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Pharmacology > HIV - Antiviral Agents > Flashcards

HIV - Antiviral Agents Flashcards

1
Q

Herpes Simplex Virus (HSV) causes what

A
  • cold sores (herpes labialis)
  • mucocutaneous infections
  • herpes simplex genitalis
    encaphalitis
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2
Q

Variacella Zoster Virus (VZV) causes what

A 
chickenpox
herpes zoster (Shingles)
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3
Q

Drugs for Non-HIV infections

A
  • Acyclovir

- Oseltamivir (Tamiflu)

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4
Q

Acyclovir

A
  • 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

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5
Q

Influenza Symptoms

A

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

  • transmitted through aerosolized droplets
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6
Q

Two types of influenza vaccines are

A
  • Inactivated vaccine
  • live attenuated vaccine

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

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7
Q

Inactivated Vaccine

A
  • IM or intradermal injection
  • Cannot cause flu

ADR

  • soreness at injection site
  • fever myalgia, malaise
  • Guillain-Barre Syndrome (RARE)
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8
Q

Live Attenuated Vaccine

A
  • 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
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9
Q

Influenza vaccine Precautions

A
  • don’t with persons with acute febrile illnesses

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

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10
Q

Influenza vaccine contraindications

A
  • Hypersensitivity to eggs
  • severe reaction to influenza vaccination in the past
  • Guillain-Barre Syndrome
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11
Q

Vaccination recommendations:

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

A

> = 6 months of age

Pregnancy

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12
Q

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

A

pregnant

immunocompromised

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13
Q

Oseltamivir (Tamiflu)

A
  • 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
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14
Q

HIV-1 are from _____ in Central Africa

HIV-2 are from _____ _____ monkeys in western Africa

A

chimpanzees

Soot Mangabey monkeys

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15
Q

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

A

opportunistic infections

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16
Q

HIV phases:

A

Initial
Middle
Late

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17
Q

_____ Phase

  • HIGH rate of REPLICATION
  • Flu like acute retroviral syndrome
A

Initial

18
Q

____ Phase

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

Middle

19
Q

_____ Phase

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

Late

20
Q

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

A

follow-up

21
Q

Antibodies may not be detectable until ____ months after infection

A

3

22
Q

Opportunistic Infections

A
  • candidiasis
  • coccidioidomycosis
  • cryptococcosis
  • cytomegalovirus
  • HSV
  • histoplasmosis
  • Kaposi’s sarcoma
  • Lymphoma
  • TB
  • Myobacterium avium complex
  • pneumocystitis jirovecii pneumonia
  • toxoplasmosis
23
Q

Treatment GOALS

A
  • REDUCE HIV-associated morbidity
  • PROLONG duration and quality of life
  • SUPPRESS HIV viral load
  • restore/maintain immune function (CD4 count)
  • PREVENT transmission (education)
24
Q

ART - Antiretroviral Therapy

A
  • suppress virus and stop progression
  • lowers viral load by inhibiting viral replication
  • NOT a cure
25
Q

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

  • MOA?
  • ADR?
  • Meds?
A

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
26
Q

Abacavir ADR

A

Hypersensitivity

27
Q

Tenofovir ADR

A

Osteomalacia, renal insufficiency, N/V

28
Q

Emtricitabine ADR

A

hyperpigmentation of hands and soles of feet

29
Q

Non-Nucleoside Reverse Transcriptase (NNRTIs)

MOA?
ADR ?
MED?

A

MOA:
- binds directly and non-competitively to reverse transcriptase, blocking DNA polymerase activity

ADR:
- RASH

MED:
- Efavirenz (Sustiva)

30
Q

Efavirenz (Sustiva)

A
  • 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

31
Q

Protease Inhibitors

MOA?
ADR?

A

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 **

32
Q

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

A

simvastatin and lovastatin

33
Q

Lopinavir/Ritonavir

A
  • 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*
34
Q

CCR5 Antagonist: Maraviroc

Not on module

A
  • block entry to cell
  • must be combined
  • expensive
35
Q

InTEGrase Inhibitors : RalTEGravir

A
  • 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
36
Q

Preferred 1st line treatment regimens:

  • ____ + 2 _____
  • ____ + 2 _____
A

INSTI (Integrase Inhibitor) + 2 NRTIs

PI (Protease inhibitor) + 2 NRITIs

37
Q

PR intervals prolongation will cause an increase in _____ ______

A

AV BLOCK

38
Q

QT interval prolongation will cause _______ __ ______

A

TORSADES DE POINTES

39
Q

Monitoring:

What is the goal?

A

Undetectable viral load

40
Q

Perform HIV-Drug ______ testing BEFORE initiating treatment

A

resistance

41
Q

_________ can lead to drug resistance

A

Noncompliance

42
Q

If we suspect resistance, we _____ for resistance.

A

retest!

Pharmacology (17 decks)

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