December 2017 Newsletter
Illuminated waterfront Savannah Historic District at night
Save the Date

GSHP Spring Meeting

March 23-25, 2018
Marriott Riverfront
Savannah, GA

 
Webinar-Thursday, December 14, 2017 - 12 noon-1:00 pm
Clinical Case: Dual Calcium Channel Blockade for the Treatment of Hypertension 
 
 
AdrianStephens,PharmD
PGY2AmbulatoryCarePharmacyResident
GradyHealthSystem
 
Objectives: 

Recall current treatment options in the management of resistant hypertension

Evaluate the mechanisms and potential synergistic activity of nondihydropyridine (Non-DHP) and dihydropyridine (DHP), calcium channel blockers (CCBs)

  Identify patient populations which may benefit from dual CCB therapy
 
Georg ia  Society of Health-System Pharmacists is accredited by the Accreditation Council for Pharm acy Educati on (ACPE) as a provider of continuing pharmacy education. This program is approved for 1 hour (0.1 CEUs) of continuing pharmacy education credit.  Proof of participat ion will be posted to your NABP CPE profile within 4 to 6 weeks to 
participants who have successfully completed the post-test.   Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit.  UAN  # 0228-0000-17-144-L01-P; 0228-0000-17-144-L01-T

This is a member service of GSHP.  There is no charge for members to attend.   Dues must be current to receive CE credit.

Non-members will be charged $20.


Non-member registration:  Email
sglass@gshp.org
Call for Committee Volunteers


GSHP invites you to serve as a member of one our committees during the 2018 year.  


 

GSHP's mission is to help our members become better practitioners.  We work towards fulfilling our mission every year through education of our members via district meetings, statewide meetings, newsletters, and our website; fostering professional standards; educating the public about the role of health system pharmacists; monitoring legislative issues that affect pharmacy; and by promoting health system pharmacy as a career path for future pharmacists.  The majority of our Society's work is done by member volunteers working through our committees.  You can play a vital role by serving on one of our committees.  


 

What will you get out of it?  It looks good on your resume.  You will meet and get to know many of the current and future pharmacy leaders in Georgia, make new friends, and maybe make a good impression on a future employer.  Also, you will have the professional satisfaction of helping shape and advance health system pharmacy in Georgia.  

What is your commitment?  It can be as little as giving your input during our upcoming
Committee Day on Saturday, January 6, 2018 and participating in conference calls, to taking on other assignments depending on your interests and time.   


 

The following is a description of the functions of each committee.  If you are interested in serving on a committee for GSHP, please click on the link below:  

https://www.surveymonkey.com/r/2018gshpcommittee

 

If you were a member of a committee last year, please also click on the link and confirm your participation for this year.  

Committees will meet on Saturday, January 6, 2018 from 9am to 12 noon at Eagles Landing Country Club in Stockbridge, (directions).  If you cannot attend  Committee Day, you can still serve on a committee.  The Committee Chair will contact you regarding upcoming meetings or other opportunities to participate. 


 

COMMITTEE FUNCTIONS AND CHARGES: 


 

COMMUNICATIONS COUNCIL: The Communications Council and Editorial Board is responsible for the direction, development, and quality control of all GSHP publications, including the GSHP web site. 


 

EDUCATIONAL AFFAIRS: The Educational Affairs Committee is responsible for planning, coordinating, and evaluating educational content of the 3 statewide GSHP meetings.   


 

LEGISLATIVE AFFAIRS: The Legislative Committee is responsible for informing the GSHP membership and Board of Directors of important legislation and regulations and how they will impact pharmacy practice in organized health care settings in Georgia. 


 

ORGANIZATIONAL AFFAIRS: The Organizational Affairs Committee reviews and analyzes the GSHP organization and make recommendations to increase its effectiveness. It also serves as a liaison between GSHP and other professional organizations. 


 

PROFESSIONAL AFFAIRS: The Professional Affairs Committee provides recommendations to the Board of Directors on policies and actions to be taken by GSHP on issues of professional practice.  


 

PUBLIC RELATIONS: The Public Relations Committee provides the public with information and awareness of GSHP's mission and values through a variety of forums and media. GSHP's publics include, but are not limited to: patients/consumers and their families, industry, other healthcare professionals, organized healthcare executives, academia, pharmacists, technicians and other pharmacy support staff, and other pharmacy professional organizations.  

 

STUDENT and RESIDENTS COMMITTEE: The Student and Residents Committee provides input to GSHP on how to get students interested in health-system pharmacy practice and how to get them interested and involved in GSHP.   


 

Make a commitment to get involved with a GSHP Committee.

 

ASHP Pharmacy Technician Forum 
Executive Committee Nominations
 
ASHP recently launched the Pharmacy Technician Forum and is currently seeking recommendations for technicians to serve on the inaugural Pharmacy Technician Forum Executive Committee for the 2018-2019 term.
 
The Executive Committee will be comprised of five pharmacy technicians who will advise ASHP on the optimal benefits and services, education, tools, professional practice policies, and resources technicians need to enhance and advance their careers and to further elevate their vital roles as members of the interprofessional patient care team.
 
The deadline for recommendations is February 5, 2018.
 
ASHP is especially interested in appointing pharmacy technicians to this inaugural committee who reflect a diverse pool of knowledge, practice expertise, and have a strong interest to represent pharmacy technician workforce needs and abilities on a national level.
 
Individuals must complete the online Submission Form to recommend themselves or someone else for appointment. Individuals may also make more than one recommendation. If you have any questions, please contact Tyffani Wingfield in the Office of Member Relations at membership@ashp.org.
 
For more information about the Pharmacy Technician Forum, please visit ashp.org/technicians
 
GSHP Leadership Profile
Anthony Hawkins, PharmD, BCCCP
 
What is your current leadership position in GSHP?
Elected to New Practitioner seat for the Board of Directors in 2016
 
What benefits do you see in being active in a professional association such as GSHP?  
Excellent networking with colleagues across the state, ability to further develop my leadership skills, give back to the profession in the form of service, and represent a specific demographic of pharmacists across the state based on my position on the board.
 
What initially motivated you to get involved in GSHP?
I wanted to build my network, find a platform to teach pharmacists across the state about my passion for critical care and optimizing fluid management, and help grow the organization by bringing my unique skill set and perspective to the table.
 
Where did you go to pharmacy school?
I completed my PharmD at University of Georgia in 2012.
 
Where have you trained or worked?  
PGY-1 Pharmacy Practice: Emory Healthcare. Completed in 2013
PGY-2 Critical Care specialty: Emory Healthcare. Completed in 2014
Clinical Assistant faculty with University of Georgia since Fall 2014
Adjunct clinical assistant faculty with Medical College of Georgia since Fall 2015
 
Describe your current area of practice and practice setting:
Full time clinical faculty with University of Georgia. I work in a 12-bed medical ICU at Phoebe Putney Memorial Hospital in Albany, GA. This is my practice site for pharmacy students, pharmacy residents, and medical students.
 
What advice would you give to student pharmacists?
Get involved and do so early. 'Who you know' is just as important as 'what you know.'
 
What pharmacy related issues keep you up at night?
Zero. Work-life balance is very important to me.
 
Do you have any special interests or hobbies outside of work?
Most anything outdoors, but special preference to bowhunting and disc golf/frisbee. Cold months you can find me by a fire or in a deer stand. Warm months, you can find me by a pool or in the river, either swimming or kayaking. Good food and friends on the patio is a year-round priority.
 
What is your favorite place to vacation?
I take 2 or 3 days every November and April to chase deer and turkeys, respectively. For travel, I try not to go to the same place twice. Grand Canyon, Flagstaff, San Antonio, Chicago, Oregon, Washington...its all good, you just gotta go with the right people.
 
What 3 adjectives would people use to best describe you?
Easy-going, Intelligent, Welcoming 

Clinical Article

Chronic Hepatitis C Update

Authors: Seth Garner, PharmD Candidate, Class of 2019
Miki Hayashi an d Katie Fitton, PharmD Candidates, Class of 2020
Reviewed By: Dr. Brian Seagraves, Pharm.D.
Academic Professional Associate
University of Georgia College of Pharmacy
 
Background
            Hepatitis C is a viral disease of the liver that affects roughly 2.7 - 3.9 million people in the United Statesalone according to the Center of Disease Control (CDC).[1] In 2014, there was an estimated 30,500 new acute hepatitis C cases.[1]One study, published in Clinical Infectious Diseases, shows that the annual hepatitis C-related mortality in 2013 was greater than the total combined number of deaths from 60 other infectious diseases such as HIV, pneumococcal disease, and tuberculosis.[1]Difficulties in diagnosing the disease, treatment inaccessibility, and lack of education could be potential causes for the increased number of Hepatitis C cases.
Hepatitis C is caused by a blood-borne RNA virus that replicates copiously in the cytoplasm albeit making many replication errors. The disease begins as an acute infection which then develops into a chronic disease state after the patient has been infected for at least 6 months. The CDC estimates that 75-85% of acute hepatitis C cases will progress to this chronic stage, in which receiving treatment then becomes vital. [1]  Despite being a very curable disease with numerous high success rate therapies currently available on the market, the medications often remain inaccessible due to their costly price. 
 
Signs and Symptoms
Due to the majority of newly acquired Hepatitis C individuals remaining asymptomatic, many cases go unreported. Hepatitis C can take as little as 4 weeks or up to 20 years for people to present with symptoms. These symptoms include jaundice, abdominal pain, joint pain, nausea, vomiting, dark urine, loss of appetite, and fever. If left untreated, the liver becomes at risk for cirrhosis, liver failure, and hepatocellular carcinoma.    
Only about 20-30% of newly infected individuals will start to experience these symptoms early on that reflect acute illness. [1]  The remaining patients will develop chronic Hepatitis C, often not realizing they are positive for the virus. Identification can occur while being screened for blood donations, during routine exams, or being examined upon incarceration. It often first appears as an elevated level of alanine aminotransferase (ALT) which then leads to further testing for the Hepatitis C virus in the blood.[1]
 
Etiology           
            Hepatitis C is primarily transmitted through contact with infectious blood. IV drug users, people who receive blood products, those born to a HCV-infected mother, and those receiving tattoos in non-sterile environments are all at severe risk of developing an infection. Some less common ways people can become infected are through the sharing of razors and sexual contact. It is not known the exact mechanism for the spread of HCV through sex, but there seems to be a strong correlation between individuals with multiple sex partners and those infected with HCV.]2]
 
The U.S. Department of Health and Human Services recommends the following groups to be tested due to an increased risk for HCV infection.[3]
  1. Person born from 1945 through 1965
  2. Person who has ever injected illegal drugs- including those who only injected once
  3. Recipients of clotting factor concentrates made before 1987
  4. Recipients of blood transfusions or solid organ transplants before July 1992
  5. Patients who have ever received long-term hemodialysis treatment
  6. Persons with known exposure to HCV
    • Health care workers
    • Recipients of blood or organs from a donor who later tested HCV-positive
  7. All persons with an HIV infection
  8. Patients with signs or symptoms of liver disease
  9. Children born to HCV-positive mothers 
 
Testing and Diagnosis
       The types of blood tests used to detect an infection are immunoassays and qualitative/quantitative tests using Hepatitis C Virus RNA Polymerase Chain Reaction (HCV RNA PCR). Through these tests, the Hepatitis C virus and its genotype is identified. The possible genotypes are listed in the table below. The extent of infection can then be determined by quantifying the specific number of viruses measured in one milliliter of blood (viral load). A viral load in the millions is considered very high and can be indicative of chronic Hepatitis C.
Genotypes
1 (a, b)
2 (a,b,c,d)
3 (a,b,c,d,e,f)
4 (a,b,c,d,e,f,g,h,i,j)
5a
6a
 


Figure 1. The most prevalent genotype, affecting approximately 75% of Americans, is genotype 1 (1a or 1b) while 20-25% of HCV infected patients have genotypes 2 or 3. In Africa, genotype 4 is most common, and genotype 6 is most common in Southeast Asia. Only a small portion of North Americans have genotypes of 4, 5, or 6. In most cases, individuals will only have one principle genotype, but co-infection with multiple genotypes is possible.[4]

 
Individuals in the acute stage of the disease will typically develop abnormal lab findings in the following order: detectable HCV RNA, elevation of ALT, and finally anti-HCV. The gold standard for diagnosing acute Hepatitis C is the anti-HCV seroconversion combined with a positive HCV RNA test and elevated ALT.[5]
            Patients who have chronic Hepatitis C will have similar HCV RNA, anti-HCV and ALT results to individuals diagnosed with acute Hepatitis C; however, patients with chronic Hepatitis C will have fluctuating ALT levels with periodic returns to normal or near normal levels. Once a positive diagnosis of chronic or acute Hepatitis C has been identified, patients will need to obtain a viral genotype in order to adequately treat the disease.[1]
            Likewise, it is imperative to determine the extent of liver damage done in order to appropriately determine the correct treatment for each patient. In patients with a cirrhotic liver, the tissue slowly deteriorates, and non-functional scar tissue replaces functional liver tissue. There are four stages for those individuals with cirrhosis. Stages 1 and 2 are considered compensated. Stages 3 and 4 are considered decompensated. The methods for stage determination are: needle liver biopsy, Fibrosure analysis, and Fibroscan, otherwise known as fibrosis staging. (See Supplemental Figure 1)
 
Treatment options
      Prior treatment options of Hepatitis C included PEG/Interferon alpha combinations, but are no longer recommended as first line therapies.[6] Current treatment focuses on direct acting antivirals. In selecting from these treatments, prior HCV treatment, the condition of the liver, genotype, and potential comorbidities need to be considered.
The drugs target 3 specific sites on the viral RNA which encodes for proteins that are vital for replication: NS3/4A, NS5A, and NS5B. The first site, NS3/4A, encodes for a protease/cofactor complex. NS5A and NS5B encode for different RNA polymerases. The targets for the current direct acting antivirals are listed in Table 1 with the genotype indications. Contraindications and side effects of these agents can be found in Supplemental Figures 2 and 3.
 
Table 1: Genotype Indications for Direct Acting Anti-virals
Drug (Active Components)
▼Most Recent Release
NS3/4A
Serine Protease
NS5A
RNA Polymerase
NS5B
RNA Polymerase
Genotype Indication
Mavyret (2017)
(Glecaprevir / Pibrentasvir)
 
 
 
1-6
 
Vosevi (2017)
(Sofosbuvir / Velpatasvir / Voxilaprevir)
 
 
 
1-6
Epclusa (2016)
(Velpatasvir / Sofosbuvir)
 
 
 
1-6
Zepatier (2016)
(Grazoprevir / Elbasvir)
 
1,4
Viekira XR (2016)
(Dasabuvir / Ombitasvir / Paritaprevir / Ritonavir)
 
 
 
 
1
Daklinza (2015)
Daklatasvir
 
 
1,3
Technivie (2015)
(ombitasvir / paritaprevir / and ritonavir)
 
 
 
4
Viekira Pak (2014)
Ombitasvir / Paritaprevir / Ritonavir and Dasabuvir
 
 
 
1
Harvoni (2014)
Ledipasvir / Sofosbuvir
 
1,4,5,6
Sovaldi (2013)
Sofosbuvir
 
 
1-4
Olysio (2013)
Simeprevir
 
 
1a, 4
*The information found in this table was taken from the product inserts for each respective drug
 
Prevention
There is currently no available vaccine for Hepatitis C, but there are ways to reduce exposure to the virus. These include:
  •  Never sharing syringes, needles, or equipment as an injection drug user
  • Avoid sharing objects that might contain blood such as razors and toothbrushes from a person with Hepatitis C
  • Use barrier precautions during sexual contact with someone who is at high risk of HCV infection
 
It is important to educate patients who are cured from Hepatitis C that they can still be re-infected. In addition, while treatment is being administered, patients need to be educated on ways to prevent the transmission of the disease to others around them. Individuals with diagnosed Hepatitis C should not donate blood, organs, or participate in activities that would expose others to their infected blood.
Initiatives for increased testing and treatment in communities will help prevent the spread and prevalence of Hepatitis C. Due to the asymptomatic nature of the disease, many infected individuals are unaware that they have it. This then decreases the possibility of treatment and increases the risk of other individuals coming in contact with infectious blood. Another obstacle in treating Hepatitis C patients is the expense of the available medication therapies. The cost of the medication can range up to $95,000 for a 12 week treatment; just one pill of Harvoni is priced at $1,000.[9] By taking steps towards making treatments more affordable and testing more available for patients, the spread and prevalence of this disease in the United States can be significantly reduced.
 
   
References
[1] HCV FAQs for Health Professionals | Division of Viral Hepatitis | CDC. (2017). Cdc.gov. Retrieved 28 September 2017, from https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm#section1
[2] Terrault, N. (2002). Sexual activity as a risk factor for hepatitis C. Hepatology, 36(5), s99-s105. http://dx.doi.org/10.1053/jhep.2002.36797
[3] "Hepatitis C: The Facts." OPA Hepatitis C Factsheet, 19 Oct. 2012, pp. 1-5., www.hhs.gov/opa/reproductive-health/sexually-transmitted-infections/hepatitis-c/index.html .
[4] Hepatitis C Genotypes and Quasispecies - Viral Hepatitis . (2017). Hepatitis.va.gov. Retrieved 9 October 2017, from https://www.hepatitis.va.gov/provider/reviews/genotypes.asp#note2
[5] Fox, Rena. "Lesson 5. Diagnosis of Acute HCV Infection." Hepatitis C Online, University of Washington, The University of Alabama at Birmingham, and the International Antiviral Society-USA, 13 Mar. 2017, www.hepatitisc.uw.edu/go/screening-diagnosis/acute-diagnosis/core-concept/all .
[6] Recommendations for Testing, Managing, and Treating Hepatitis C | HCV Guidance . (2017). Hcvguidelines.org. Retrieved 9 October 2017, from https://www.hcvguidelines.org/
[7] DiPlacido, Ph.D. Leah. "What Are the 4 Stages of Cirrhosis?" LIVESTRONG.COM, Leaf Group, 14 Apr. 2015, www.livestrong.com/article/240024-what-are-the-4-stages-of-cirrhosis/ .
[8] Thornton , Karla. "Lesson 5. Evaluation and Prognosis of Patients with Cirrhosis." Hepatitis C Online, University of Washington, The University of Alabama at Birmingham, and the International Antiviral Society-USA, 14 July 2016, www.hepatitisc.uw.edu/go/evaluation-staging-monitoring/evaluation-prognosis-cirrhosis/core-concept/all .
[9] Laurie Toich. (2017). Will Hepatitis C Virus Medication Costs Drop in the Years Ahead?. Retrieved from http://www.pharmacytimes.com/resource-centers/hepatitisc/will-hepatitis-c-virus-medicaton-costs-drop-in-the-years-ahead

Supplementary Figures:
 
Supplementary Figure 1[7][8]
 
 
 
 
 
Compensated
 
 
 
Stage 1
  •      Characterized by:
     Inflammation
     Swelling
     Influx of inflammatory-promoting immune cells
     Some destruction of liver tissue
     No Varices
     No Ascites
 
 
 
Stage 2
  •      Characterized by:
     Inflammation
     Fibrosis
     Scar tissue replaces normal liver tissue
     Transformation is permanent
     No Ascites
     Varices
 
 
 
 
 
 
Decompensated
 
 
 
Stage 3
  •      Characterized by:
     Liver damage increases in severity
     Bridging fibrosis between hepatic arteries, vein and other vessels
     Abnormal blood flow
     Hepatic Hypertension
     Ascites +/- Varices
 
 
 
Stage 4
  •      Characterized by:
     Liver is not functioning normally
     Jaundice
     Hepatic Encephalopathy
     Slurred speech
     Edema
     Bleeding +/- Ascites
 
   
Supplementary Figure 2
Contraindications to Consider
Drug
Contraindications
Mavyret (2017)
(Glecaprevir / Pibrentasvir)
  •      Severe Hepatic Impairment (Child-Pugh C)
  •      Co-administration with atazanavir and rifampin
 
Vosevi (2017)
(Sofosbuvir / Velpatasvir / Voxilaprevir)
  •      Co-administration with Rifampin
Epclusa (2016)
(Velpatasvir / Sofosbuvir)
  •      Epclusa + Ribavirin combination is contraindicated in patients for whom ribavirin is contraindicated
Zepatier (2016)
(Grazoprevir / Elbasvir)
  •      Moderate or severe hepatic impairment
  •      OATP1B1/3 inhibitors
  •      Efavirenz
  •      Strong CYP3A Inducers
  •      If administered with Ribavirin, contraindications apply.
Viekira XR (2016)
(Dasabuvir / Ombitasvir / Paritaprevir / Ritonavir)
  •      Moderate or severe hepatic impairment
  •      If administered with Ribavirin, contraindications apply.
  •      Co-administration with drugs that are highly dependent on CYP3A for clearance
  •      Moderate or strong inducers of CYP3A
  •      Strong inducer/inhibitor of CYP2C8
  •      Known hypersensitivity to ritonavir
Daklinza (2015)
Daklatasvir
  •      Strong CYP3A Inducers
Technivie (2015)
(ombitasvir / paritaprevir / and ritonavir)
  •      Moderate or severe hepatic impairment
  •      If administered with Ribavirin, contraindications apply.
  •      Co-administration with drugs that are highly dependent on CYP3A for clearance
  •      Moderate and strong inducers of CYP3A
  •      Known hypersensitivity to ritonavir
Harvoni (2014)
Ledipasvir / Sofosbuvir
  •      If administered with Ribavirin, contraindications apply.
Sovaldi (2013)
Sofosbuvir
  •      If administered with Ribavirin or peg-interferon alpha/ribavirin, contraindications apply.
Olysio (2013)
Simeprevir
  •      Contraindications of any other drug used concomitantly apply.
*The information found in this table was taken from the product inserts for each respective drug
 
Supplementary Figure 3
Drug (Active Components)
▼Most Recent Release
Side Effects
Mavyret (2017)
(Glecaprevir / Pibrentasvir)
Headache, Fatigue, and Nausea
Warnings and Precautions: Risk of Hepatitis B Reactivation
Vosevi (2017)
(Sofosbuvir / Velpatasvir / Voxilaprevir)
Headache, Fatigue, Diarrhea, and Nausea
Warnings and Precautions: Risk of Hepatitis B Reactivation and Bradycardia with Amiodarone Co-administration
Epclusa (2016)
(Velpatasvir / Sofosbuvir)
Epclusa Alone: Headache and Fatigue
Epclusa + Ribavirin: Fatigue, Anemia, Nausea, Headache, Insomnia, and Diarrhea
Warnings and Precautions: Risk of Hepatitis B Reactivation and Bradycardia with Amiodarone Co-administration
Zepatier (2016)
(Grazoprevir / Elbasvir)
Zepatier alone: Headache, fatigue, nausea
Zepatier + Ribavirin: Headache and anemia
Warnings and Precautions: Risk of Hepatitis B Reactivation and ALT Elevations
Viekira XR (2016)
(Dasabuvir / Ombitasvir / Paritaprevir / Ritonavir)
Viekira XR alone: Nausea, pruritis, insomnia
Viekira XR + Ribavirin: Fatigue, nausea, pruritis, insomnia, asthenia
Warnings and Precautions: Risk of Hepatitis B Reactivation, Risk of Hepatic Decompensation and Hepatic Failure in Patients with Cirrhosis, Increased Risk of ALT Elevations
Daklinza (2015)
Daklatasvir
Daklinza + Sovaldi: Headache and fatigue
Daklinza + Sovaldi + Ribavirin: Headache, anemia, fatigue, nausea
Warnings and Precautions: Risk of Hepatitis B Reactivation and Bradycardia When co-administered with Sofosbuvir and Amiodarone
Technivie (2015)
(ombitasvir / paritaprevir / and ritonavir)
Technivie + Ribavirin: Asthenia, fatigue, nausea, and insomnia
Technivie + Ribavirin in cirrhotic patients: fatigue, asthenia, headache, musculoskeletal pain, pruritus, insomnia/sleep disorder, skin reactions, mood disorders, nausea, dizziness and dyspnea
Warnings and Precautions: Risk of Hepatitis B Reactivation, Risk of Hepatic Decompensation and Hepatic Failure in Patients with Cirrhosis, Increased Risk of ALT Elevations
Viekira Pak (2014)
Ombitasvir / Paritaprevir / Ritonavir and Dasabuvir
Viekira XR alone: Nausea, pruritis, insomnia
Viekira XR + Ribavirin: Fatigue, nausea, pruritis, insomnia, asthenia
Warnings and Precautions: Risk of Hepatitis B Reactivation, Risk of Hepatic Decompensation and Hepatic Failure in Patients with Cirrhosis, Increased Risk of ALT Elevations
Harvoni (2014)
Ledipasvir / Sofosbuvir
Fatigue, headache, and asthenia
Warnings and Precautions: Risk of Hepatitis B Reactivation and Bradycardia with Amiodarone Co-administration
Sovaldi (2013)
Sofosbuvir
Sovaldi + Ribavirin: Fatigue, headache
Sovaldi + Peginterferon alfa + Ribavirin: Fatigue, headache, insomnia, nausea, and anemia
Warnings and Precautions: Risk of Hepatitis B Reactivation and Bradycardia with Amiodarone Co-administration
Olysio (2013)
Simeprevir
Olysio + Sovaldi: Fatigue, headache, and nausea
Olysio + Peginterferon alfa + Ribavirin: Rash, photosensitivity, pruritis, nausea
Warnings and Precautions: Risk of Hepatitis B Virus Reactivation, Serious Symptomatic Bradycardia with Sofosbuvir and Amiodarone co-administration, Hepatic Decompensation and Hepatic Failure, Photosensitivity, Rash
*The information found in this table was taken from the product inserts for each respective drug
 
   
Supplementary Figure 4
Drug (Active Components)
▼Most Recent Release
Side Effects
Mavyret (2017)
(Glecaprevir / Pibrentasvir)
Headache, Fatigue, and Nausea
Warnings and Precautions: Risk of Hepatitis B Reactivation
Vosevi (2017)
(Sofosbuvir / Velpatasvir / Voxilaprevir)
Headache, Fatigue, Diarrhea, and Nausea
Warnings and Precautions: Risk of Hepatitis B Reactivation and Bradycardia with Amiodarone Co-administration
Epclusa (2016)
(Velpatasvir / Sofosbuvir)
Epclusa Alone: Headache and Fatigue
Epclusa + Ribavirin: Fatigue, Anemia, Nausea, Headache, Insomnia, and Diarrhea
Warnings and Precautions: Risk of Hepatitis B Reactivation and Bradycardia with Amiodarone Co-administration
Zepatier (2016)
(Grazoprevir / Elbasvir)
Zepatier alone: Headache, fatigue, nausea
Zepatier + Ribavirin: Headache and anemia
Warnings and Precautions: Risk of Hepatitis B Reactivation and ALT Elevations
Viekira XR (2016)
(Dasabuvir / Ombitasvir / Paritaprevir / Ritonavir)
Viekira XR alone: Nausea, pruritis, insomnia
Viekira XR + Ribavirin: Fatigue, nausea, pruritis, insomnia, asthenia
Warnings and Precautions: Risk of Hepatitis B Reactivation, Risk of Hepatic Decompensation and Hepatic Failure in Patients with Cirrhosis, Increased Risk of ALT Elevations
Daklinza (2015)
Daklatasvir
Daklinza + Sovaldi: Headache and fatigue
Daklinza + Sovaldi + Ribavirin: Headache, anemia, fatigue, nausea
Warnings and Precautions: Risk of Hepatitis B Reactivation and Bradycardia when co-administered with Sofosbuvir and Amiodarone
Technivie (2015)
(ombitasvir / paritaprevir / and ritonavir)
Technivie + Ribavirin: Asthenia, fatigue, nausea, and insomnia
Technivie + Ribavirin in cirrhotic patients: fatigue, asthenia, headache, musculoskeletal pain, pruritus, insomnia/sleep disorder, skin reactions, mood disorders, nausea, dizziness and dyspnea
Warnings and Precautions: Risk of Hepatitis B Reactivation, Risk of Hepatic Decompensation and Hepatic Failure in Patients with Cirrhosis, Increased Risk of ALT Elevations
Viekira Pak (2014)
Ombitasvir / Paritaprevir / Ritonavir and Dasabuvir
Viekira XR alone: Nausea, pruritis, insomnia
Viekira XR + Ribavirin: Fatigue, nausea, pruritis, insomnia, asthenia
Warnings and Precautions: Risk of Hepatitis B Reactivation, Risk of Hepatic Decompensation and Hepatic Failure in Patients with Cirrhosis, Increased Risk of ALT Elevations
Harvoni (2014)
Ledipasvir / Sofosbuvir
Fatigue, headache, and asthenia
Warnings and Precautions: Risk of Hepatitis B Reactivation and Bradycardia with Amiodarone co-administration
Sovaldi (2013)
Sofosbuvir
Sovaldi + Ribavirin: Fatigue, headache
Sovaldi + Peginterferon alfa + Ribavirin: Fatigue, headache, insomnia, nausea, and anemia
Warnings and Precautions: Risk of Hepatitis B Reactivation and Bradycardia with Amiodarone co-administration
Olysio (2013)
Simeprevir
Olysio + Sovaldi: Fatigue, headache, and nausea
Olysio + Peginterferon alfa + Ribavirin: Rash, photosensitivity, pruritis, nausea
Warnings and Precautions: Risk of Hepatitis B Virus Reactivation, Serious Symptomatic Bradycardia with Sofosbuvir and Amiodarone co-administration, Hepatic decompensation and Hepatic Failure, Photosensitivity, Rash
*The information found in this table was taken from the product inserts for each respective drug 
 
Clinical Writing Opportunities 
Writing a clinical article for the GSHP newsletter is a great way for students to get publication experience. Topics can be anything related to hospital-system pharmacy. Examples include (but are not limited to): new drug updates, national policy updates for hospital pharmacy, guideline updates, therapeutics reviews, and clinical controversies. Articles are generally 1-3 pages in length, and can include tables and figures. Interested members and students should email Steve Glass (sglass@gshp.org) for more details.

Did you know that if you missed one of our monthly webinars, you can view them on the GSHP website?

Go to:  https://www.gshp.org/development_webinars.aspx 
     


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