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T&D 1 > HIV drugs > Flashcards

HIV drugs Flashcards

1
Q

Antiretroviral therapy reccommended in CD4 count

A

less than 350 cells/mm3

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2
Q

CD4

A

CMV/MAC

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3
Q

CD4

A

Pneumocystis carinii pneumonia (PCP)

Bactrim DS - daily or 3/day

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4
Q

CD4

A

Toxoplasmosis

positive serology – Bactrim daily

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5
Q

Nevirapine requires

A

gender
pretreatment CD4 count

don’t start if CD4 count:
females > 250
males >400

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6
Q

what is the ADR seen with nevirapine

A

high levels of liver toxicity

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7
Q

who has higher risk of liver toxicity with nevirapine

A

males

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8
Q

Abacavir requires

A

allergy screening with HLA B*5701

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9
Q

Co-morbities of therapy

A

TB, pregancy

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10
Q

Atripla

A

efavirenz, emitricitabine, tenofovir

1 tab daily, preferably QHS and empty stomach

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11
Q

Complera

A

rilpivirine, emitricitabine, tenofovir

1 tab daily

watch if high viral load > 100 K viral load

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12
Q

Stribild

A

“Quad Pill”: Elvitegravir, Cobicistat, emitricitabine, tenofovir

1 tab daily: treatment naiive ptns

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13
Q

Cobicistat

A

Booster

  • always in combo
  • no antiviral activity
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14
Q

inh cyt p450 3A

A

Cobicistat

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15
Q

Cobicistat enhances

A

atazanavir

darunavir

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16
Q

Cobicistat utilized with

A

Elvitegravir

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17
Q

what are common in Atripla, complera, stribild

A

emitricitabine, tenofovir

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18
Q

number 1 cause of chronic renal failure in HIV ptns

A

nephropathy

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19
Q

Nevirapine requires

A

gender
pretreatment CD4 count

females > 250
males >400

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20
Q

who has higher risk of liver toxicity with nevirapine

A

males

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21
Q

Abacavir requires

A

allergy screening with HLA B*5701

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22
Q

Co-morbities of therapy

A

TB, pregancy

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23
Q

What is affected by food

A

NRTI

  • didanosine - acidity
  • zidovudine - high fat meal

Protease inhibitor

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24
Q

Complera

A

rilpivirine, emitricitabine, tenofovir

1 tab daily

watch if high viral load > 100 K viral load

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25
Q

Stribild

A

“Quad Pill”: Elvitegravir, Cobicistat, emitricitabine, tenofovir

1 tab daily: treatment naiive ptns

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26
Q

Cobicistat

A

Booster

  • always in combo
  • no antiviral activity
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27
Q

inh cyt p450 3A

A

Cobicistat

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28
Q

Cobicistat enhances

A

atazanavir

darunavir

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29
Q

Cobicistat utilized with

A

Elvitegravir

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30
Q

what are common in Atripla, complera, stribild

A

emitricitabine, tenofovir

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31
Q

CCR5 antagonist

A
  • restricted to CCR5 tropic virus
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32
Q

Fusion inhibitor

A

binds heptad repeat in gp41

Injection site irritation: nodules, erythema

SQ INJ

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33
Q

NNRTI vs NRTI

need phosphorylation

A

NRTI

34
Q

Which PI linked to nephrolithiasis

A

Indinavir

Hydrate!!

inc SCR
pyuria
Hydronephrosis

35
Q

Long half life - double edge

A

NNRTI

  • monotherapy
  • Resistance
36
Q

RASH RASH RASH

A

NNRTI

37
Q

Good for PI resistant virus

A

Darunavir, Tipranivir

  • cross sensitivity with Sulfa rash
38
Q

how to decrease hepatic effects and risk of rash in nevirapine (NNRTI)

A

2 wk dose escalation

39
Q

MOA

NRTI

A

similar to building blocks of RNA/DNA

  • Posphorylated intra-cellular
  • incorporate themselves to block reverse transcriptase
40
Q

What is affected by food

A

NRTI

  • didanosine - acidity
  • zidovudine - high fat meal
41
Q

Stavudine

ADR

A

NRTI

  • peripheral neuropathy
  • lipoatrophy
  • lactic acidosis/hepatomegaly w/ hepatic steatosis
42
Q

Didanosine + Stavudine

A

peripheral neuropathy

toxic
pancreatitis
hyperprolactemia

43
Q

Booster in protease inhibitor

A

Ritonavir

44
Q

what does Ritonavir do

A

booster - allows lower doses, less pill burden

inc LDL, TG (esp), HDL

45
Q

Endocrine type side effects

A

Hyperlipidemia
fat maldistribution
insuline resistance/DM
osteonecrosis

46
Q

endocrine type side effects seen with

A

Preotease inhibitors

47
Q

Hallmark ADR of PIs

A

endocrine type side effects

48
Q

The booster of all boosters

A

Ritonavir

49
Q

ADR of PI in addition to endocrine type side effects

A
  • spontaneous bleeding
  • inc hepatitis risk
  • MI/stroke
50
Q

highest incidence of drug-drug intrxn

A

PI

- tipranavir – inc hepatitis

51
Q

Which PI linked to nephrolithiasis

A

Indinavir
Hydrate!!

inc SCR
pyuria
Hydronephrosis

52
Q

ADR

Atazanavir

A
  • PI
  • Hyperbilirubinemia –> jaundice
  • prolonged QT
53
Q

Taste disturbance –> anorexia (ADR)

A

Ritonavir (PI)

  • also paresthesias
54
Q

Good for PI resistant virus

A

Darunavir, Tipranivir

  • rash
55
Q

Combinations to avoid for 1st trimester of pregnancy/childbearing potential

A

Efavirenz

  • teratogenic
56
Q

avoid in pregnancy

A

nelfinavir

  • ethyl methanesulfonate - carcinogen
57
Q

pharmacologic antagonism

A

Stavudine + Zidovudine

58
Q

additive hyperbilirubinemia

A

Atazanavir + Indinavir

59
Q

Didanosine + Stavudine

A

toxic
peripheral neuropathy
pancreatitis
hyperprolactemia

60
Q

IV Zidovudine in pregnancy

A
  • omit if maternal HIV RNA 400 copies/ml at delivery

but continue combination ART during labor

61
Q

Postpartum management of ARVs and NNRTIs

A

NNRTIs should be stopped first while continuing ARVs for at least 7 days to avoid effective monotherapy

62
Q

Post exposure prophylaxis for

A
  • percutaneous expo
  • mucous membrane and non-intact skin expo
  • start w/in 2 hrs of expo
  • DONT DELAY
  • 28 days
63
Q

PEP regimen

A

Raltegravir - 400 mg BID

Truvada daily

64
Q

Pre- exposure px

A
  • lowers risk by 90%

only TRUVADA approved

65
Q

Truvada is a combo of

A

Tenofovir

Emtricitabine

66
Q

Bone marrow suppression

A

Zidovudine

67
Q

Pigmentation: Nail

A

Zidovudine

68
Q

Pigmentation: Skin

A

Emtricitabine

69
Q

Pancreatitis

A

Didanosine

70
Q

NNRTIs : examples

A

Delvaridine
Efavirenz
Etravirine
Nevirapine

71
Q

Lactic acidosis w/ hepatic steatosis

A

Tenofovir

All NRTIs

72
Q

NRTIs: examples

A 
Abacavir
Didanosine
Emtricitabine
Lamivudine
Stavudine
Zidovudine
73
Q

Lipid abnormalities

A

Protease Inhibitors

74
Q

Protease Inhibitors: example

A 
Atazanavir
Darunavir
Fosamprenavir
Indinavir
Nelfinavir
Ritonavir
Saquinavir
Tipranavir
75
Q

Paresthesias

A

Fosamprenavir, Ritonavir

76
Q

booster without antiviral activity

A

cobicistat

77
Q

Insulin Resistance/ DM

A

PIs

78
Q

Injection site reaction/irritation

A

Enfuvirtide

79
Q

Restricted to treatment experienced HIV ptns and causes CPK elevation/Pyrexia

A

Raltegravir

80
Q

CPK elevation

A

muscle weakness

rhabdo

81
Q

why should screen if woman is pregnant before prescribing efavirenz?

A

Neural tube defect in 5-6 wks

but pregnancy isn’t detected until 4-6 wks

82
Q

what do you give a baby post partum? for how long?

A

zidovudine +/- nevirapine

6 wks

T&D 1 (7 decks)

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