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Pharm Fall > HIV > Flashcards

HIV Flashcards

1
Q

HIV 1 / HIV 2

A
  • HIV 1 is the main cause of AIDS

- HIV 2 can cause AIDS but it is less virulent, less transmissible and less prevalent

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2
Q

What are the purposes of ART?

A
  • Suppress HIV replication
  • Delay the onset of AIDS
  • Reverse HIV associated immunologic deficits
  • Prolong survival
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3
Q

How is HIV transmitted

A
  • Infected needle prick
  • Used needles
  • Receive HIV infected blood products
  • HIV infected organ donation
  • Perinatal infection
  • Sexual intercourse
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4
Q

What two surrogate markers are used to diagnose HIV?

A
  • CD4 cell count

- Viral load

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5
Q

At what CD4 count should you initiate therapy?

A

<350 cells/mm3

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6
Q

What are the goals of therapy?

A
  • Reduce HIV-associated morbidity and prolong the duration and quality of survival
  • Restore and preserve immunologic function,
  • Maximally and durably suppress plasma HIV viral load
  • Prevent HIV transmission
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7
Q

What are the 4 therapy classes?

A
  • Entry inhibitors
  • Reverse transcriptase inhibitors
  • Integrase strand transfer inhibitors
  • HIV protease inhibitors
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8
Q

What are the two subtypes of Reverse Transcrpitase Inhibitors?

A
  • Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
  • Nonnucleoside reverse transcriptase inhibitors (NNRTIs)
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9
Q

What do NRTIs require for activation?

A

Phosphorylation

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10
Q

NRTI toxicities

A
  • Peripheral neuropathy
  • pancreatitis
  • lipoatrophy
  • myopathy
  • anemia
  • lactic acidosis w/ fatty liver (rare)
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11
Q

What three NRTIs are preffered over Stavudine and didanosine?

A
  • Emtricitabine
  • Lamivudine
  • Tenofovir
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12
Q

Do NNRTIs require intracellular activation?

A

No

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13
Q

Can you effectively use NNRTIs with NRTIs?

A

Yes

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14
Q

Name the NNRTIs (4)

A
  • Efavirenz (EFV)
  • Delavirdine (DLV)
  • Nevirapine (NVP)
  • Etravirine (ETR)
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15
Q

What are NNRTIs associated with?

A

Rash and elevated Liver Function tests

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16
Q

What do all Protease Inhibitors end with?

A

-vir

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17
Q

Name the Protease Inhibitors (PIs) (10)

A
  • amprenavir (APV)
  • fosamprenavir (FPV) (prodrug of amprenavir)
  • atazanavir (ATV)
  • darunavir (DRV)
  • indinavir (IDV)
  • lopinavir (LPV)
  • nelfinavir (NFV)
  • ritonavir (RTV)
  • saquinavir (SQV)
  • tipranavir (TPV)
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18
Q

PIs MOA

A

competitively inhibit the cleavage of the gag-pol polyprotein (stops viral replication)

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19
Q

What are PIs associated with?

A

GI distress and metabolic changes

20
Q

What are PI mostly given with and why?

A

Ritonavir (CYP3A inhibitor)–> Enhances plasma concentration of the PI

21
Q

What are the two types of Entry Inhibitors?

A
  • Fusion inhibitors

- CCR5 inhibitors

22
Q

What is the one fusion inhibitor?

A

Enfuvirtide

23
Q

Enfuvirtide MOA

A

Inhibits fusion of HIV with the target cell

24
Q

What is the preferred route of administration of enfuvirtide?

A

SQ

Oral route is impossible to do its peptide nature

25
Q

Side Effects of enfuvirtide

A

Injection site reaction

26
Q

How is enfuvirtide cleared?

A
  • protein catabolism

- amino acid recycling

27
Q

What is the one CCR5 inhibitor?

A

Maraviroc

28
Q

MOA of Maraviroc

A

Antagonist that blocks human receptors

29
Q

Potential Side Effects of Maraviroc

A

Drug to drug interactions because it is a substrate of P-glycoprotien

30
Q

MOA of Integrase Inhibitors (InSTIs)

A

Binds to HIV integrase at a certain time which therefore prevents the HIV viral DNA from getting into the human genome. Cellular components then break down the unincorporated viral DNA.

31
Q

What are the two Integrase Inhibitors (InSTIs)?

A
  • Raltegravir

- Elvitegravir

32
Q

What is Elvitegravir susceptible to?

A

Drug interactions with CYP3A drugs. (its metabolized by CYP3A drugs)

33
Q

What should Elvitegravir be coadministered with?

A

Ritonavir. It increases plasma concentrations.

34
Q

What is the drug combination for Atripla?

A

Efavirenz (EFV) +
Tenofovir (TDF) +
Emtricitabine (FTC)

35
Q

What is the drug combination for Stribild?

A

Elvitgravir +
Cobicistat +
Tenofovir +
Emtricitabine

36
Q

What is the drug combination for Complera?

A

Rilpivirine +
Tenofovir +
Emtricitabine

37
Q

What is the drug combination for Truvada?

A

Tenofovir +

Emtricitabine

38
Q

What is the drug combination for Combivir?

A

Lamivudine +

Zidovudine

39
Q

What is the drug combination for Kaletra?

A

Lopinavir +

Ritonavir

40
Q

When should stribild be used?

A

In patients with pre treatment creatinine clearance of >70ml/min

41
Q

When should you do HLA-B 5701 screening?

A

Before starting patients on an abacavir containing regimen to reduce the risk of hypersensitivity reactions

42
Q

When should you do Coreceptor tropism assays?

A
  • Whenever using a CCR5 inhibitor

- May be considered in patients who exhibit virologic failure on a CCR5 inhibitor

43
Q

What lab tests can be done for HIV?

A
  • CD 4 T cell count
  • Plasma HIV RNA Testing
  • Drug resistance testing
  • HLA-B 5701 screening
  • Coreceptor Tropism Assay
44
Q

What is the combination for Epzicom?

A

Abacavir +

Lamivudine

45
Q

What is the combination for Trizivir?

A

Abacavir +
Lamivudine +
Zidovudine

Pharm Fall (12 decks)

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