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Pharm 4 > Antiretroviral therapy for HIV > Flashcards

Antiretroviral therapy for HIV Flashcards

1
Q

MOA of NRTI

A

competitive inhibition of reverse transcriptase to prevent formation of viral DNA from viral RNA
*DNA chain termination

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2
Q

ADRs of NRTIs

A

potential for lactic acidosis, hepatic steatosis, lipodystrophy
*No significant drug interactions

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3
Q

zidovudine (AZT)

A

nucleoside RTI

ADR: marrow suppression

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4
Q

didanosine (ddI)

A

nucleoside RTI

ADR: pancreatitis, neuropathy

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5
Q

stavudine (D4T)

A

nucleoside RTI

ADR: all shared ADRs of NRTIs increased; neuropathy

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6
Q

lamivudine (3TC)

A

nucleoside RTI

ADR: headache

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7
Q

emtricitabine (FTC)

A

nucleoside RTI

ADR: headache, diarrhea

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8
Q

abacavir (ABC)

A

nucleoside RTI

ADR: hypersensitivity reaction

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9
Q

tenofovir (TDF)

A

*nucleotide RTI
ADR: diarrhea, n/v, Fanconi syndrome (dz of prox renal tubules -> glucose, amino acids, uric acid, phosphate, bicarb passed into urine, instead of reabsorbed)

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10
Q

MOA of NNRTI

A

direct, non-nucleoside inhibitors of RT; doesn’t require metabolic conversion, not incorporated into viral DNA, additive effect to NRTI

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11
Q

ADR of NNRTI

A

rash, may -> Stevens-Johnson syndrome

significant drug interactions

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12
Q

nevirapine

A

NNRTI
ADR: rash, SJS, hepatotoxicity (esp CD4 > 250), modest CYP 3A4 inducer, may precipitate withdrawal in methadone maintenance patients

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13
Q

delaviridine

A

NNRTI
ADR: rash, SJS, HA, strong CYP 3A inhibitor
*rarely used d/t low potency

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14
Q

efavirenz

A

NNRTI

ADR: rash, SJS, neuropsych reaction, mod CYP 3A4 inducer, teratogenic

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15
Q

etravirine

A

NNRTI

ADR: rash, SJS, hyperlipidemia, modest CYP 3A4 inducer; CYP 2C9 and 2C19 inhibitor

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16
Q

rilpivirine

A

NNRTI

ADR: rash, HA, prolonged QT interval

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17
Q

MOA protease inhibitors

A

prevents viral protease from forming functional viral proteins necessary to mature viral particle and viral replication

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18
Q

ADR of protease inhibitors

A

GI distress, hyperglycemia, insulin resistance, hyperlipidemia, CAD, fat accumulation, hepatotoxicity
Metabolism by and inhibits CYP 3A4 (ritonavir most)
Metabolism induced by rifampin and phenytoin
Absorption reduced with rising gastric pH d/t H2-blockers and PPIs

19
Q

saquinavir

A

PI

ADR: n/v/d

20
Q

darunavir

A

PI

ADR: n/v, rash

21
Q

indinavir

A

PI

ADR: n/v, nephrolithiasis

22
Q

nelfinavir

A

PI

ADR: nausea, diarrhea

23
Q

fosamprenavir

A

PI

ADR: nausea, rash

24
Q

atazanavir

A

PI

ADR: increased bilirubin

25
Q

Kaletra

A

AKA lopinavir + ritonavir
PI used to boost levels of other PIs
ADR: GI distress, hyperlipidemia

26
Q

enfuviratide

A

fusion inhibitor; binds TM GP to prevent fusion of viral particle with CD4 cell membrane
ADR: injection site rxn and HS rxns

27
Q

maraviroc

A

entry inhibitor; antagonist of CCR5-R on CD4 necessary for HIV entry; active if resistance to other drug classes
ADR: cough, rash, infections, substrate of CYP 3A4 (intx w PIs)

28
Q

MOA integrase inhibitors

A

blocks integrase enzyme necessary for integration of viral DNA into cellular DNA
INSTI = integrase strand transfer inhibitor

29
Q

ADR integrase inhibitors

A

diarrhea, nausea, HA, myositis (monitor CPK)

30
Q

Truvada

A

2NRTIs

emtricitabine + tenofovir

31
Q

Combivir

A

2 NRTIs

AZT + lamivudine

32
Q

Epizicom

A

2 NRTIs

ABC + lamivudine

33
Q

Trizivir

A

3NRTIs (not recommended)

AZT + lamivudine + ABC

34
Q

Atripla

A

NNRTI + 2NRTI

efavirenz + emtracitibine + tenofovir

35
Q

Complera

A

NNRTI + 2NRTI

rilpivirine + emtracitibine + tenofovir

36
Q

Who to test for HIV drug resistance and what to test for?

A

All HIV-infected people when they enter care
Genotype testing for ARV-naive patients
Look for mutations in RT and protease genes and INSTI resistance

37
Q

Regimen for pregnant women

A

lopinavir/ritonavir (Kaletra) + AZT/lam (Combivir)

*PI may increase hyperglycemia risk

38
Q

When is transmission of HIV from pregnant woman to infant most likely?

A

During labor/delivery

39
Q

Regimen for infant of HIV+ mother

A

AZT for first 6 weeks of life

40
Q

Teratogenic ARV drug

A

efavirenz

41
Q

Pre-exposure prophylaxis for high-risk adults

A

Truvada

42
Q

Post-exposure prophylaxis for occupational exposure

A

3 or more drugs

for all exposures

43
Q

Post-exposure prophylaxis for non-occupational exposure (sex, drugs)

A

3 or more active drugs if source patient known to be HIV+ or exposure event high risk for transmission

44
Q

When to start post-exposure prophylaxis

A

Within 72 hours of exposure and continue for 4 weeks

with follow-up HIV-Ab testing for 4-6 months post-exposure

Pharm 4 (8 decks)

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