Fitz - Pharm of HIV Inf

Question 1

first line Nuceloside Reverse Transcriptase Inhibitors (NRTIs)

Answer 1

• abacavir
• emtracitabine
• lamivudine
• tenofovir
• zidovudine > azidothymidine

Question 2

first line non-NRTIs (NNRTIs)

Answer 2

efavirenz

Question 3

what NNRTI do you want to avoid in pregnancy

Answer 3

efavirenz

Question 4

first line HIV Protease Inhibitors (PIs)

Answer 4

• atazanavir

- darunavir

Question 5

adjunct PI drug always used with first line PIs

Answer 5

ritonavir

Question 6

Integrase Strand Transfer Inhibitors (IIs)

Answer 6

raltegravir

Question 7

CCR5 angtagonist Viral Fusion Inhibitor

Answer 7

maraviroc

Question 8

GP41 antagonist Viral Fusion Inhibitor

Answer 8

enfuvirtide

Question 9

MC initial HIV drug regimens

Answer 9

2 NRTIs +

• NNRTI
• PT
• INSTI

Question 10

NRTIs that penetrate CNS

Answer 10

• zidovudine

- azidothymidine

Question 11

NNRTI that penetrates CNS

Answer 11

nevirapine

Question 12

MOA: NRTIs

Answer 12

modified versions of nucleosides > causes irreversible termination of DNA elongation > inhibits HIV DNA integration into host DNA

Question 13

Purine NRTIs

Answer 13

• abacavir
• didanosine
• tenofovir

Question 14

Pyrimidine NRTIs

Answer 14

• lamivudine
• emtricitabine
• zidovudine
• stavudine

Question 15

host enzyme that adds initial phosphate group to NRTIs

Answer 15

cytosine kinase

Question 16

AEs: NRTIs

Answer 16

• lactic acidosis syndrome

- lipoatrophy, lipodystrophy

Question 17

s/s of lactic acidosis syndrome

Answer 17

nausea, vomiting, abd pain, wt loss, fatigue, myalgia, features of hepatic dysfunction

Question 18

hallmark of NRTI toxicity

Answer 18

mitochondrial toxicity

Question 19

mechanism of mitochodiral toxicity leading to lactic acidosis syndrome

Answer 19

mito DNA needed for ox phos proteins > def in proteins = impaired ox phos > anaerobic glucose metabolism > lactic acidosis

Question 20

“not so bad” NRTIs

Answer 20

• tenofovir
• lamivudine
• emtricitabine
• abacavir

Question 21

worst NRTIs

Answer 21

didanosin > stavudine > zidovudine

Question 22

AE: tenofovir

Answer 22

nephrotoxicity

Question 23

tenofovir elimnitation

Answer 23

glom filtration and active tubular secretion

Question 24

what NRTI should you use in a pt with kidney disease

Answer 24

abacavir

Question 25

s/s of abacavir hypersentivity

Answer 25

fever, rash, GI, respiratory s/s, lethargy, malaise

Question 26

avoid used of abacavir in

Answer 26

HLA-B*5701 genotype pts > HSN rxn

Question 27

NNRTI & PI elim

Answer 27

hepatic - CYP450

Question 28

major NRTI combo to avoid

Answer 28

triple nucleoside analog combinations

Question 29

preferred initial dual-NRTI therapy

Answer 29

tenofovir/emtricitabine

Question 30

preferred initial dual NRTI therapy IN PREGNANCY

Answer 30

zidovudine/lamivudine

Question 31

dual-NRTI therapies that tx Hep B too

Answer 31

- tenofovir/emtricitabine | - abacavir/lamivudine

Question 32

dual-NRTI therapy that runs risk of ABC HSN

Answer 32

abacavir/lamivudine

Question 33

NNRTI to use in preganacy

Answer 33

nevirapine

Question 34

NNRTI to use with resistant HIV strains

Answer 34

etravirine

Question 35

NNRTI prefered in treatment-experienced HIV pts

Answer 35

etravirine

Question 36

MOA: NNRTIs

Answer 36

binds and distorts reverse transcriptase enzyme stopping viral DNA assembly > less HIV DNA > doesn't get integrated into host genome

Question 37

pregnant women taking what drug should continue tx if their HIV viral load is managed?

Answer 37

efavirenz

Question 38

hypersensitivity to NNRTIs can cause what? which one is the worst?

Answer 38

- steve-johnson syndrome | - nevirapime

Question 39

NNRTI that induces drug-drug interactions

Answer 39

efavirenz

Question 40

signature mutation that confirs resistance to NNRTIs

Answer 40

K103N

Question 41

NNRTIthat has activity against HIV strains resistant to other NNRITs

Answer 41

etravirine

Question 42

first line initial triple drug therapy NRTIs + NNRTI

Answer 42

tenofovir/emticitabine/efavirenz

Question 43

PIs used in drug resistant HIV

Answer 43

- darunavir | - tiranavir

Question 44

AE: indinavir

Answer 44

kidney stones

Question 45

MOA: PIs

Answer 45

mimics peptide bond btwn pehnylalanine and proline at 167 and 168 to stop translation of functional proteins

Question 46

role of ritonavir use with other PIs

Answer 46

"boosts" bioavailability of PI it's paired with by inhibiting CYP3A4 and prolonging their T1/2

Question 47

AEs: PIs

Answer 47

- sulfonamide HSN - hepatotoxicity (acute) - lipodistrophy (LT)

Question 48

Preferred dual-NRTI + PI

Answer 48

tenofovir/emtricitabine + ataxanavir/ritonavir

Question 49

Alternative dual-NRTI + PI

Answer 49

tenofovir/emtricitabine + lopinavir/ritonavir

Question 50

post exposure prophylaxis for HIV should be started within how many days

Answer 50

3

Question 51

3 drug PEP recommended in pregnancy

Answer 51

- zidovudine + lamivudine - lopinavir + ritonavir - 2x/d

Question 52

3 drug PEP recommended w/ chance of liver toxicity

Answer 52

- tnofovir + enmticitabine qd | - lopinavir + ritonavir

Question 53

MOA: raltegravir

Answer 53

inhibition of HIV intrgrase > stops integration of HIV DNA into host DNA

Question 54

AEs: raltrgravir

Answer 54

- myopathy - rhabdomyolysis - skin reactions

Question 55

MOA: maraviroc

Answer 55

blocks gp120* binding to CCR5 > prevents gp41 exposure and viral fusion

Question 56

what receptor is maraviroc ineffective against

Answer 56

CXCR4

Question 57

MOA: Enfuvirtide

Answer 57

blocks gp41 fusion and inhibits HIV entry into host cell