HIV Flashcards
What kind of virus is HIV?
Retrovirus and lentivirus
What enzyme allows RNA to be converted into DNA?
Reverse transcriptase
What enzyme allows HIV viral maturation?
Protease
What enzyme allows viral genes to enter nucleus and host DNA?
Integrase
When should antiretroviral therapy (ART) be started?
All HIV (+) patients
Should ART be used in pregnancy? Why of why not?
Yes. prevents transmission and provides clinical benefit to mother
In what condition should ART initiation be delayed?
cryptococcal meningitis
-can increase mortality if started to early, refer to specialist
Preferred Regimen to treat AIDS
NNRTI-base
-efavirenz/tenofovir/emtricitabine
Protease Inhibitor- based
-Darunavir or Ataxanavir + tenofovir/emtricitabine
INST- based
-Raltegravir + tenofovir/emtricitabine
Post exposure HIV prophylaxis should include
3 anti-HIV drugs, 4 week minimum
-Dual NRTI+ protease inhib or INSTI
Pre-exposure prophylaxis should include
tenovir/emtrictabine daily
-ie to prevent transmission from mother to baby
Dose a NRTI
Truvada
one tablet daily
Dose a NNRTIs
Atripla
one tablet daily
Dose a protease inhibitor
Prezista 800mg
one table daily, long with Truvada
Dose a fusion inhibitor
Enfuvirtide(Fuseon) 90mg
Inject subq twice a day
Dose an integrase strand transfer inhibitor
Isentress 400mg
1 tablet twice a day, with Truvada
Dose a CCR5 inhibitor
Selzentry 300mg
1 tablet twice a day
How are NRTIs excreted from the body
renally
30-49 adjust dose, <30 not recommended
General class effect ADR seen in NRTI: what drugs in this class is this generally not seen
Lactic Acidosis, Hepatomegaly
-not generally seen with abacavir, emtricitabine, lamivudine, tenofovir
Who does no one continue to prescribe the NRTIs didanosine and stavudine?
Peripheral Neuropathy
How are NNRTIs metabolized?
CYP3A
can act as an inhibitor or inducer
MOA NRTI
integrate into structure, changing RNA/DNA, leading to host cell death
MOA NNRTI
block activity of reverse transcriptase
Name 2 NRTIs
Emtricitabine (Emitra)
Tenofovir (Viread)
Name 2 NNRTIs
Efavirenz (Sustiva) Delaviridine (Rescriptor) Etravirine (Intelence) Nevirapine (Viramune) Rilpivirine (Endurant)
ADRs of efavirenz
dizzy, depression, insomnia, HA, rash, increase total cholesterol, triglycerides, HDL, GI symptoms
Name 3 protease inhibitors
atazanavir (reyataz)
darunavir (prezista)
ritonavir (norvir)
What drug class reduces viral shedding?
protease inhibitors
How are protease inhibitors metabolized?
CYP3A4
What drug interaction could affect effectiveness of a protease inhibitor?
stomach pH drugs
H2blocker, PPI
also keep in mind CYP3A4 metabolism
Atazanavir can be used _______ an H2 blocker or________ after a PPI
with or 10 hours after H2blocker
12hrs after PPI
What drug group can lead to new onset diabetes or worsen a diabetics control?
Protease Inhibitors
-monitor blood sugar
What drug is used to increase maximum concentration of concomitant protease inhibitor
Ritonavir
What ADR would you be concerned for with atazanavir?
nephrolithiasis
What ADR would be watch for usin Darunavir?
pancreatitis, sulfonamide cross-reactions
Name a fusion inhibitor
enfuvirtide (fuseon)
Name the only HIV drug given by injection
enfuvirtide (fuseon)
Which HIV drug would be a pneumonia risk
Fuseon
Name an integrase strand inhibitor
Elvitegravir which is integrated into
Raltelgravir (Isentress)
what is cobicistat
CYP3A inhibitor that allos elvitegravir to obtain therapeutic levels
ADRs of Isentress
Skin & Hypersensitivity- SJS
Myopathy
ADR concern for patient on statins and integrase strand inhibitor
rhabdomyolysis
Name a CCR5 Inhibitor
Maraviroc (Selzentry)
How are ccr5 inhibitors metabolized
CYP3A
ADRs of Selzentry
Hepatotoxicity w/allergic features
Myocardial ischemia/infarction
postural hypotension
