Enzymes and stuffs for Exam 2

Question 1

EFV/NVP + rifampin pk result

Answer 1

Decreased [EFV/NVP]

Increase dose

Question 2

EFV/NVP + statins pk result

Answer 2

Decreased [statins]

Monitor cholesterol/more aggressive statin dose

Question 3

RPV + PPIs pk results

Answer 3

Decreased [RPV]

Avoid this combo

Question 4

ETV + PIs pk result

Answer 4

Decreased [PI]

Question 5

ETV + warfarin pk result

Answer 5

Increased [warfarin]

Monitor INR

Question 6

Contraindicated with PIs

Answer 6

Rifampin
St. John's Wort
Pimozide
Lovastatin/simvastatin
Triazolam/midazolam
Ergots

Question 7

PI + rifampin pk results

Answer 7

Decreased PI

Increased RIF

Question 8

PI + St. John’s Wort

Answer 8

Decreased PI

Question 9

PI + triazolam/midazolam

Answer 9

Increased triazolam/midazolam

Question 10

PI + pimozide

Answer 10

Increased pimozide

Question 11

PI + ergots

Answer 11

Increased ergots

Question 12

PI + lovastatin/simvastatin

Answer 12

Increased Lovastatin/simvastatin

Question 13

ATV + PPIs

Answer 13

Decreased ATV
Avoid use in experience pts w/ resistance
Always boost with RTV
Max omeprazole 20mg/d or equivalent

Question 14

PIs + amiodarone, lidocaine, quinide, bepridil

Answer 14

Increased anti-arrhythmics

Avoid if possible; TDM

Question 15

PIs + trazodone

Answer 15

Increased trazodone

Use lowest dose possible

Question 16

PIs + immunosuppressants

Answer 16

Increased immunosuppressants

TDM

Question 17

PIs + statins

Answer 17

Increased statins

Prava/atorv preferred (+/- rosuv)

Question 18

PIs + fluticasone

Answer 18

Increased fluticasone

Use alternative

Question 19

MVC + inhibitor

Answer 19

Increased MVC

Halve MVC dose

Question 20

MVC + inducer

Answer 20

Decreased MVC

Double MVC dose

Question 21

RAL + rifampin

Answer 21

Decreased RAL

Double RAL dose

Question 22

RAL + phenytoin/phenobarbital

Answer 22

Potentially decreased RAL

Use caution

Question 23

EVG

Answer 23

Coformulated with cobi - follow cobi guide

Similar to ritonavir - similar interactions

Question 24

DTG + dofetilide

Answer 24

Increased dofetilide

Contraindicated

Question 25

DTG + rifampin

Answer 25

Decreased DTG | Increase DTG dose

Question 26

DTG + cations

Answer 26

Take DTG 2 hours before/6 hours after cations

Question 27

Cobi contraindications

Answer 27

``` Rifampin St. John's Wort Sildenafil ergot lovastatin/simvastatin triazolam/midazolam ```

Question 28

SOF

Answer 28

NS5B nucleotide polymerase inhibitor

Question 29

LDV

Answer 29

NS5A inhibitor

Question 30

Absorption of Harvoni

Answer 30

Tmax = 4 hours

Question 31

Distribution of SOF

Answer 31

65%

Question 32

Distribution of LDV

Answer 32

> 99%

Question 33

Metabolism of SOF

Answer 33

Hydrolysis and phosphorylation/dephosphorylation to an active metabolite

Question 34

Elimination of SOF

Answer 34

Renal (80%)

Question 35

Elimination of LDV

Answer 35

Biliary/feces

Question 36

Metabolism of LDV

Answer 36

Via oxidative metabolism

Question 37

Half-life of SOF

Answer 37

25

Question 38

Half-life of LDV

Answer 38

47

Question 39

Absorption of Epclusa

Answer 39

Tmax: 3 hours

Question 40

Distribution of VEL

Answer 40

> 99%

Question 41

Metabolism of VEL

Answer 41

2B6 2C8 3A4

Question 42

Elimination of VEL

Answer 42

Biliary/feces

Question 43

Half-life of VEL

Answer 43

15 hours

Question 44

Ombitasvir

Answer 44

NS5A inhibitor

Question 45

Paritapravir

Answer 45

NS3/4A protease inhibitor

Question 46

Dasabuvir

Answer 46

NS5B non-nucleoside polymerase inhibitor

Question 47

Absorption of Viekira XR

Answer 47

Tmax = 4-8 hours | Food enhances absorption

Question 48

Distribution of Viekira XR

Answer 48

> 97% | High apparent Vd for all 4 components

Question 49

Ombitasvir metabolism

Answer 49

Amide hydrolysis, followed by oxidative metabolism

Question 50

Paritaprevir metabolism

Answer 50

3A4

Question 51

Ritonavir metabolism

Answer 51

Mostly 3A4 | To lesser extent by 2D6

Question 52

Dasabuvir metabolism

Answer 52

Mostly 2C8 | To lesser extent 3A4

Question 53

Elimination of Viekira XR

Answer 53

Predominantly feces | Minimal renal elimination

Question 54

Ombitasvir half-life

Answer 54

21-25 hours

Question 55

Paritaprevir half-life

Answer 55

5.5 hours

Question 56

Ritonavir half-life

Answer 56

4 hours

Question 57

Dasabuvir half-life

Answer 57

5.5-6.0

Question 58

Elbasvir

Answer 58

NS5A inhibitor

Question 59

Grazoprevir

Answer 59

NS3/4A protease inhibitor

Question 60

Elbasvir absorption

Answer 60

Tmax: 3-6 hours

Question 61

Grazoprevir absorption

Answer 61

Tmax: 0.5-3 hours

Question 62

Zepatier distribution

Answer 62

> 97% | High Vd

Question 63

Zepatier metabolism

Answer 63

3A | - only drug approved for patients with all CrCl

Question 64

Zepatier elimination

Answer 64

Predominantly via feces | Minimal renal elimination

Question 65

Elbasvir half-life

Answer 65

24 hours

Question 66

Grazoprevir half-life

Answer 66

31 hours

Question 67

Ritonavir and CYP

Answer 67

inhibitor of 3A4

Question 68

Contraindications with Viekira XR

Answer 68

Anticonvulsants: carbamazepine, phenytoin, phenobarbital Antimycobacterial: rifampin Herbal: St. John's Wort Statins: lovastatin/simvastatin

Question 69

Contraindications with Zepatier

Answer 69

Anticonvulsants: phenytoin, carbamazepine Antimycobacterial: rifampin Herbal: St. John's Wort Immunosuppressants: CsA

Question 70

Drugs not recommended with Harvoni/Epclusa

Answer 70

Amiodarone P-gp inducers: rifampin, St. John's wort Anticonvulsants

Question 71

Drugs not recommended with Zepatier

Answer 71

3A4 inducers: nafcillin | 3A4 inhibitors: ketoconazole, cobi