HIV Flashcards
Abacavir
Ziagen, ABC (NRTI)
use: HIV (preferred)
tablet, oral soln (BID)
AE: lactic acidosis, hepatomegaly, hypersensitivity, increased LFTs
screen for HLA-B*5701 gene (increased risk of rxn)
avoid alcohol (inc. AUC)
no renal dose adjustment
Didanosine
ddl, Videx (NRTI) use: HIV (avoid) casule, soln (QD) AE: lactic acidosis. hepatomegaly, pancreatitis, peripheral neuropathy, diarrhea, increased LFTs, insulin resistance/diabetes, HTN, vision/retinal changes decrease dose in renal impairment take on empty stomach (EC) avoid with stavudine and tenofovir
Emtricitabine
FTC, Emtriva (NRTI) use: HIV (preferred) capsule, oral soln (200mg QD) AE: lactic acidosis, hepatomegaly, hyperpigmentation, increased CPK/LFTs exacerbation of HepB with D/C decrease dose in renal impairment avoid with lamivudine (no benefit)
Lamivudine
3TC, Epivir (NRTI) use: HIV (preferred), HBV tablet, oral soln (BID or QD) AE: lactic acidosis, hepatomegaly, myalgias, increased LFTs decrease dose in renal impairment may exacerbate Hep B with D/C Epivir-HBV for Hep B treatment avoid combo with emtricitabine
Stavudine
d4T, Zerit (NRTI)
use: HIV (avoid)
capsule, oral soln (BID)
AE: lactic acidosis, hepatomegaly, increased LFTs, pancreatitis, insulin resistance/diabetes, peripheral neuropathy, lipoatrophy/lipodystrophy, hyperlipidemia
decrease dose in renal impairment
avoid with didanosine (pancreatitis) and zidovudine
Tenofovir
TDF, Viread (NRTI) use: HIV (preferred), HBV (1st line) tablet, oral powder (QD) AE: lactic acidosis, hepatomegaly, fanconi syndrome, renal insufficiency, osteomalacia, decreased bone density, increased LFTs decrease dose in renal insufficnency D/C may exacerbate Hep B avoid with didanosine supplement with Vit D + Ca 1st line therapy in HBV infection
Zidovudine
ZDV/AZT, Retrovir (NRTI) use: HIV (pregnancy) cap, tab, oral soln (BID) AE: lactic acidosis, hepatomegaly, hematologic toxicities, myopathy, nail hyperpigmentation, lipoatrophy, increased LFTs, insulin resistance/diabetes, hyperlipidemia, bone marrow supression, macrocytic anemia decrease dose in renal failure (CrCl<15) avoid with stavudine IV given during labor
Efavirenz
EFV, sustiva (NNRTI) use: HIV (preferred) cap, tab (QD) AE: Rash (SJS/TEN), hepatotoxicity, CNS, psychiatric symptoms, hyperlipidemia take on empty stomach HS Pregnancy Category D (avoid in 1st trimester) can sprinkle onto food CYP inhibitor/inducer and 3A4 substrate
Etravirine
ETR, Intelence (NNRTI)
use: HIV (experienced)
tablet (BID)
AE: SJS/TEN, rash, hepatotoxicity, increased cholesterol, hyperglycemia, peripheral neuropathy
take after meals
CYP 3A4 inducer, CYP inhibitor and substrate
activity against K103N mutation
Nevirapine
NVP, Viramune (NNRTI)
use: HIV (pregnancy)
tablet, oral susp (QD, BID)
AE: SJS/TEN/rash, HEPATOTOXICITY, increased LFTs
14-day lead in period
CYP 3A4 inducer and substrate
avoid in women with CD4>250, men >400 (hepatotoxicity)
Rilpivirine
RPV, Edurant (NNRTI) use: HIV (alternative) tablet (QD) AE: SJS, TEN, rash, CNS (depression, mood changes, suicidal ideation) take with LARGE MEAL separate from antacids (CI with PPIs) CI with CYP 3A4 inducers/inhibitors no dose adjustments
Atazanavir
ATV, Reyataz (PI)
use: HIV (preferred + pregnancy)
capsule (QD)
AE: metabolic (hyperglycemia, hyperlipidemia), lipoatrophy, hepatitis, immune reconstitution syndrome, PR interval prolongation, hyperbilirubinemia, rash, nephrolithiasis, cholelithiasis, jaundice ("bananavir")
take with food and water
*separate from acid-supressive agents
CYP drug interactions (inhibition)Darunavir
DRV, Prezista (PI) use: HIV (preferred) tablet, oral suspension AE: metabolic (hyperglycemia, hyperlipidemia), lipoatrophy, hepatitis, immune reconstitution syndrome, N/V/D, rash (SJS/TEN) caution in sulfa allergy take wit food (swallow whole) CYP drug interactions (inhibition)
Fosamprenavir
FPV, Lexiva (PI) use: HIV (alternative) tablet, oral susp (QD, BID) AE: metabolic (hyperglycemia, hyperlipidemia), lipoatrophy, hepatitis, immune reconstitution syndrome, rash (SJS, TEN), nephrolithoasis caution in sulfa allergy susp= take without food CYP drug interactions (inhibition)
Ritonavir
RTV, Norvir (PI) use: HIV (preferred) cap, tab, oral soln AE: metabolic (hyperglycemia, hyperlipidemia), lipoatrophy, hepatitis, immune reconstitution syndrome, N/V/D, paresthesias, asthenia, altered taste, PR prolongation Take with food MANY DRUG INTERACTIONS (CYP 3A4) BOOSTER capsules= refrigerate
Lopinavir
LPV, Kaletra (PI)
tab, oral soln (QD, BID)
AE: metabolic (hyperglycemia, hyperlipidemia), lipoatrophy, hepatitis, immune reconstitution syndrome, pancreatitis, asthenia, abdominal pain, PR/QT prolongation
oral soln= take with food and refrigerate
avoid QD dosing with CYP inducers
CYP drug interactions (inhibition)
Enfuvirtide
T20, Fuzeon (Fusion inhibitor)
use: HIV (tx-experienced/salvage therapy)
AE: injection site rxn**, increased risk of bacterial pneumonia
no significant drug interactions
Maraviroc
MVC, Selzentry (CCR5 antagonist) use: HIV (tx-experienced) AE: hepatotoxicity, URTI, fever, rash (SJS), musculoskeletal symptoms, hepatotoxicity, dizziness, orthostasis decrease dose in renal inpairment only effective in CCR5-tropic disease P-gp and 3A4 substrate
Raltegravir
RAL, Isentress (INSTIs) use: HIV (preferred) tablet (BID) AE: CPK elevation, myopathy, rhabdomyolysis, rash (SJS) UGT1A1 metabolism
Dolutegravir
DTG, Tivicay (INSTIs) use: HIV (preferred) tablet (QD) AE: insomnia, CPK elevation, increased LFTs avoid with dofetilide
Elvitegravir
EVG, Stribild combo (INSTIs) use: HIV (preferred) tablet (QD) AE: renal impairment, decreased bone mineral density, proteinuria separate from antacids 2C9 inducer (mild)
Emtricitabine + Tenofovir
Truvada (NRTIs)
1 tablet QD
preferred combo
Lamivudine + Zidovudine
Combivir (NRTIs)
1 tablet BID
preferred for pregnancy
Abacavir + Lamivudine
Epzicom (NRTIs)
1 tablet QD
alternative combo
