HIV DRUGS Flashcards
initial monitoring
CD4, Viral load, Pregnancy, Hep B and C, HLA-B *5701 (abacavir), Tropism (maraviroc)
CD4 count less than 200
OI: PCP
Txt: Bactrim DS qd or SS qd or DS 3x per wk
Dapsone
Atovaquone
CD4 count <100
OI: Toxoplasma gondii encephalitis (IgG + Pt)
Txt preferred: Bactrim DS tab qd
Txt Alternative: Bactrim DS 3x/week or SS po qd or (Dapsone + pyrimethamine + Leucovorin) or Atovaquone +/- pyrimethamine + leucovorin
CD4 count <50
OI: Mycobacterium Avium Complex
TXT preferred: Bactrim DS qd
TXT Alternative: Azithromycin 1,200mg po weekly or clarithromycin 500 mg po BID or Azithromycin 600 mg po twice weekly.
Abacavir (ABC)
Brand and BBW
Brand: Ziagen, Epzicom (+3TC), Triumeq (+3TC, DTG)
BBW: Test for HLA-B *5701 gene positive due to hypersensitivity. Do not rechallenge
NRTI’s
Class BBW: lactic acidosis and hepatomegaly with steatosis (Fatty LIVER)
No renal Adjustment besides abacavir
No CYP interactions
Abacavir/Lamuvidine (ABC, 3TC)
Brand
Brand: Epzicom
Abacavir/Lamuvidine/Dolutegravir (ABC/3TC/DTG)
Brand
Triumeq
Lamuvidine (3TC)
Brand, BBW, SE:
Brand: Epivir
BBW: Do not use Epivir-HBV for txt of HIV (Has lower dose)
SE: N/V/D
avoid 3TC and FTC (both antagonize the cytosine analogs)
Lamuvidine/Zidovudine
Brand
Combivir
Emtricitabine (FTC)
Brand and BBW
Emtriva
BBW: acute HBV Exacerbations
SE: n/v/d, HA, rash, Insomnia, hyperpigmentation
TDF/FTC
Brand, Use
Truvada
use: Prep
TAF/FTC
Descovy
TDF/FTC/RPV
Complera
TAF/FTC/RPV
Odesfey
TDF/FTC/cobicistat/EVG
Stribild
TAF/FTC/cobicistat/EVG
Genvoya
TDF/EFV/FTC
Atripla
Take on empty stomach and qhs
TDF
Brand, BBW, SE
Viread
BBW: ALL Tenofovir containing products can exacerbate HBV. D/C with HBV infections.
SE: Renal Tox, Fanconi Syndrome , Oseteomalacia and decrease bone mineral density
TAF
BBW: Not approved for txt of chronic HBV
SE: less incidents of TDF Side effects; Fanconi syndrome, decrease bone mineral density, renal toxicity, osteomalacia
Zidovudine (ZDV, AZT)
Brand and Box warnings
Retrovir
BBW: Hemotologic toxicities
Didanosine (ddl)
Videx
BBW: Pancreatitis
Efavirenz
Brand, BBW, SE, counseling points
Sustiva
BBW: Serious psychiatric and CNS symptoms, convulsions, QT prolongation
SE: CNS effects (impaired concentration, abnormal dreams, confusion, dizziness) rash
Take on empty stomach and qhs
Rilpvirine (RPV)
Brand, CI, SE, what is it in?
Brand: Edurant
AVOID PPIs
SE: Depressive disorders, mood change, insomnia
Drug in Complera and Odefsey
NNRTIs
No renal dose adjustment except for atripla and complera
Heptatox and rash including SJS/TENS with the NNRTI
Efavirenz before food.
Protease Inhibitors
ends in -navir
ALL PI’s are metabolized in liver and are 3A4 sub and most are Strong inhibitors of 3A4
taken with boosters (Ritonavir and cobicistat)
hepatotoxicity
Darunavir (DRV)
Brand, Caution, notes
Prezista
Caution with sulfa allergy, drug induced hepatitis, SJS/TENS
Must be given with ritonavir or cobicistat
DRV/Cobicistat
Brand
Prezcobix
Atazanavir (ATV)
ReyATAZ
SE: Indirect bilirubinemia
Avoid acid supressive agents (H2RA, PPI etc)
ATV/cobicistat
Brand
EvoTAZ
1 t QD dosing
Lopinavir + Ritonavir (LPV/r)
Kaletra
Solution contains alcohol
Drug interactions with PIs
Since they are ALL 3A4 substrates…
Avoid 3A4 inducers, dronedarone (Multaq)
direct Xa Oral agents, alfuzosin
Alter INR (many decrease)
Boosters (RItonavir + Cobicistat)
Ritonavir (Norvir) & Cobicistat (Tybost)
Take with food for all boosters.
Interacts with many drugs
INSTIs
ends in -tegravir
Increase CPK
Headaches + Insomnia
avoid polyvalent cations
Elvitegravir (EVG)
Renal dosage, SE
No single agent it is in Stribild and Genvoya
CrCl <70 do not initiate Stribild (TDF; more renal toxic)
CrCl < 30 do not initate Genvoya ( TAF; Less renal toxic)
SE: HA and Insomnia (INSTI component)
Dolutegravir (DTG)
Brand and SE
Tivicay
SE: Insomnia and HA. Increase Scr without affecting GFR
Raltegravir (RAL)
Issentress, Issentress HD
SE: CPK, myopathy, rhado
Drug interations with INSTIs
Taken 2 h before or 6 hours after cation-containing products
Maraviroc
Selzentry
BBW: Hepatox
Test for tropism (testing for co-receptor) Will only work for CCR5-tropic disease
Pt must be negative for CXCR4 or dual/mixed diease.
Major 3A4 sub
Enfuvirtide (T20)
Fuzeon
SE: Local injection site rx 98%
PrEP
People who do not have HIV Take truvada 1 po qd
Confirm: HIV negative CrCl greater than 60, screen for HBV
Follow up q 3 months
nPEP
Non occupational Post exposure prophy due to sexual activity, injection drug use. Within 72 hours
Txt: INSTI-based or PI Based
1st line INSTI based: Truvada + Dolutegravir (DTG)
PI-Based: Truvada + Darunavir + Ritonavir qd
PEP
Start within 72 hours
Should be a 3 drug regiment
Raltegravir (RAL) (Issentress) + Truvada for 4 weeks
Megastrol
Megace
Use: Anorexia or cachexia associated with HIV
Dronabinol
Marinol
Use: AIDS related anorexia
Poly-L-Lactic Acid
Sculptra (SC)
Use: Lipoatrophy (facial)
Calcium Hydroxyalpatite
Radiesse, Radiesse plus (IM)
Use Lipoatrophy (facial)
Initial HIV naive treatment
INSTI Based
INSTI base:
Triumeq (ABC/DTG/3TC)
Stribild
Genvoya
Truvada + Issentress (RAL) or Tivicay (DTG)
Descovy + Issentress (RAL) or Tivicay (DTG)
Intial HIV naive treatment
PI based
PI BASED:
Truvada + Prezista (DRV) + Norvir (r)
Descovy + Preszista (DRV) + Norvir(r)
Pregnancy HIV Naive Treatment
Epzicom (ABC/3TC) + Atanazavir/(r) or Issentress (RAL)
Truvada (TDF/FTC) + Prezista (DRV)/(r) BID
