Pharm agents for HIV AIDS, Martin, DSA Flashcards

1
Q

What are the Nucleoside/nNt Reverse transcriptase inhibitors

A

Emtricitabine
Tenofovir DF
Lamivudine
Zidovudine

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2
Q

What are the non-nucleoside reverse transcriptase inhibitors

A

Efavirenz

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3
Q

What are the protease inhibitors

A

Atazanavir
Darunavir
Lopinavir
Ritonavir

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4
Q

What are the Integrase Strand Transfer Inhibitors

A

raltegravir

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5
Q

What are the CCR5 Anatgonist/entry inhibitor

A

maraviroc

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6
Q

What are the fusion inhibitors

A

enfuvirtide

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7
Q

What is the preferred regimen to Tx drug-naive patients

A

backbone: 2 NNRTIs
base: one of these:
-NNRTI
Protease inhibitor
INSTI
CCR5 antagonist

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8
Q

What are the antiretroviral agent combinations

A

Emtircitabine +Tenofovir
DF
efavirenz+ emtricitabine+tenofovir DF

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9
Q

What are the drug regimens used during pregnangy

A
zidovudine + iopinavir + ritonavir
Intrapartum period (IV) zidovudine
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10
Q

Infants from HIV mothers receive what drug and for how long

A

zidovudine for 6 mo

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11
Q

What are the pre and post exposure prophylaxis regimen for HIV

A

ralegravir + emtircitabine + tenofovir DF

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12
Q

goals of HIV therapy

A

reduce HIV assoc morbidity and prolong duration and quality of survival
rstore and preserve immunologic function
maximally and durably suppress plasma HIV viral load
prevent HIV transmission

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13
Q

why are combination druge regimens used

A

minimize development of resistance

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14
Q

What is CD4 count indicative of AIDS

A

<350

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15
Q

HIV Tx should be initiated regardless of CD4 in what patients

A

pregnant women
patients with HIV assoc nephropathy
patients co infected with hep B virus

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16
Q

CD4 T cell counts are used for what

A

decide when to initiate therapy
monitor the Therapeutic response
monitored every 3-4 mo

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17
Q

what is most important indicator of response to antiretroviral therapy

A

plasma HIV RNA (viral load)

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18
Q

What is considered a success in antiviral Tx HIV

A

decrease in viral load of 3X or more

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19
Q

viral suppression takes how long from initiation of Tx

A

12-24 mo

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20
Q

when is drug resistance testing recommended

A

patient enters care
there is a drug treatment failure
changing drug protocols

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21
Q

what is genotypic assays

A

involve sequencing of the reverse trasncriptase and protease genes to detect mutations that are known to confer drug resistance

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22
Q

What is recommended for pregnant women prior to initiation of Tx

A

genotypic resistance

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23
Q

phenotypic assays do what

A

measure ability of a virus to grow in a different [ ] of antiretroviral drugs

24
Q

what are used to make pseudotyped viruses that express the patient-derived HIV genes of interest

A

when gene sequences are from patient plasma HIV RNA are inserted into the backbone of a laboratory clone of HIV

25
Q

do NRTI and NNRTI bind to same sites

A

no 2 different sites

26
Q

What is the preferred NNRTI? exception?

A

efavirenz

not in pregnant women or women who could be potentially pregnant in future

27
Q

What is the preferred dual-NRTI

A

tenofovir/emtricitabine

28
Q

Patient has HLA B5701, should not use what dual NRTI regimen

A

abacavir/lamivudine

have HS reaction

29
Q

how does tenofovir inhibit reverse transcriptase

A

incorporated into growing viral DNa chain and causes chain termination

30
Q

Tenofovir DF is avaiable in combination with what drugs

A

emtricitabine

emtricitabine and efavirenz

31
Q

What is the best tolerated NRTI

A

emtricitabine

32
Q

adverse effects emtricitabin

A

hyperpigmentation of palms and soles

33
Q

emtricitabine is used to Tx what other condition besides HIV

A

HBV

34
Q

side effects of zidovudine

A

anemia, neutropenia, nausea, vomiting, HA, fatigue, confusion, malaise, myopathy, hepatitis, hyperpigmentation or oral mucosa and nail beds
lipoatrophy, lactic acidosis and hepatic steatosis

35
Q

how do the NNRTIs work

A

bind directly to reverse trancriptase blocking RNA and DNA-dependent DNA polymerase activity

36
Q

what are the NNRTI drugs

A

efavirenz and delavirdine, necirapine, etravirine

37
Q

when does R to efavirenz occur

A

when used as monoTx

only used in combinations to prevent this

38
Q

NNRTI toxicity signs

A

CNS: dizzy, drowsy, insomnia, HA, confusion, agitation, depression
Psych: severe
Rash and HS syndrome, steven-johnson syndrome

39
Q

What are the preferred protease inhibitor regimens

A

atazanavir + ritonavir

darunavir + ritonavir once daily

40
Q

What is the alternative PI regimen

A

iopinavir + ritonavir

41
Q

What 2NRTIs are give with PI

A

tenofovir/emtricitabine

42
Q

how do protease inhibitors affect CYP3A4

A

inhibitors of it

43
Q

why is low dose ritonavir given with other PIs

A

increases serum [ ]

44
Q

PIs work how

A

prevent mature proteins, result in immature noninfective viral particles

45
Q

result of monoTx of PI

A

contraindicated because cause phenotypic resistance

46
Q

Adverse effects of PI

A

GI distress, increased bleeding in hemophliacs, hyperglycemia, insulin R and hyperlipidemia
assoc with increased risk of coronary artery disease

47
Q

adverse effects of atazanavir (PI)

A

hyperbilirubinemia

rash in 20% that is mild or moderate

48
Q

What is the role of HIV-1 integrase

A

catalyzes viral DNA insertion in host genome

49
Q

what is the integrase inhibitor drug

A

raltegravir

50
Q

What are the 2 major coR used by HIV-1 to gain entry

A

CCR5 and CXCR4

51
Q

Maraviroc antagonizes what R

A

CCR5

52
Q

how do you determine if HIV patient has R5 or X4

A

commercial assay

53
Q

side effects maraviroc

A

cough, pyrexia, upper respiratory tract infection, rash, MSK Sx, abdominal pain and postural dizziness

54
Q

if considering use of maraviroc what should be done

A

Coreceptor tropism assay

also done if virologic failure of drug is apparent

55
Q

patient has CD4 <100

most likely R type

A

either X4 or dual or mixed-tropic because more resistant to Tx

56
Q

MOA enfuvirtide

A

inhibition of fusion binding to gp41 of viral envelop glycoprotein & prevents conformational changes required for fusion of viral and cellular membranes

57
Q

Administration of enfuvirtide

A

BID subcu

usually Tx-experienced patients