HIV/AIDS

Question 1

efavirenz

Answer 1

Do not use in 1st trimester or women of childbearing potential
dose at bedtime to avoid “CNS disengagement” and dizziness
nightmares & vivid dreams
avoid in pts with substance abuse or psychiatric dx
must dose adjust: saquinavir, indinavir, lopinavir/ritonavir, atazanavir, tipranavir, darunavir, maraviroc

Question 2

zidovudine

Answer 2

NRTI
do not use with stavudine
ADE: anemia

Question 3

NRTIs

Answer 3

end in “dine”, “sine”, “bine”
plus abacavir and tenofovir
preferred regimens have 2 NRTIs + NNRTI or PI or integrase inhibitor

Question 4

Combivir

Answer 4

zidovudine + lamivudine

1 capsule daily

Question 5

Truvada

Answer 5

emtricitabine + tenofovir

1 tablet daily

Question 6

NNRTIs

Answer 6

end in “pine”, “rine”, or “renz”

Question 7

Protease inhibitors

Answer 7

end in “avir”
except: abacavir (NRTI) and raltegravir (Integrase inhib)
GI toxicity, lipid disturbances

Question 8

enfuvirtide (Fuzeon)

Answer 8

CD4 receptor antagonist
90mg subq injection BID
reserved for salvage therapy - costly

Question 9

maraviroc (Selzentry)

Answer 9

CCR5 co-receptor antagonist

150mg oral BID

Question 10

raltegravir (Isentress)

Answer 10

integrase inhibitor

few ADE and few drug interactions

Question 11

Atripla

Answer 11

emtricitabine, tenofovir, efavirenz
1 tablet daily (at bedtime)
current TOC in tx naive
don’t use if hx of CNS disorders or childbearing potential

Question 12

Complera

Answer 12

emtricitabine, tenofovir, rilpivirine
1 tablet daily
no CNS effects, safer in pregnancy
possibly not as effective as Atripla

Question 13

Stribild

Answer 13

emtricitabine, tenofovir, elvitegravir (integrase inhibitor), cobicistat (PI booster, enzyme inhibitor with no antiviral activity)
1 tablet daily

Question 14

lamivudine

Answer 14

NRTI
relatively benign ADE profile
has activity against hep B

Question 15

emtricitabine

Answer 15

lamivudine analogue with long half-life, once daily dosing

activity against hep B

Question 16

abacavir

Answer 16

NRTI
ADE: hypersensitivity rxn
HLA-B*5701 screening (positive test precludes drug use)

Question 17

tenofovir

Answer 17

NRTI
ADE: nephrotoxicity
has activity against hep B
do not give with didanosine
when given with atazanavir, must adjust atazanavir dose

Question 18

ritonavir

Answer 18

PI
potent CYP450 inhibitor
only a booster, doesn’t count toward 3 drug regimen

Question 19

atazanavir

Answer 19

PI (least likely to alter serum lipids)
may cause increase in serum bilirubin and jaundice
requires acidity in stomach for absorption
do not give PPI’s; separate antacids and h2’s from atazanavir dose

Question 20

PCP prophylaxis

Answer 20

start primary Bactrim if CD4 < 200

Question 21

Toxoplasmosis prophylaxis

Answer 21

start primary Bactrim if CD4 < 100

Question 22

M. avium prophylaxis

Answer 22

start primary azithrozmycin 1200mg weekly if CD4 < 50