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HIV Flashcards

1
Q

HIV1 vs HIV2

A

HIV-1- more prevelant in the U.S and more pathogenic (rapid progression to AIDS)

HIV-2- more in Western Africa, less pathogenic, more resistant to NNRTs

Souce of Transmission: body fluids of infected person

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2
Q

Cell surface receptors for HIV

A

CD4

CCR5

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3
Q

HIV testint

A

Seroconversion window period

  • time of infection to production of antibodies
  • average 3-4 weeks but up to 6 months
  • acute HIV

HIV tetsing

  • Rapid (antibody test)- bllod or oral fluid, rapid test requires confirmation if reactive
  • Combination immunotherapy (4th gen)- HIV-1 or HIV-2 antibodies and HIV-1 protein 24, more sensetive to early detection
  • PCR test- viral load test detects genetic material of HIV
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4
Q

Emtriva (emtricitabine, FTC)

A

NRTI

Headache, GI intolerance, rash

Emtricitabine used for HIV and HBV

Rare hyperpigmentaition of palms and soles of feet more with African Americans

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5
Q

Epivir (lamivudine, 3TC)

A

NRTI

Headache, GI intolerance, rash

Can be used in HBV infections

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6
Q

Viread (tenofovir disoproxil fumarate or TDF)

A

NRTI

GI intolerance (fatulence and diarrhea), headache,

decreased bone marrow density, osteomalacia, renal impairment (TDF), Fanconi Syndrome

TDF associated with lower lipid levels (good patients with hyperlipidemia)

Used to treat HBV too

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7
Q

Vemlidy (tenofovir alafenamide, TAF)

A
  • NRTI
  • Higher lipid levels but better for the kidneys
  • substrate of p- glycoprotein- DDI will lower the TAF levels (subtheraputic)
    • Phenytoin, oxcarbazepine, phenobarbital, rifampin, rifabutin, rifapentine, St. John’s Worts
  • Used to treat HBV too
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8
Q

Ziagen (abacavir, ABC)

A

NRTI

Liver metabolism via alcohol dehydrogenase- caution in hepatic impairment and alocholics

Hypersenitivity reactions- check HLA-B*5702 test

  • Positive then avoid the drug and report as allergy on patient chart
  • Even if the test is negative report signs and symptoms if they develop

Increased risk of MI

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9
Q

Travada (emtricitabine/ tenofovir disoproxil furarate, FTC/ TDF)

A

NRTI

Can be used as prophylaxis too

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10
Q

Descovy (emtricitabine/ tenofovir alafenamide, FTC/TAF)

A

NRTI

For HIV and HBV

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11
Q

Epzicom (lamivudine/ abacavir, 3TC/ABC)

A

NRTI

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12
Q

Generally what is the MOA of NRTIs and drug class side effects?

Pharmacokinetics?

A

MOA- inhibit HIV-1 reverse transciptase (RT) by competitive inhibition of the enzyme as well as chain termination

  • drug binds to RT instead of virus

ADR- lactic acidoisis and hetaptic steatosis, lipodystrophy/ lipoatrophy (more common with stavudine)

Pharmacokinitics- mostly renally excreted except Ziagen (abacavir)- liver metabolism via ADH

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13
Q

Which NRTI can be used to treat HBV?

A

Emtriva (emtricitabine)

Epivir (lamivudine)

Viread (tenofovir disoproxil fumarate, TDF)

Vemlidy (tenofovir alafenamide, TAF)

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14
Q

Pifeltro (doravirine)

A

NNRT

LEAST CNS TOXICITY IN CLASS

Nausea, diarrhea, abdominal pain, dizsiness, headache, fatigue, abnormal dreams

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15
Q

Edurant (rilpivirine, RPV)

A

NNRT

A bit more CNS effetcs then doravirine

Depression, insomnia, headache, rash

Take with food (need acidic environment for absportion)

Contraindicated with PPIs

Take H2 anatagonist at least 12 hours before or 4 hours after rilpivirine

Take anatacids 2 hours before or 4 hours after rilpivirine

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16
Q

Sustiva (efavirenz, EFV)

A

NNRTI

MOST CNS EFFECTS

dizziness, drowsiness, sleepiness, insomnia, vivid dreams

Lipophilic drug so take on an empty stomach _(_food would cause increase CNS effects)

CYP2B6 substrate induction pathway- genetic polymorphism may lower the metabolism (increased ADR)

  • ​give lower dose efavirenz in symfi Lo may be better tolerated

Neural tube defects in first trimester of pregnancy

Decreases levels of rifampin, rifabutin, voriconazole, methoaone, statin

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17
Q

Delstrigo (doravirine/ lamivudine/ TDF)

A

NNRTI/ NRTI/ NRTI

18
Q

Complera (rilpivirine/ emtricitabine/ TDF)

A

NNRTI/ NRTI/ NRTI

Rilpivirine

  • Contraindicated with PPIs
  • Take H2 anatagonist at least 12 hours before or 4 hours after rilpivirine
  • Take anatacids 2 hours before or 4 hours after rilpivirine
19
Q

Odefsey( rilpivirine/ emtricitabine/ TAF)

A

NNRTI/ NRTI/ NRTI

Rilpivirine

  • Contraindicated with PPIs
  • Take H2 anatagonist at least 12 hours before or 4 hours after rilpivirine
  • Take anatacids 2 hours before or 4 hours after rilpivirine
20
Q

Atripla (efavirenz/ emtricitabine/ TDF)

A

NNRTI/ NRTI/ NRTI

21
Q

What is the MOA of NNRTI and drug class side effects?

A
  • MOA- inhibits RT by directly binding to it (non-competitve inhibition of RT)
  • ADR
    • ​Toxic epidermal necrolysis (TEN)
    • Stevens- Johnson Syndrome (SJS)
    • Liver toxicity
  • NNRTI levels decrease with
    • ​rifampin, carbamazepine and phenytoin
  • CYP 3A4 inducer
  • Kinietics- liver elimination
22
Q

Prevista (darunavir)

A

Protease Inhibitors

600 mg tablet + Norvir (ritonavir)- for pregnant women

800 mg tablet+ norvir (ritonavir) or cobicistate- everyone else

Possible skin reaction due to sulfonamide

Potenial CV risk

23
Q

Norvir (ritonavir)

A

Protease Inhibitior

but used as PK booster

24
Q

Reyataz (atazanavir)

A

Protease Inhibitor

Hyperbilirubinemia and nephrolithiasis

Interactions with acid sepressive therapy (no PPI and spacing with H2 blockers, and antacids)

25
Q

Symtuza (darunavir/ cobicistat/ emtricitabine/ TAF)

A

Protase inhibitor/ PK booster/ NRTI/ NRTI

26
Q

Prezocobix (darunavir/ cobicistat)

A

Protase Inhibitor/ PK booster

NOT for pregnant women combined formulation only comes with darunavir 800 mg

26
Q

Evotaz (atazanavir/ cobicistate)

A

Protease inhibitor and PK booster

Atazanavir- Interactions with acid sepressive therapy (no PPI and spacing with H2 blockers, and antacids)

27
Q

What is the MOA of protease inhibitors? class side effects? Pharmacokinites?DDI?

A

MOA- inhibit HIV protease to prevent cleavage of proteins, resulting in no active proteins

ADR- GI intolerance, Hyperlipidemia, CV risk, blood glucoase elevation, liver toxicity, possible bleeding risk in hemophiliacs, body fat re-distribution (lipodystrophy)

PK- Liver metabolism

CYP 450 and P-gp- cyp inhibitor- statins, fluticasone, salmeterol, rifampin, hep c antiviral, anticoagulant, certain antifungals, quetiapinem st, johns worts

28
Q

Isentress (raltegravir)

A

Integrase Inhibitor

Pg-P substrate

29
Q

Trivicay (dolutegravir)

A

Integrase Inhibitor

ADR- Neuropsychiatric effects (insomnia, depression, etc. do not use if there is underlaying psych condition), nural tube defects (avoid in women of childbearing age not on contreception or within12 weeks post conception

Metformin interactions- increase metformine levels (1000mg daily max)- increases diarrhea

30
Q

Virekta( elvitegravir)

A

Integrase inhibitor

Take with food

31
Q

Biktarvy (emtricitabine/ TAF/ Bictegravir)

A

NRTI/ NRTI/ INTI

Bictegravir-increases metformin levels but done need to adjust dose just monitor

32
Q

Genvoya (emtricitabine/ TAF/ elvitegravir/ cobicistat)

A

NRTI/NRTI/ INSTI/PK

  • Elvitegravir
    • Take with food- less GI effects
  • Cobicistat
    • ​nausea, diarrhea, lipid abnormalitiesand glucose elevation
33
Q

Stribild (emtricitabine/ TDF/ Elvitegravir/ cobicistat)

A

NRTI/ NRTI/ INSTI/ PK

  • Elvitegravir
    • Take with food- less GI effects
  • Cobicistat
    • nausea, diarrhea, renal impairment, decrease bone mineral density
34
Q

Triumeq (lamivudine/ abacavir/ dolutegravir)

A

NRTI/ NRTI/ INSTI

35
Q

MOA if intergrase inhibitors? class side effects? metabolism? DDI?

A

MOA- inhibit integrase, prevent integration of viral DNA into human DNA

ADR- Insomnia, headache, possible weight gain, increase in liver enzymes and creatine kinase (CK)

Metabolism- UGT1A1

DDI- calcium or iron supplements, cation containing antacids or laxatives, sucralfate, buffered metabolism (spacing from INSTI)

DDI- Rifampin, carbamazepine, phenytonin, St. Johns Worts (reduce plasma levels of integrase inhibitors)

36
Q

Juluca (rilpiverine/ Dolutegravir)

A

NNRTI/ INSTI

must have undetectable viral load

Rilpivirine effects- has to be taken with food,

  • Contriindicated with PPIs, defetilide
  • interactions with antacids, H2 blockers

Dolutegravir

  • interactins between metformin and rifampin
37
Q

Tybost (cobicistat)

A

PK booster

inhibitor of CYP 3A4

38
Q

Sekzentry (maraviroc)

A

CCR5 inhibitor

must have CCR5 receptor- CCR5 tropism test

Treatemt for HIV resistance+ added to therapy

Side effects- LIVER TOXICITY- BLACK BOX WARNING

METABOLISM- CYP 3A4 and P-gp

39
Q

Fuzeon (enfuvirtide)

A

Infusion infections

only injectable part of HIV regimen

inhibits function of transmembrane gp 41

No significant DDI

40
Q

Trogarzo (ibalizumab)

A

Post attachment inhibitor

Recombinant monoclonal antibodies

binds to host CD4 cell and interfers with post-attachment steps

Used for HIV resistance or people born with HIV

Administered IV- loading dose, followed by maintenance dose every 2 weeks

Pharm (9 decks)

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