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Pharmacology > HIV Antivirals > Flashcards

HIV Antivirals Flashcards

1
Q

HIV Background

A
  • Attacks human CD4 cells of our immune system
  • Also infect macrophages and microglial cells
  • Uses CD4 cell to replicate
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2
Q

Stages of HIV

A
  • Acute infection
  • Clinical latency
  • Symptomatic AIDS
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3
Q

AIDS Diagnosis

A

<200 or AIDS Defining illness

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4
Q

Normal CD4 Levels

A

Normal level 800-1200 cells/ mm3

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5
Q

HIV Life Cycle

A
  • Attachment and fusion
  • Injection of core
  • Uncoating
    -Conversion to DNA (Reverse Transcriptase inhibitors)
  • Circular DNA
    -Entrance into nucleus
  • integration ( Integrase inhibitors)
    Transcription
  • Translation
    -Protein modification ( Protease inhibitors)
    -Assembly of core
  • Budding
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6
Q

Drugs that block viral entry into cells

A
  • CCR5 antagonists

- Fusion inhibitors

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7
Q

Inhibit enzymes required for HIV replication

A
  • reverse transcriptase inhibitors
  • Nucleoside
  • Non- nucleoside
  • Integrase inhibitors
  • Protease inhibitors
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8
Q

CCR5 Antagonists

A

MOA: Block ability for co=receptor (CCR5) to bind with GP 120 HIV virion blocking entry of HIV into CD4 Cell

  • Test first to see if patient’s HIV strain is CCR5- tropic
  • Prototype: Maraviroc (Selzentry)
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9
Q

Fusion inhibitor

A

MOA: block entry of HIV into CD4 cells by binding gp41 on the HIV envelope preventing the HIV molecule from binding to the CD4 cell and fusing the two lipid bilayer membranes.

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10
Q

Fusion inhibitor prototype

A

Enfuvirtide (Fuzeon, T-20)

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11
Q

Frequency of fusion inhibitor

A

BID SQ dosing

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12
Q

Cost of fusion inhibitor

A

52K a year

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13
Q

AE: of fusion inhibitors

A
  • Rotate sites
  • Inhjection site reactions in almost all patients
  • bacterial pneumonia
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14
Q

Indication of fusion inhibitor

A
  • Used when resistance to other drugs occurs
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15
Q

NRIT MOA

A

MOA: Inhibit the creation of viral DNA by substituting a useless nucleotide in the strand of base pairs, which presents further base pairs to be added.
- Included in most 1st line treatment regimens

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16
Q

Serious AE of NRIT

A

Lactic acidosis and severe hepatomegaly with fatty liver

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17
Q

Key points to know about Zidovudine (AZT)

A

SE: anemia and neutropenia

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18
Q

Key pts to know about Abacavir (Ziagen, ABC)

A

Test for genetic variant HLA-B* 5701. If positive, drug not used due to hypersensitivity reaction. Result in multi-organ failure and anpahylaxis.

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19
Q

NNRIT (Non-nucleotide reeverse transcriptase inhibitors) MOA

A

Bind to the active center of reverse transcriptase and cause direct inhibition.

20
Q

AE of NNRTI

A

Rash and hypersensitivity rxns. Stop drug if severe reaction.
- Lots of drug-drug interactions CY450

21
Q

Prototype of NNRTI

A

Efavirenz (Sustiva)

  • Cross BBB
  • Teratogenic: (Not for pregnancy) need barrier method of birth control as drug interaction with hormonal control.
22
Q

Integrase Inhibitors MOA

A

MOA: Prevent HIV genetic material from being integrated into the DNA of a CD4 cell

23
Q

Protypes of Integrase Inhibitors:

A

Raltegravir & Doltegravir & Elvitegravir

24
Q

Raltegravir AE

A

Well tolerated, can cause increased liver enzymes and rarely cause hypersensitivity reactions.

25
Q

Protease Inhibitors

A
  • Most effective antiretroviral drugs available
  • Can reduce viral load to undetectable levels
  • Turn HIV from acute illness to chronic infection
26
Q

Protease inhibitors MOA

A

-Prevent protease enzyme from cutting HIV polyprotein. This keeps HIV cell inactive and useless.

27
Q

Special considerations for protease inhibitors

A
  • if resistant to one PI likely to be resistant to all

- Lots of drug-drug interactions

28
Q

AE of protease inhibitors

A
  • Hyperglycemia/ DM (secondary)
  • Lipodystrophy
  • Hyperlipidemia
  • Increase liver enzymes- watch with Hep B& C
  • Decrease cardiac conduction- watch with BB
29
Q

Pharmocokinetic Enhancers

A

Ritnovi (Norvir) and Cobicstat (Tybost)

30
Q

Ritonavir

A

Low doses of ritonavir combined with other drugs to increase the drug level of the other drug

31
Q

Cobicistat

A

Blocks CYP450 3A4 enzyme increasing the concentration of certain antiviral drugs

32
Q

Core principles in HIV Treatment : HAART

A

Highly active retroviral therapy

  • Treat pts with 3-4 drugs
  • 2 NRTIS and one other drug
  • Never use just one drug
  • When resistance occurs- change all drugsi nthe therapy
  • Treat all patinets regarless of CD4 count
  • Goal: reach undetectable load
  • Many drug-drug interactions with CYP450 enzymes
33
Q

Drug therapy for HIV includes

A

Drugs to treat the HIV virus

  • Drugs to treat the side effects of drugs
  • Drugs to prevent or treat opportunisitic infections
34
Q

HIV treatment in pregnancy

A
  • Same principles that guide antiretroviral therapy in nonpregnant adults
  • Treat all HIV + pregnant women
  • Mother- to- child transmission
  • occurs primarily during labor and delivery: antiviral therapy adminstered before delivery, during delivery and to baby after delivery ( 6weeks). C-section for woman with viral load over 1000 copies/ mL.
  • IV AZT
35
Q

PrEP: Pre- exposure prophylaxis

A
  • Used in high risk populations ( selling sex services, recreational drug use, STI)
  • Can reduce risk by 44-73%
  • Right now oen medication FDA approved, but others being tested
  • Take one tablet daily
  • Episodic recommendations also
36
Q

PEP: Post exposure prophylaxis

A

One -time tx after exposure

  • Exposure risk evaluated
  • most effective 1-2 hours of exposure and within 72 hours
  • Test for HIV antibodies at tiem of exposure, 6 weeks, 12 weeks and 6 months
  • Three drug regimen for 28 days
37
Q

HIV Lab testing

A
  • CD4 Cells: where are they in disease process
  • Not used in children only % of CD4 cells
  • Drug resistance, other infections, CBC, Blood chem, genetic variants
38
Q

Plasma HIV RNA (Viral Load)

A

Measures replication and predicts clinical outcomes

  • Tells response to meds
  • High (> 100k)
39
Q

Opportunistic infections

A
  • Risk based on CD4 cell count

- Drugs are used to treat and prevent OIs and prophylaxis

40
Q

PCP

A
  • < 200 Cd4

- Meds: prophylaxis with bactrim (TMP/SX) DS

41
Q

CMV Retinitis

A
  • <50 cells/ mm3
  • Used after infection
  • Prevention can stop when cells >100
  • Prophylaxis with Valgancic;ovir or ganciclovir implant
42
Q

MAC

A

<50 mm

- Azithromycin for prophylaxis

43
Q

Candidiasis

A

Clotrimazole troches

44
Q

HSV

A

Acyclovir or ganacyclovir fro primary or secondary prophylaxis

45
Q

Cryptococcal meningitis

A
  • Risk for disease when CD4 <100 cells/ mm3

- Use fluconazole or itraconazole for prophylaxis

Pharmacology (14 decks)

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