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Pharm > HIV > Flashcards

HIV Flashcards

1
Q

Which of the NRTI’s can cause lactic acidosis-hepatic steatosis syndrome?

A

Didanosine > Stavudine > Zidovudine

Dan Stan Dove

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2
Q

Which of the NRTI’s can cause HBV flare (upon discontinuation)?

A

Lamivudine
Emtricitabine
Tenofovir

(LET’s HBV flare)

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3
Q

When is abacavir contraindicated?

A

HLA-B 5701+ pts (hypersensitivity rxn)

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4
Q

Which NNRTI is a/w birth defects most?

When would it be contraindicated?

A

Efavirenz (EFV)

Contraindicated in 1st trimester pregnancy or women planning to conceive.

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5
Q

Either of which 2 drugs can be used w/rifapentin for TB tx along w/the standard 2 NRTIs or alternatives?

A

Efavirenz (NNRTI) and Raltegravir (INSTI)

(in combination with abacavir/lamivudine or tenofovir/emtricitabine) are recommended w/ rifapentine. Bottom line is that coadministration of rifabutin and ART will require monitoring and dose adjustment

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6
Q

Which NNRTI is contraindicated for coadministration w/other NNRTIs and some PI’s?

A

Etravirine

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7
Q

Which NNRTI is a/w severe hepatotoxicity?

A

Nevirapine (NVP)

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8
Q

Besides in pts w/liver disease, when (specifically) else is nevirapine (NNRTI) contraindicated?

A

HIV drug is contraindicated in women with pretreatment CD4 > 250 cells/mm and men with CD4 > 400 cells/mm

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9
Q

Name the NRTIs.

What is the NNRTI that sounds like an NRTI?

A 
Abacavir
Didanosine
Emtricitabine (FTC)
Lamivudine
Stavudine
Tenofovir (TFV)
Zidovudine

“dine”
- NOT Delavirdine (NNRTI)

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10
Q

Name the NNRTIs.

A 
Delavirdine
Efavirenz (EFV)
Etravirine
Nevirapine (NVP)
Rilpivirine
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11
Q

Name the PI’s.

A

“navir’s” (Lady Guinevere)

Ritonavir (RTV)
Fosamprenavir
Atazanavir
Indinavir
Nelfinavir
Saquinavir
Tipranavir
Lopinavir
Darunavir
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12
Q

What does INSTI stand for?

Name the INSTI’s.

A

(Integrase Strand Transfer Inhibitors)

Raltegravir
Elvitegravir
Dolutegravir

“gravir’s”
(gravy should not be integrated w/the HIV+ diet)

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13
Q

Name the fusion inhibitor.

A

Enfuvirtide

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14
Q

Name the CCR5 antagonist.

A

Maraviroc

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15
Q

How do some statins affect the CYP enzymes?

Which class of drugs affect statin metabolism? How?

Which statins can be used?

A

They are metabolized by CYP3A4

Levels of some statins decreased w/protease inhibitors.

Pravastatin and fluvastatin may be used.

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16
Q

Which PI can cause paresthesias?

A

Ritonavir (RTV)

17
Q

Which PI is the most potent CYP3A4 inhibitor?

A

Ritonavir (RTV)

18
Q

Which PI’s are preferred for naive HIV pts?

A
  1. Darunavir
  2. Atazanavir
    Lopinavir
    Fosamprenavir

(DALF)

19
Q

Which PI’s can cause metabolic syndrome?

A

All

20
Q

What is the exact MoA for INSTIs?

A

Blocks the insertion of reverse-transcribed viral DNA into the host DNA by binding the Mg++ cofactors required for the strand transfer. Mutations that alter orientation of Mg++ ions can be resistant to INSTIs.

21
Q

List the ISNTI’s in order of shortest to longest T1/2

A

Elvitegravir < Raltegravir < Dolutegravir

22
Q

What are the adverse effects of miraviroc?

A

Hepatotoxicity and possible hypersensitivity

23
Q

What are the adverse effects of enfuvirtide?

A

Injection site reaction/inflammation is very common, hypersensitivity

24
Q

Which non-NNRT/PI/NRTI is a CYP substrate?

A

Miraviroc

25
Q

In general, what are the recommended ART options for tx-naive HIV pts?

A

Either:
1 INSTI + 2 NRTIs
or
1 PI (boosted w/RTV) + 2 NRTIs

26
Q

When giving 1 INSTI (+ 2 NRTIs) for a tx-naive HIV pt, what are the INSTI options?

A

Raltegravir
Elvitegravir
Dolutegravir
(ie any of them)

27
Q

When giving 1 PI (+ 2 NRTIs) for a tx-naive HIV pt, what are the PI options?

A

Darunavir (boosted w/ritonavir)

Alt: Atazanavir (boosted w/ritonavir or cobicistat)

28
Q

When would you NOT use the alternative PI tx?

Alt: Atazanavir (boosted w/ritonavir or cobicistat)

A

Pts who require high dose PPIs

29
Q

What is the PREFERRED dual NRTI option when treating a tx-naive HIV pt?

When can you not use this first-line dual NRTI therapy?

A

Tenofovir prodrug (TAF or TDF) + emtricitabine

Do not use with unboosted atazanavir.
Use w/caution w/nevirapine or in pts w/underlying renal insufficiency.

30
Q

What is the ALTERNATIVE dual NRTI option when treating naive HIV pts?

When can you not use this alternative dual NRTI therapy?

A

Abacavir + lamivudine

Do not use when positive for HLA-B 5701.
Use w/caution w/pts w/ > 100,000 HIV copies/mL or in high risk CV pts.

31
Q

Name 3 regimens that you should NOT use in naive HIV tx.

A

Monotherapy with NRTI
Dual NRTI regimens
Triple NRTI regimens

32
Q

Why should you never use mono or dual NRTI regimens without other drugs?

What are the exceptions?

A
  1. Rapid resistance development
  2. Inferior antiretroviral activity

No exceptions

33
Q

Why should you never use triple NRTI regimens without other drugs?

What are the exceptions?

A

High rate of non-response in tx-naive pts

Abacavir/zidovudine/lamivudine or tenofovir/zidovudine/lamivudine in pts whom other options are worse.

34
Q

List drugs that should NOT be co-administered w/

PIs due to CYP-dependent metabolism.

A 
Quinidine (substrate)
Ergotamine (substrate)
Rifampin (inducer)
Midazolam (substrate)
Phenobarbital (inducer)
Warfarin (substrate)
St. John's wart (inducer)
35
Q

Is Maraviroc effective against CXCR4 virus entry?

A

No, only CCR5

36
Q

Which of the NNRTIs are CYP3A4 inducers?

A

Nevirapine

Efavirenz

37
Q

Which NRTI can cause renal toxicity?

A

Tenofovir (TFV)

Pharm (32 decks)

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