HIV

Question 1

What are the non-nucleotide reverse transcriptase inhibitors?

Answer 1

Efavirenz

Rilpivirine

Question 2

What are the common toxicities of all of the protease inhibitors?

Answer 2

Altered body fat distribution “buffalo hump and truncal obesity”

Insulin resistance/hyperglycemia

High cholesterol (but not ok to combine with statins)

Bleeding in pts with hemophilia

Question 3

What is the one drug that is an integrase inhibitor?

Answer 3

Dolutegravir (Tivicay)

*****NOT A PROTEASE INHIBITOR despite it’ ending in -avir

Question 4

What do you need to do before you give your patient maraviroc (Selzentry)?

Answer 4

You need to test to see which type of receptor the patient has.

You’re either CXCR4 or CCR5 or a combo of both. Maraviroc only works on CCR5.

Won’t work on R4 or mixed infections

Question 5

What is the MOA of the NNRTI’s?

Answer 5

Bind directly to viral reverse transcriptase, which is ESSENTIAL for the conversion of RNA to DNA

Question 6

What is the MOA of dolutegravir?

Answer 6

Prevents the viral DNA from incorporating into the host DNA

Question 7

What nucleotide is zidovudine an analogue of?

Answer 7

Thymidine

Question 8

What do you need to screen for before starting abacavir?

Answer 8

HLA-B-5701 due to extreme hypersensitivity

Question 9

Ok so i know i can’t give ritonavir with saquinavir, but what else should i not give Ritonavir with and why?

Answer 9

Do not give with metronidazole, disulfiram, or cephalosporins

Ritonavir contains ethanol 🍺🍻🥂🍾🍸

Question 10

Which HIV drugs are Nucleoside reverse transcriptase inhibitors?

Answer 10

Zidovudine-thymidine

Emtricitabine-cytosine

Tenofovir-adenosine

Lamivudine-cytosine

Abacavir-guanosine

Question 11

If you take your patient off of abacavir, can you ever start them back on it?

Answer 11

No may be fatal

Question 12

What are the two NRTI’s that can be used to treat Hep B as well as HIV?

Answer 12

Tenofovir

Lamivudine

Question 13

What is the MOA of enfuvirtide (Fuzeon)?

Answer 13

Binds to gp41 subunit of the viral envelope and prevents the conformational change required for membrane fusion and subsequent viral entry into cells

Question 14

What is the MOA of protease inhibitors?

Answer 14

They all work “post-integration” by binding to proteases and inhibiting their function, which is to cut up huge chunks of protein into smaller, functional proteins

Question 15

Why does ritonavir “boost” the other protease inhibitors?

Answer 15

It inhibits CYP3A4, so it increases the bioavailability of the other ones since they are metabolized by CYP3A4

(Except fot saquinavir…it will make the QT issues even worse for that person)

Question 16

Would we ever give rilpivirine to a non-pregnant person

Answer 16

No, use efavirenz for every non pregnant patient

Question 17

Which NRTI’s should not be used together since they both are analogues of the same nucleoside?

Answer 17

Emtricitabine

Lamivudine

Question 18

What are the protease inhibitors?

Answer 18

Darunavir

Atazanavir

Ritonavir

Saquinavir

Lopinavir

Indinavir

Tipranavir

Question 19

What are the fusion inhibitors?

Answer 19

Enfuviritde (Fuzeon)

Maraviroc (selzentry)

Question 20

Which one of the protease inhibitors is used to give a boost to the other protease inhibitors?

Answer 20

Ritonavir

Except don’t give it with Saquinivir due to QT prolongation issues

Question 21

Every single NRTI has two rare but serious side effects. What are they?

Answer 21

Lactic acidosis

Hepatotoxicity

(Especially if they are obese, have liver disease, or take them for a long time)

Question 22

Which NNRTI are you going to give to your HIV+ pregnant patient?

Answer 22

Rilpivirine

Question 23

Which two NRTIs have flatulence as their main side effect?

Answer 23

Tenofovir

Emtricitabine

Question 24

Your aids patient starts developing lactic acidosis, which can be deadly. Which drug do you think is causing it?

Answer 24

The NRTI they are on.

NRTIs: Zidovudine, Emtricitabine, tenofovir, lamivudine, abacavir

Question 25

Which one of the NNRTIs are you going to give to 99% of your Aids patients? When wouldn’t you give it?

Answer 25

Efavirenz

Do NOT use in pregnancy

Question 26

Which of the protease inhibitors have sulfa components and may cause hypersensitivity?

Answer 26

Darunavir

Tipranavir

(Don’t Take……DT)

Question 27

What nuclsoede is lamivudine an analogue of?

Answer 27

Cytosine

Question 28

What is the MOA of maraviroc (Selzentry)?

Answer 28

Inhibits the fusion of the virus by binding to the CCR5 receptor of the CD4 T-cell