Chapter 7 anti infective - antiviral for HIV/retroviruses + pneumocystis carinii agents (fungal based)

Question 1

Maraviroc (selzentry)

HIV + retrovirus

Answer 1

• blocks CCR5 rreceptors
• blocks CC5-tropic HIV (point of entry) from entering cell

indication
* cc5-tropic HIV, as part of combination therapy

effects
* rash, hepatotoxicity

contraindicated in renal impaired pt

Question 2

talegravir (isentress)
dolutegravir (tivicay)

HIV + retrovirus

Answer 2

• blocks integrase
• it integrates viral DNA into the host genome
• which is needed for viral replication

indiction
* HIV
* part of combination therapy

effects
* dizziness
* serious skin reactions

Question 3

Zidovudine (Retrovir)
lamivudine (epivir)
emtricitabine (emtriva)
abacavir (ziagen)
tenofvoir (Viread)

hiv + retrovirus

Answer 3

• nucleoside HIV reverse transcriptase inhibitor (HIV uses reverse transcriptase to convert its RNA into DNA (reverse transcription). )

indication
* HIV in cominbation therapy
* zidovudine – for prevention of maternal-fetal transmission of HIV

resistance
* mutations in reverse transcriptase

effects
* peripheral neuropathy
* pacnreatitis
* diarrhea
* insomnia
* n/v
* zidovudine-myelosuppression —> bone marrow suppression, is a decrease in bone marrow activity that results in reduced production of blood cells. Some blood cell disorders include: fewer red blood cells (anemia) fewer white blood cells (neutropenia)

pharmcokinetics:
* enhanced by renal or hepatic dysfunction

limited utility by itself

Question 4

Doravirine (pifeltro)
nevirapine (Viramune)
delavirdine (recriptor)
efavirenz (sustiva)
etravirine (intelence)
rilpivirine (edurant)

hiv + retrovirus

Answer 4

non-nucleoside inihbitor of HIV rever transcriptase

indication
* HIV
* never as monotherapy — rapid development to resistance

Question 4

ritonavir (norvifr)
indinavir (crixivan)
squinavir (invirase)
nelfinavir (virecept)
fosamprenavir (lexiva)
atazanavir (reyataz)
tipranavir (aptivus)
darunavir (prezista)

hiv + retro

Answer 4

• protease inhibitor
• enzhyme necessary for cleaving the gal-pol precurser
• results in immature virus formation

indication
* HIV in combination

resistance
* mutations in protease sequence

effects
* neurologic sx (weakness, anorexia, parasthesias)
* Indinavir —- inc risk of kidney stones

Potentially serious drug interactions d/t p450 enzyme competition

Question 5

enfuvirtide (fuzeon)

hiv + retro

Answer 5

• fusion inhibitors
• block HIV from entering CD4 T- cells

use
HIV w/ combination therapy

Question 6

ibalizumab (trogarzo)

Answer 6

• post attachment inhibitors (block cd4 receptors on the surface of T-cells; HIV needs the cd4 receptor cell entry

use:
* HIV in combination therapy

Question 7

combination HIV drugs

Answer 7

• 2 dozen combination therapies

Question 8

trimethoprim-sulfamethoxazole (bactrim, septra)

pneumocystis carinii agents

Answer 8

• inhibits folate synthesis pathway

indication:
* drug of choice for PCP prphylaxis in immuno-suppressed (oral)
* IV —- for PCP infection
* Pneumocystis pneumonia (PCP) is a serious infection caused by the fungus Pneumocystis jirovecii. Most people who get PCP have a medical condition that weakens their immune system, like HIV/AIDS, or take medicines (such as corticosteroids) that lower the body’s ability to fight germs and sickness.

Question 9

pentamidine (pentam)

penumocystis carinii agent

Answer 9

• unknown mech

indication
* nebulized form — alternative PCP prophylaxis
* IV – alternative PCP tx

effect
* bronchoconstriction frequent – use w/ bronchodilator

Question 10

dapsone

pneumocystis carinii agent

Answer 10

• unknown mech

indication
* alternative for PCP prophylaxis

Question 11

atovaquone (mepron)

pneumocystis carinii agent

Answer 11

• unknown mech

indication
* tx for mild PCP in TMP-SMZ resistant patient
* Trimethoprim / Sulfamethoxazole (TMP SMZ)