HIV - Antiviral Agents Flashcards
Herpes Simplex Virus (HSV) causes what
- cold sores (herpes labialis)
- mucocutaneous infections
- herpes simplex genitalis
encaphalitis
Variacella Zoster Virus (VZV) causes what
chickenpox herpes zoster (Shingles)
Drugs for Non-HIV infections
- Acyclovir
- Oseltamivir (Tamiflu)
Acyclovir
- 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
Influenza Symptoms
fever, cough, chills, sore throat, HA, muscle pain
- transmitted through aerosolized droplets
Two types of influenza vaccines are
- Inactivated vaccine
- live attenuated vaccine
Takes 1-2 weeks to get for protection
Lasts >6 months
Effect depends on age, health, predominant strains
Inactivated Vaccine
- IM or intradermal injection
- Cannot cause flu
ADR
- soreness at injection site
- fever myalgia, malaise
- Guillain-Barre Syndrome (RARE)
Live Attenuated Vaccine
- 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
Influenza vaccine Precautions
- don’t with persons with acute febrile illnesses
- can vaccinate those with minor illnesses w/ or w/o common cold
Influenza vaccine contraindications
- Hypersensitivity to eggs
- severe reaction to influenza vaccination in the past
- Guillain-Barre Syndrome
Vaccination recommendations:
Give to those ages >= to ____ months
Approved for use in _____ and with chronic health conditions.
> = 6 months of age
Pregnancy
Do not administer intranasal (live, attenuated) vaccine to ______ or _____________ patients
pregnant
immunocompromised
Oseltamivir (Tamiflu)
- 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
HIV-1 are from _____ in Central Africa
HIV-2 are from _____ _____ monkeys in western Africa
chimpanzees
Soot Mangabey monkeys
Death does not usually occur because of having HIV, but due to _______ ________
opportunistic infections
HIV phases:
Initial
Middle
Late
_____ Phase
- HIGH rate of REPLICATION
- Flu like acute retroviral syndrome
Initial
____ Phase
- Prolonged clinical latency
- Low HIV blood levels
- Asymptomatic
- PROLONG with Drugs
Middle
_____ Phase
- CD4 <200 cells/mL
- AIDS and opportunistic infections more likely occur
Late
If test is (+), ______-__ testing performed to test results
follow-up
Antibodies may not be detectable until ____ months after infection
3
Opportunistic Infections
- candidiasis
- coccidioidomycosis
- cryptococcosis
- cytomegalovirus
- HSV
- histoplasmosis
- Kaposi’s sarcoma
- Lymphoma
- TB
- Myobacterium avium complex
- pneumocystitis jirovecii pneumonia
- toxoplasmosis
Treatment GOALS
- REDUCE HIV-associated morbidity
- PROLONG duration and quality of life
- SUPPRESS HIV viral load
- restore/maintain immune function (CD4 count)
- PREVENT transmission (education)
ART - Antiretroviral Therapy
- suppress virus and stop progression
- lowers viral load by inhibiting viral replication
- NOT a cure
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
- MOA?
- ADR?
- Meds?
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
Abacavir ADR
Hypersensitivity
Tenofovir ADR
Osteomalacia, renal insufficiency, N/V
Emtricitabine ADR
hyperpigmentation of hands and soles of feet
Non-Nucleoside Reverse Transcriptase (NNRTIs)
MOA?
ADR ?
MED?
MOA:
- binds directly and non-competitively to reverse transcriptase, blocking DNA polymerase activity
ADR:
- RASH
MED:
- Efavirenz (Sustiva)
Efavirenz (Sustiva)
- 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
Protease Inhibitors
MOA?
ADR?
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 **
Protease inhibitors (CYP3A4) should be avoided with the use of _____ and _______ (statins)
simvastatin and lovastatin
Lopinavir/Ritonavir
- 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*
CCR5 Antagonist: Maraviroc
Not on module
- block entry to cell
- must be combined
- expensive
InTEGrase Inhibitors : RalTEGravir
- 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
Preferred 1st line treatment regimens:
- ____ + 2 _____
- ____ + 2 _____
INSTI (Integrase Inhibitor) + 2 NRTIs
PI (Protease inhibitor) + 2 NRITIs
PR intervals prolongation will cause an increase in _____ ______
AV BLOCK
QT interval prolongation will cause _______ __ ______
TORSADES DE POINTES
Monitoring:
What is the goal?
Undetectable viral load
Perform HIV-Drug ______ testing BEFORE initiating treatment
resistance
_________ can lead to drug resistance
Noncompliance
If we suspect resistance, we _____ for resistance.
retest!
