Drugs

Question 0

Didanosine

Answer 0

NRTI

Mitochondrial effects more common than newer NRTI

Take on empty stomach

Question 1

Abacavir

Answer 1

NRTI

Dose adjust in hepatic impairment
NOT Renal

Hypersensitivity in HLA-B*5701
Must screen, record as allergy if +

Question 2

Emtricitabine

Answer 2

NRTI Hepatitis B active

Very well tolerated

Question 3

Lamivudine

Answer 3

NRTI Hepatitis B active

Very well tolerated

Question 4

Stavudine

Answer 4

NRTI

Most associated with mitochondrial symptoms, not well tolerated long term.

Not a rec. part of ART

Question 5

Tenofovir

Answer 5

NRTI-nucleotide hepatitis b active

Nephrotoxic- proximal tubular necrosis, fanconi, increased risk with PIs

Question 6

Zidovudine

Answer 6

NRTI- first of its class
Prevention of perinatal transmission

Anemia almost 100% within 4-6 weeks
Mitochondrial toxicity more common than newer agents

Question 7

Delavirdine

Answer 7

NNRTI

Not used due to high pill burden
CYP3A4 inhibitor

Question 8

Efavirenz

Answer 8

NNRTI
Possibly teratogenic. Avoid in preg.
Vivid dreams and nightmares

Question 9

Etravirine

Answer 9

NNRTI

May be effective against efavirenz/nevirapine resistance

Generally well tolerated

Question 10

Nevirapine

Answer 10

NNRTI

14-day lead in due to auto-induction
Highest incidence of rash of all NNRTIs
Hepatotoxic- higher risk in ART naive pts avoid if CD4 count is >250 in females and >400 in males

Question 11

Rilpivirine

Answer 11

NNRTI

CI with PPIs separate with H2A use need acid for absorption

Taken with at least 500 kcal meal

Question 12

Atazanavir

Answer 12

PI
Needs acid for absorption
No PPIs in unboosted atv, >20 mg omeprazole, treated experienced pts
Fewer effects on lipids than other PIs, better GI tolerability, must boost with TDF, EFV, or PPIs
Hyperbilirubinemia, nephrolithiasis

Question 13

Darunavir

Answer 13

PI need to boost
Give with food, potent
Skin rash due to sulfonamide moiety

Question 14

Fosamprenavir

Answer 14

PI, taken without regard to food.
Once daily if boosted
Skin rash due to sulfonamide moiety

Question 15

Indinavir

Answer 15

PI, must take with water

Nephrolithiasis possibly AKI

Question 16

Lopinavir

Answer 16

PI, only with ritonavir
Once daily unless pregnant, 3+ LPV mutations, on inducer then need more.
Recommended to prevent mother-child transmission in pregnancy
Dyslipidemia worse than other PIs especially trigs

Question 17

Nelfinavir

Answer 17

PI only one not boosted

Most diarrhea of all PIs

Question 18

Ritonavir

Answer 18

PI
Not active part of ART anymore, only as kinetic booster
Administer at same time as other PI
Paresthesia

Question 19

Saquinavir

Answer 19

PI, highest pill burden

Most significant ECG changes need baseline

Question 20

Tipranavir

Answer 20

PI, hepatotoxic

Sulfonamide rash

Question 21

Dolutegravir

Answer 21

Newest INSTI
CI with dofetilide use
Increases serum creatinine without reducing glomerular fxn

Question 22

Elvitegravir

Answer 22

INSTI coformulated with cobi
Only in patients with CrCl >70 stop if <50 while on treatment
Cobicistat- increases serum creatinine without reducing glomerular fxn

Question 23

Raltegravir

Answer 23

INSTI ugt1a1 no 3a4
Taken without regard to food,
No renal/mild-mod hepatic adjustment
Myopathy, rhabdo

Question 24

Enfuvirtide

Answer 24

``` Binds gp41 SubQ injection only Low genetic barrier to resistance Injection site rxns No drug intrxns Reserved for salvage therapy ```

Question 25

Maraviroc

Answer 25

``` Binds CCR5 Must have documented CCR5 tropic strain, virus may shift to CXCR4 Adjust dose if CrCl <30 or HD Hepatitis Orthostatic hypotension ```