HIV antivirals Flashcards

1
Q

List the 6 types of HIV antiviral drugs

A
  1. CCR5 antagonist
  2. Fusion Inhibitors
  3. Reverse transcriptase Inhibitors (NARTIs)
  4. Reverse Transcriptase Inhibitors (NNRTIs)
  5. Integrase Inhibitors
  6. Protease Inhibitors
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2
Q

Which 2 drugs block viral entry into the cell?

A
  1. CCR5 antagonist

2. Fusion Inhibitors

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3
Q

Which 4 drugs Inhibit enzymes required for HIV replication?

A
  1. NARTI’s (reverse transcriptase inhibitor)
  2. NNRTIs (reverse transcriptase inhibitor)
  3. Integrase Inhibitor
  4. Protease Inhibitor
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4
Q

CCR5 Antagonist MOA

A

Block ability for CCR5 co-receptor to bind with gp120 on HIV virion blocking entry of HIV into CD4 cell

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5
Q

Why do you need to test pt first for CCR5 drug?

A

to see if pt’s HIV strain is CCR5-tropic

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6
Q

CCR5 Antagonist Prototype:

A

Maraviroc (Selzentry)

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7
Q

Fusion Inhibitor MOA

A

Blocks entry of HIV into CD4 cells, binding gp41 on HIV envelope, preventing HIV molecule and CD4 cell binding by fusing two lipid bilayer membranes

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8
Q

Fusion Inhibitor Prototype

A

Enfuvirtide (Fuzeon, T-20)

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9
Q

Cost and AE of Enfuvirtide

A

$52,000/year
Injection site reaction
^less med adherence

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10
Q

When is Enfuvirtide used?

A

When resistance to other drugs occurs

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11
Q

Nucleotide/nucleoside Reverse Transcriptase Inhibitor (NARTI) MOA

A

-Inhibit creation of viral DNA by substituting useless nucleotide in strand of base pairs (Dummy pair)

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12
Q

NARTIs Prototype:

A

Zidovudine (AZT)

Abacavir (ABC, Ziagen)

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13
Q

Key SE and considerations for NARITs

A

Zidovudine (AZT)- SE: anemia, neutropenia

Abacavir (Ziagen, ABC)- Test for HLA-B*5701. if positive, do not give drug

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14
Q

When would you use NARTIs? (Zidovudine, AZT or Abacavir, Ziagen)

A

1st line of treatment regimens

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15
Q

Non-Nucleotide reverse transcriptase inhibitors (NNRTIs) MOA

A

bind to the active center of reverse transcriptase and cause direct inhibition (Pie)

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16
Q

NNRTI Prototype:

A

Efavirenz (Sustiva)

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17
Q

AE of NNRTIs

A

Rash, hypersensitivity. If these are sever, discontinue use

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18
Q

Key consideration for NNRTIs

A

Many drug-drug interactions CYP450

19
Q

Key points for Efavirenz (Sustiva)

A

Crosses the blood brain barrier

Teratogenic (NOT for pregnancy)

20
Q

InTEGRase Inhibitors MOA

A

Prevent HIV genetic material from being integrated into DNA of CD4 cell (CD4 being guarded by the tiger)

21
Q

Integrase Inhibitor Prototype:

A

RalTEGRavir

22
Q

AE of Raltegravir

A

well tolerated, can cause increased liver enzymes and rarely cause hypersensitivity reaction

23
Q

Protease Inhibitors MOA

A

Prevent protease enzyme from cutting HIV polyprotein. Leaves cell inactive and useless. (He’s a proTEASE, leaving HIV homeboy lip and useless)

24
Q

PI effectiveness

A

Most effective antiretroviral drug available. Can reduce viral load to undetectable levels.

25
Q

Fun facts about PI

A

If resistant to one PI, likely resistant to others.

Lots and lots of drug interactions

26
Q

PI AE:

A

Hyperglycemia/ DM
Lipodystrophy
Hyperlipidemia
Increase liver enzymes- watch with Hep B and C
Decreases cardiac conduction- watch with beta blockers

27
Q

Pharmacokinetic Enhancers: Boosters

A

it has been RITon that NORvil will work with COBI to BOOST the HIV drug

28
Q

Pharmacokinetic Enhancers: Boosters

A

Ritonavir (Norvir): low doses of Ritonavir + other drugs increase drug level of other drug (Cobicistat, Tybost)
Cobicistat (Tybost), blocks CYP 450 3A4 enzyme, increasing the concentration of certain antiviral drugs

29
Q

Antiretroviral drugs mnemonic

Fusion Inhibitors

A

Fusion Inhibitors: A man is trying to inhibit the fusion between the rock (Maraviroc) and the tide (Enfuvirtide)

30
Q

Antiretroviral drugs mnemonic: Protease Inhibitors

A

Never (navir) tease a pro

  • Atazanavir
  • Darunavir
  • Fosamprenavir
31
Q

Antiretroviral drugs mnemonic: Integrase Inhibitors

A

Tiger! Tegra

32
Q

Antiretroviral drugs mnemonic:

NNRTIs

A

“vir” common for all of them, Has to be in the MIDDLE

33
Q

Antiretroviral drugs mnemonic:

The rest are NRTIs

A
  • Abacavir (ABC)

- Zidovudine (AZT)

34
Q

Core Principles in HIV treatment

A

HAART (Highly Active Antiretroactive Therapy)

  • Treat with 3-4 drugs
  • Treat all, regardless of CD4 count
  • Change all drugs in regimen if resistance occurs
  • Goal: reach undetectable viral load
  • Drug-drug interactions: many related to CYP450
35
Q

What does Drug Therapy for HIV include?

A
  • Drugs to treat HIV virus
  • Drugs to treat SE of HIV meds
  • Drugs to treat opportunistic infections
36
Q

HIV Tx in Pregnancy

A
  • Treat ALL
  • Mother-to-child transmission
  • Occurs primarily mid labor, use AZT
  • C section for mothers with viral load over 1000 copies/mL
37
Q

PrEP: Pre-exposure prophylaxis

A
  • High risk populations
  • reduce infection by 44-73%
  • 1 tablet daily
  • Episodic recommendations
38
Q

PEP: Post-Exposure Prophylaxis

A
  • one-time tx after exposure
  • most effective within 1-2 hours of exposure (must be within 72 hours)
  • Test for antibodies at: time of exposure, 6 weeks, 12 weeks, and 6 months
  • 3 drug regimen per day for 28 days
39
Q

PCP: CD4 count, prophylaxis

A

Pneumocystis Jeroveci Pneumonia (PCP), <200 cells/mm3, TMP/SMX DS

40
Q

CMV Retinitis

A

Cytomegaly Virus, Used AFTER infection. At risk <50 cells/mm3. Prevention can stop when cells reach >100 cells/mm3, Valganciclovir, ganciclovir

41
Q

Mycobacterium Avium Complex

A

<50 cells/mm3, Azithromycin (Z-pack, Macrolide)

42
Q

Candidiasis

A

Clotrimazole troche

43
Q

HSV

A

Acyclovir, valacyclovir

44
Q

Cryptococcal meningitis

A

CM risk for disease when CD4 count <100 cells/mm3, Fluconazole or itraconazole