HIV - Antiviral Agents

Question 1

Herpes Simplex Virus (HSV) causes what

Answer 1

• cold sores (herpes labialis)
• mucocutaneous infections
• herpes simplex genitalis
  encaphalitis

Question 2

Variacella Zoster Virus (VZV) causes what

Answer 2

chickenpox
herpes zoster (Shingles)

Question 3

Drugs for Non-HIV infections

Answer 3

• Acyclovir

- Oseltamivir (Tamiflu)

Question 4

Acyclovir

Answer 4

• First line for HSV (cold sores prophylactically) and VZV (chickenpox and shingles)
• resistance is rare (watch out for those immunocompromised)

ADR:
- GI symptoms, HA, vertigo

Given IV for heavier dose

Question 5

Influenza Symptoms

Answer 5

fever, cough, chills, sore throat, HA, muscle pain

• transmitted through aerosolized droplets

Question 6

Two types of influenza vaccines are

Answer 6

• Inactivated vaccine
• live attenuated vaccine

Takes 1-2 weeks to get for protection
Lasts >6 months
Effect depends on age, health, predominant strains

Question 7

Inactivated Vaccine

Answer 7

• IM or intradermal injection
• Cannot cause flu

ADR

• soreness at injection site
• fever myalgia, malaise
• Guillain-Barre Syndrome (RARE)

Question 8

Live Attenuated Vaccine

Answer 8

• form of a weak virus
• INTRANASAL spray
• Careful with immunosuppressed patients or pregnant women

ADR

• Runny nose, nasal congestion
• HA
• sorethroat, cough
• muscle aches, fever

Question 9

Influenza vaccine Precautions

Answer 9

• don’t with persons with acute febrile illnesses

- can vaccinate those with minor illnesses w/ or w/o common cold

Question 10

Influenza vaccine contraindications

Answer 10

• Hypersensitivity to eggs
• severe reaction to influenza vaccination in the past
• Guillain-Barre Syndrome

Question 11

Vaccination recommendations:

Give to those ages >= to ____ months
Approved for use in _____ and with chronic health conditions.

Answer 11

> = 6 months of age

Pregnancy

Question 12

Do not administer intranasal (live, attenuated) vaccine to ______ or _____________ patients

Answer 12

pregnant

immunocompromised

Question 13

Oseltamivir (Tamiflu)

Answer 13

• used ONLY to MANAGE symptoms
• use w/in 1st 48 hrs
• give After 2 weeks of vaccination
• Stop 2 days before getting vaccination
• Does not kill ….NOT ABX or ANTI-VIRAL
• Stop taking when N/V
• take with food to reduce Nausea

Question 14

HIV-1 are from _____ in Central Africa

HIV-2 are from _____ _____ monkeys in western Africa

Answer 14

chimpanzees

Soot Mangabey monkeys

Question 15

Death does not usually occur because of having HIV, but due to _______ ________

Answer 15

opportunistic infections

Question 16

HIV phases:

Answer 16

Initial
Middle
Late

Question 17

_____ Phase

• HIGH rate of REPLICATION
• Flu like acute retroviral syndrome

Answer 17

Initial

Question 18

____ Phase

• Prolonged clinical latency
• Low HIV blood levels
• Asymptomatic
• PROLONG with Drugs

Answer 18

Middle

Question 19

_____ Phase

• CD4 <200 cells/mL
• AIDS and opportunistic infections more likely occur

Answer 19

Late

Question 20

If test is (+), ______-__ testing performed to test results

Answer 20

follow-up

Question 21

Antibodies may not be detectable until ____ months after infection

Answer 21

3

Question 22

Opportunistic Infections

Answer 22

• candidiasis
• coccidioidomycosis
• cryptococcosis
• cytomegalovirus
• HSV
• histoplasmosis
• Kaposi’s sarcoma
• Lymphoma
• TB
• Myobacterium avium complex
• pneumocystitis jirovecii pneumonia
• toxoplasmosis

Question 23

Treatment GOALS

Answer 23

• REDUCE HIV-associated morbidity
• PROLONG duration and quality of life
• SUPPRESS HIV viral load
• restore/maintain immune function (CD4 count)
• PREVENT transmission (education)

Question 24

ART - Antiretroviral Therapy

Answer 24

• suppress virus and stop progression
• lowers viral load by inhibiting viral replication
• NOT a cure

Question 25

Nucleoside Reverse Transcriptase Inhibitors (NRTIs) - MOA? - ADR? - Meds?

Answer 25

MOA: - incorporate into viral DNA strand by reverse transcriptase terminating DNA synthesis (Preventing) ADR: - Hepatic steatosis - Lactic Acidosis - Lipoatrophy (change in body shape) MEDs: (ATE) - Abacavir - Tenovir - Emtricitabine

Question 26

Abacavir ADR

Answer 26

Hypersensitivity

Question 27

Tenofovir ADR

Answer 27

Osteomalacia, renal insufficiency, N/V

Question 28

Emtricitabine ADR

Answer 28

hyperpigmentation of hands and soles of feet

Question 29

Non-Nucleoside Reverse Transcriptase (NNRTIs) MOA? ADR ? MED?

Answer 29

MOA: - binds directly and non-competitively to reverse transcriptase, blocking DNA polymerase activity ADR: - RASH MED: - Efavirenz (Sustiva)

Question 30

Efavirenz (Sustiva)

Answer 30

- 1st line therapy (NNRTI) - Birth control pills don't prevent spread of STI, STD's, or HIV Drx Interactions: - metabolized by CYP450 - Hormonal Contraceptives - St. John's Wort ADR: - CNS effects, RASH, pose Liver Damage risk CONTRA: - Pregnancy ***Monitor LFT***

Question 31

Protease Inhibitors MOA? ADR?

Answer 31

MOA: - prevent HIV PROTEASE enzyme from cleaving polyprotein into individual proteins responsible for assembling new viron (mature) ADR: - GI effects - Lipodystrophy - Hyperlipidemia - Hyperglycemia (watch out for patients who have DM) - increased bleeding *** usually given with 2 NRTI's ***

Question 32

Protease inhibitors (CYP3A4) should be avoided with the use of _____ and _______ (statins)

Answer 32

simvastatin and lovastatin

Question 33

Lopinavir/Ritonavir

Answer 33

- Lopinivar (active) - Ritonavir (boost effects) Drx Int: - Oral contraceptives - PO solutions with disulfiram (antabuse) and Flagyl ADR: - Diarrhea - PR and QT intervals prolonged - PO solution toxic to newborns (not recommended in breast feeding) * **Not for severe Hepatic problems*** * **REFRIGERATE MED***

Question 34

CCR5 Antagonist: Maraviroc Not on module

Answer 34

- block entry to cell - must be combined - expensive

Question 35

InTEGrase Inhibitors : RalTEGravir

Answer 35

- 1st line agent combo - Inhibits integrase (preventing incorporation of viral DNA into host genome) - Metabolized by uridine diphosphate glucuronosyl-transferase (UDGT) Drx Int: - PPIs - Rifampin ADR - Insomnia - HA - Hypersensitivity - liver failure

Question 36

Preferred 1st line treatment regimens: - ____ + 2 _____ - ____ + 2 _____

Answer 36

INSTI (Integrase Inhibitor) + 2 NRTIs PI (Protease inhibitor) + 2 NRITIs

Question 37

PR intervals prolongation will cause an increase in _____ ______

Answer 37

AV BLOCK

Question 38

QT interval prolongation will cause _______ __ ______

Answer 38

TORSADES DE POINTES

Question 39

Monitoring: What is the goal?

Answer 39

Undetectable viral load

Question 40

Perform HIV-Drug ______ testing BEFORE initiating treatment

Answer 40

resistance

Question 41

_________ can lead to drug resistance

Answer 41

Noncompliance

Question 42

If we suspect resistance, we _____ for resistance.

Answer 42

retest!