Antiretrovirals

Question 1

What class? Atazanavir, Lopinavir/Ritonavir, Ritonavir

Answer 1

Protease Inhibitors

Question 2

Protease Inhibitors - General concerns

Answer 2

Most inhibit 3A4
this class can increase lipids and increase risk of CV disease

Question 3

Atazanavir (ATV;Reyataz)

Answer 3

PO (requires acid)
“friendly” - least likely to cause lipid and glucose abnormalities
SE: jaundice, asymptomatic hyperbilirubinemia (expected and almost diagnostic as a measure of compliance)

Question 4

Abacavir (ABC, Ziagen)

Answer 4

HLA-B*5701 testing recommended (high risk for hypersensitivity)
If reaction (fever, rash, SOB - stop immediately and NEVER USE AGAIN. Counsel on reaction.
Avoidd ETOH (shared pathway)

Question 5

Zidovudine (AZT, Retrovir)

Answer 5

SE: neutropenia (give low dose EPO/GCSF), macrocytic anemia (elevated MCV)
Watch CBC!
Renal dose CrCL<15

Question 6

Delavirdine (DLV; Rescriptor)

Answer 6

Inhib: 2C9/19, 2D6, 3A4

Not used much in US because of DDI and better meds.

Question 7

Efavirenz (EFV; Sustiva)

Answer 7

qhs on empty stomach
Inducer: 3A4
SE: Bad dreams/psychosis (temporary but screen for psych and counsel)
False + for marijuana on urine tox screen.
Preg D

Question 8

Nevirapine (NVP; Viramune)

Answer 8

SE: Rash (cases of Stephen Johnson Syndrome and Toxic Epidermal Necrolysis), hepatotoxic (if it will happen, it will be in the first 4 weeks)

Question 9

Abacavir - what if hypersensitivity reaction?

Answer 9

Never give again!!!

Question 10

Atazanavir - DDI

Answer 10

Proton pump inhibitor like Prilosec

Why? Decreases absorption by 50-60% if acid is low –> will effect viral load because of ineffective therapy

Question 11

Which NNRTI can cause a false + THC?

Answer 11

Efavirenz

Question 12

Which NRTI has the ADE of peripheral neuropathy and lactic acidosis?

Answer 12

Lamuvidine

Question 13

Which is the “friendly” protease inhibitor because it is least likely to increase lipids and blood sugars?

Answer 13

Reyetaz

Question 14

Which fusion inhibitor needs to be mixed with sterile water for reconstitution?

Answer 14

Enfuvirtide

Question 15

Which NNRTI should you not eat a high fat meal with?

Answer 15

Efavirenz (increases absorption and ADEs)

Question 16

Which NRTI can increase MCV?

Answer 16

AZT (Ziduvudine)

Question 17

Which antiretroviral class are usually 3A4 inhibitors?

Answer 17

Protease inhibitors

Question 18

Which HIV drugs need acidic environment?

Answer 18

Protease inhibitors (Atazanavir, Lopinavir/Ritonavir, Ritonavir)

Question 19

Which HIV drugs are associated with peripheral neuropathy?

Answer 19

NRTI “D” drugs - Didanosine, Lamudivine, Zalcitabine (not used much)