weight, vital signs, etc.)Patient history (past medical, family, social) and medical record summary including surgical operations (site, date, procedure) and abdominal imaging findingsMedication history (include prescription, nonprescription medications and other substances) and drug allergies and intolerances. Previous HCV therapy, if applicable.Laboratory results for chronic HCV infection including HCV genotype and viral load (RNA) (Table 40-12)Laboratory results for other viral infections impacting HCV treatment (HBV core antibody, HBV surface antigen, HBV surface antibody, HAV total or IgG antibody, HIV status)Hemoglobin and hematocritAssessDetermine severity of underlying liver disease based on laboratory tests, clinical calculators (such as for the Child-Pugh Score for cirrhosis [Table 37-2]), imaging studies, and clinical history (Chapter 37, Clinical Presentation)Estimate creatinine clearance to identify which HCV therapies may be usedReview patient-specific insurance company or healthcare payor formulary preferences and requirements for HCV therapy and determine if patient assistance programs may be utilized. Identify other potential obstacles to treatment success.Determine if pre-treatment resistance testing is required Check for drug interactions with prescribed medications, any non-prescription medications, herbal products, or dietary supplementsPlanEstablish the goal of therapy (e.g., eradicate HCV infection) with monitoring parameters for each goal (e.g., viral load). Consider efficacy and toxicity. Based on HCV genotype, severity of underlying liver disease, renal function, and prior treatment experience, determine the appropriate therapy (based on the latest national guidelines) , treatment duration and monitoring plan (Table 40-13) If ribavirin is part of therapy, review hemoglobin/hematocrit and need for supplemental iron, provide patient education to avoid pregnancy and prescription for contraception (if needed)ImplementInitiate HCV anti-viral therapy according to plan.Discontinue or modify adjunct medications if drug interactions anticipated with HCV antiviralsAssess patient for response to HCV antivirals (such as HCV RNA at treatment week 4) Discuss with patient and patient's family strategies to avoid, identify and treat any potential adverse effectsProvide education to patient and care givers about drug therapies and emphasize adherence. Discuss with patient and patient's family strategies to minimize likelihood for drug therapy interruptionsFollow-up: Monitor and EvaluateContinually reassess patient's use of HCV antivirals, any changes in other medications or herbals and supplements which could compromise HCV therapy, and any adverse effectsMonitor laboratories tests for response to antiviral therapy and changes in liver enzymesMonitor for adherence and any interruptions in therapy which could risk the emergence of resistance and treatment failureEvaluate patient for cure at least 12 weeks after completion of therapy and discuss implications of cure, HCV antibody positivity, and risks for reinfectionReassess patient's risk for reinfection