Antivirals

Question 1

Zidovudine

Answer 1

reverse transcriptase inhibitor
watch anemia, neutropenia (G-CSF)
RARE hepatotoxicity and Lactic acidosis

Question 2

Zidovudine with Tylenol or ganciclovir:

Answer 2

risk of granulocytopenia

Question 3

Zidovudine with acyclovir

Answer 3

lethargy and somnolence

Question 4

Lamivudine/Zidovudine

Answer 4

2 choice for HIV combo

Question 5

Tenofovir/Emtricitabine

Answer 5

#1 choice for HIV combo
Well tolerated

Question 6

Didanosine

Answer 6

Reverse Transcriptase Inhibitor
used in combo with zidovudine
Causes PERIPHERAL NEUROPATHY, Pancreatitis, anemia, granulocytopenia, hyperuricemia

Question 7

Zalcitaibe

Answer 7

Dideoxycytidine RTI

Causes PERIPHERAL NEUROPATHY and mucosal ulcers

Question 8

Lamivudine

Answer 8

Cytosine analogue- competitive inhibitor of RT (RTI)
Very well tolerated, MUST USE WITH ANOTHER DRUG (Zidovudine) to prevent resistance
DOC FOR HBV

Question 9

Stavudine

Answer 9

Dideoxycytidine RTI
Use for ADVANCED HIV if no other therapy tolerated
resistance is uncommon
Causes PERIPHERAL NEUROPATHY, lactic acidosis
DO NOT COMBINE WITH OTHER -VUDINE!

Question 10

Abacavir

Answer 10

Guansine analogue RTI

5% hypersensitivity reactions– causes fever, malaise, rash, chills, etc. D/C AND DO NOT RESTART

Question 11

Tenofovir

Answer 11

Adenosine analogue RTI

DOC for naive patients, along with Emtricitabine

Question 12

Emtricitabine

Answer 12

Cytosine analog (like lamivudine) RTI
DOC for naive HIV patients with Tenofovir

Question 13

Big 4 HIV drugs

Answer 13

Lamivudine, Zidovudine, Tenofovir, Emtricitabine

Question 14

Protease inhibitors

Answer 14

RAPID RESISTANCE IF USED ALONE
DO NOT INTERRUPT THERAPY
ALWAYS COMBINE WITH RTI
Metabolized BY CYP3A4 (LOTS OF DRUG INTERACTIONS)
DO NOT combine with STATINS OR ST JOHN’S WORT

Question 15

Protease inhibitor side effects

Answer 15

ALTERED FAT DISTRIBUTION
Buffalo hump, truncal obesity, facial and peripheral atrophy
Insulin resistance
High serum cholesterol

Question 16

Saquinavir

Answer 16

Protease inhibitor;

GIVE WITH GRAPEFRUIT JUICE or RITONAVIR

Question 17

Darunavir

Answer 17

2nd choice Protease Inhibitor
Combine with RITONAVIR
More safe and effective, but some SEs:
Rash, HA, BAD DREAMS

Question 18

Ritonavir

Answer 18

Protease Inhibitor
Use subtherapeutically to inhibit CYP3A4– increases effectiveness of other PIs
CI WITH MANY OTHER DRUGS!
SE: GI, burning, tingling

Question 19

Indinavir

Answer 19

Protease Inhibitor
Good bioavailability and CSF PENETRATION– Take on empty stomach
DON’T GIVE WITH RIFAMPIN
SE: NEPHROLITHIASIS (Hydrate) and HYPERBILIRUBINEMIA

Question 20

Nelfanavir

Answer 20

Protease Inhibitor
BETTER ABSORBED WITH FOOD
SE: Asthenia

Question 21

Amprenavir/Fosamrenavir

Answer 21

PI
Contains PEG– DO NOT GIVE WITH DISULFRAM OR METRONIDAZOLE
SE: SJS or SEVERE RASH

Question 22

Atazanavir

Answer 22

DOC PI due to low SE

DON’T COMBINE WITH INDINAVIR (increase bilirubin)

Question 23

Tipranavir

Lopinavir

Answer 23

PI
COMBINE WITH RITONAVIR
Tip: DON’T COMBINE WITH INDUCERS/INHIBITORS OF CYP3A4 (doesn’t this pertain to all PIs?)

Question 24

Non-nucleoside RTIs

Answer 24

Directly bind RT to prevent RNA to DNA conversion
NO PHOSPHORYLATION NEEDED
RAPID RESISTANCE DEVELOPS
CYP3A4 metabolization= PI INTERACTION!!!

Question 25

Delavirdine

Answer 25

NNRTI

Inhibits CYP3A4- Antacids decrease efficacy

Question 26

Nevirapine

Answer 26

DOC NNRTI in PREGNANCY

induces CYP3A4=decreased efficacy of birth control

Question 27

Efavirenz

Answer 27

NNRTI

DOC EXCEPT IN PREGNANCY

Question 28

Enfuviritide

Answer 28

FUSION INHIBITOR
Binds to gp41 subunit of viral envelope to prevent fusion
ADVANCED HIV- HAS NO RESISTANCE WITH OTHER ANTIVIRALS
Inject in cheeks
Pneumonia more likely!

Question 29

Maraviroc

Answer 29

FUSION INHIBITOR
Binds to CCR5 receptor on CD4 Cell
Only use in pts with CCR5 trophic HIV

Question 30

Raltegravir

Answer 30

INTEGRASE INHIBITOR
Blocks integrase needed to transfer viral DNA to host cell DNA
Advanced HIV