HIV Drugs Flashcards
Trogarzo
Ibalizumab-uiyk
MOA: Binds to CD4 Cell RECEPTORS
Treats: Multidrug-Resistant HIV-1 infection FAILING from current REGIMEN
FORM: IV Q 14 DAYS (2 weeks)
SE: DIZZINESS
Rash, Diarrhea
INCREASE URIC ACID
Storage: REFRIGERATE
Maraviroc
Selzentry
PERFORM TROPOISM TEST TO SEE IF DRUG WILL WORK BEFORE USING
MOA: Binds to CCR5 co-receptors of HOST CELL
Dose: 300mg BID
150mg BID (if on CPY3A Inhibitors)
- Protease Inhibitors, antifungal azoles, macrolides
600mg BID (if on CYP3A Inducers) - Efavirenz, rifampin, Carbamazepine, Phenobarbital, Phenytoin
DO NOT TAKE ST. JOHNS WORT w/ selzentry
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-BBW: HEPATOTOXICITY
ORTHOSTATIC HYPOTENSION
**INFECTION (55%)
HEART PROBLEMS
CONTRAINDICATION: CrCl< 30mL/min + CYP3A4 Inhibitor
Fuzeon
Enfuvirtide
MOA: gp41 INHIBITOR of viral cell
Form: SUBQ
DOSE: 90mg SQ BID
PRECAUTIONS: Infection
NUCLEOSIDE Reverse Transcriptase Inhibitors (NRTI’s)
ZidovuDINE(AZT, ZDV): Retrovir
Abacavir(ABC): Ziagen
LamivuDINE(3TC): Epivir
EmtricitaBINE(FTC): Emtriva
StavuDINE(d4T): Zerit
Didanosine(ddl): Videx
Tenofovir is an NRTI, however it is a NUCLEOTIDE Reverse transcriptase inhibitor
Mneumonic: ZALES DT
NRTI’s
SIDE EFFECT PROFILE
1) HEADACHE
2) Lactic Acidosis
3) Hepatic steatosis (FATTY LIVER)
4) RENAL
Take w/ or w/o FOOD except didanoSINE
Retrovir
ZidovuDINE (AZT; ZDV)
Forms: 100mg Capsule
300mg TABLET
10mg/ mL PO Syrup
10mg/ mL IV SOLUTION
DOSE: 300mg BID W/O regards to food
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**BBW: Myelosuppression (ANEMIA; NEUTROPENIA)
( DIVING INTO THE MARROW)
Lactic acidosis/ Hepatic STEATOSIS (BBW)
MYOPATHY: BBW**
Lipoatrophy: loss of subq fat
HEADACHE most common
Nausea/vomiting
Purple NAIL DISCOLORATION
Ziagen
Abacavir (ABC)
Forms: 300mg TABLETS
SOLUTION
Dose: 300mg BID/ 600mg QD w or w/o FOOD
ONLY USE IF PT IS HLA-B*5701 NEGATIVE
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Epzicom: ABC + LamivuDINE: QD
TRIZIVIR: ABC+ LamivuDINE+ zidovudine: BID
TRIUMEQ: ABC+Lamivudine+Dolutegravir: QD
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Epzicom
Abacavir + LamivuDINE
Trizivir
Abacavir + lamivuDINE + zidovuDINE
1 PO BID
TriuMEQ
Abacavir + Lamivudine + dolutegravir
ONCE DAILY
Epivir
LamivuDINE(3TC)
Dose: 150mg BID
300mg BID
(RENAL DOSE ADJUSTMENT < 50)
Side Effects: Lactic acidosis
Hepatomegaly w/ STEATOSIS
HEADACHE
Emtriva
EmtricitaBINE (FTC)
Dose: Emtriva capsules 200mg QD
Emtriva oral sln: 240mg (REFRIGERATE)
Side EFFECTS: Lactic acidosis
Steatosis w/ Hepatomegaly
FLARE-UPS of HEP-B; LFT!!
COMMON: HEADACHE, diarrhea, NAUSEA
Darkening of PALMS and SOLES may resolve over time
Zerit
Stavudine d4T
Form: Capsules
PO SLN
WEIGHT BASED DOSING
> 60kg: 40mg BID
< 60kg: 30mg BID
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- *PANCREATITIS**
- *PERIPHERAL NEUROPATHY**
Lactic Acidosis: MORE FREQUENT (CLASS) HEPATIC STEATOSIS (CLASS) HEADACHE (CLASS)
Lipodystrophy: SUBQ FAT WASTING, Central OBESITY, BREAST ENLARGEMENT, BUFFALO HUMP
ViDEX
didanOsine
EYE EXAM NEEDED AFFECTS THE EYES
FORMS: Delayed-Release Tablets
WEIGHT BASED DOSING
Admin: ONLY NRTI THAT NEEDS TO BE TAKEN ON AN EMPTY STOMACHE
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- *Pancreatitis **
- Avoid ALCOHOL
- Monitor Amylase Q2-3 MONTHS
- n/v/ Abdominal pain
**PERIPHERAL NEUROPATHY
**RETINAL PIGMENTATION: eye exam q 6 mo
Lactic Acidosis
Hepatomegaly w/ steatosis
Viread (TDF)
Vemlidy (TAF)
tenOfOvir
only NRTI that is a nucleoTIDE inhibitor
TAF- LESS Bone/ KIDNEY tox
TDF- lower lipid levels than TAF
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Tenofovir disoproxil fumarate (TDF) (Viread)
- Treats: HIV/ Hep-B
- Tabs & Oral Powder
- Dose: Normal renal —> 300mg QD
ADJUST AS FNX DECLINES
Precautions: 1) Lactic Acidosis; Hepatic Steatosis 2) **ACUTE renal failure: FANCONI SYNDROME** 3) ***^ OSTEOPOROSIS RISK** 4) Post treatment HEP-B EXACERBATION 5) Hepatic impairment ———————————————-
Tenofovir aladenamide (TAF) (VEMLIDY)
Treats: Chronic hepatitis B
Form: 25mg tablets
Admin: 25mg PO QD w/ FOOD
PRECAUTIONS: Lactic Acidosis
Hepatic steatosis
SIDE EFFECTS OF NRTI’s
ZALES-DT
1) **HEADACHE
2) Lactic Acidosis
3) Hepatomegaly w/ steatosis (FATTY LIVER)
- ddl, d4T, AZT cause the MOST
4) PANCREATITIS & PERIPHERAL NEUROPATHY only with ddl(didanoSINE) & d4T(Stavudine). These pts should AVOID ALCHOHOL**
TDF: RENAL TOXICITY & OSTEOPOROSIS
Non-Nucleoside Reverse TRANSCRIPTASE INHIBITORS (NNRTI’s)
Rilpirivine(RVP): (Edurant)
Nevirapine(NVP): Viramune
Efavirenz(EFV): SUSTIVA
Etravirine(ETR): Intelence
Doravirine (Pifeltro)
Delavirdine(DLV): Rescriptor
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CLASS SIDE EFFECTS: RASH + HEPATOXICITY
Edurant
Rilpirivine (RPV)
Dose: 25mg WITH FOOD. REQUIRES ACIDIC ENVIRONMENT
- DRUGS THAT ^ pH may REDUCE ITS CONCENTRATION!!!
DI: CYP3A4 SUBSTRATE
SE: depression, insomnia, headache, RASH, QT prolongation, HEPATOTOXICITY
Viramune
Nevirapine(NVP)
Forms: 200mg IR tabs, XR TABLETS, PO SUSP,
Dose: w or W/O Food HOWEVER XR 400mg must be started after INITIAL period with IR FORMULATION
SE:
1) Life-threatening HEPATOXICITY
2) STEVEN-JOHNSON SYNDROME (RASH)
DI: CYP SUBSTRATE
NOT RECOMMENDED FOR TREATMENT NAIVE PATIENTS
Sustiva
EfaVIRENZ (EFV)
Forms: Capsules
Dose: 600mg QHS: EMPTY STOMACHE
Side EFFECTS
1) drowsiness
2) VIVID DREAMS/Hallucinations
3) FALSE CANNABINOID TEST
4) CLASS EFFECT: HEPATOTOXIC/ RASH
NOTE: ^ SUICIDALITY: NOT RECOMMENDED FOR PTS W/ MENTAL DISORDER
PREGANCY: AVOID IN 1ST TRIMESTER DUE TO FETAL HARM
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COMBO: Atripla
Intelence
Etravirine
Form: 25,100, & 200mg tabs
Dose: 200mg BID AFTER A MEAL
KEEP IN ORIGINAL CONTAINER
SE: RASH(SJS/ TEN)
DI: CYP SUBSTRATE
Pifeltro
Doravirine (NNRTI)
Dose: W OR WO FOOD.
Rescriptor
Delavirdine
- TID W or W/O Food.
ANTACIDS DECREASE ABSORPTION.
SE: RASH/ HEPATOXICITY
3A4 INHIBITOR: ^ PI (conc)
NOT USED MUCH DUE TO RAPID RESISTANCE
Integrase INHIBITORS
Raltegravir (Isentress)
Bictegravir
Biktarvy = Emtriva+ TAF+ Bictegravir
Elvitegravir
1) Cobicistat+TDF+Emtriva+ int = STRIBILD
2) Cobicistat+TAF+Emtriva+int = GENVOYA
Dolutegravir (TiviCAY)
CLASS EFFECTS OF
- INTEGRASE INHIBITORS
GI: diarrhea/ Nausea
CNS: HA, Insomnia, & dizziness
Fatigue
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COUNSELING POINTS:
1) W OR W/O FOOD
2) SEPERATE FROM ALL ANTACIDS
Isentress
Raltegravir
Forms: chewables, 100mg packet, tablets
Dose: 400mg BID or 1200mg QD W OR WITHOUT food. **SEPERATE FROM ALUMINUM/Mg 2+. ORIGINAL CONTAINER HAS DESICCANT!!
S/E: myopathy/ rhabdomyolysis,^^CPK
^^ALT, ^^GLU
Tivicay
DolueteGRAVIR
DOSE: 50mg QD w or w/o FOOD; SEPERATE FROM ANTACIDS
- Potent 3A4 inducers: efavirenz/ rifampin: 50mg BID
- oxcarbazepine, Carbamazepine, rifampin, Phenytoin, St. Johns wort should be AVOIDED
SE: Hypersensitivity Rxns
DO NOT USE IN PREGNANCY
^ LFT, ^ GLUCOSE
Insomnia; HA
Protease Inhibitors
LopiNAVIR/RitoNAVIR: KALETRA
AtazaNAVIR: Reyataz w/ cobicistat
*NelfiNAVIR: Viracept
DaruNAVIR: Prezista / prezcobix
- FosampreNAVIR: Lexiva
- Indinavir: Crixivan
RitoNAVIR(RTV): Norvir
- SaquiNAVIR: Invirase
- TipraNAVIR: Aptivus
MNEMONIC: LAND FIRST
Protease Inhibitor
CLASS SIDE EFFECTS
GI: N/V/D, gas
LIPODYSTROPHY: SubQ fat wasting, Central obesity, peripheral fat wasting, buffalo hump
^ Hyperglycemia
^ Hyperlipidemia
^Risk of Myocardial INFARCTION
^ Bleeding in hemophiliacs
- HEPATOXICITY & ALT
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DRUG INTERACTIONS
- Rifampin is contraindicated with PI’s
- MOST TAKEN W/ FOOD
Kaletra
Lopinavir + Ritonavir
Forms: film coated TABLETS
PO SOLN- RefriGERATE!!!
Precaution: 3A4 inihibtor
Ritonavir (Inhibitor) ^ lopinavir by 100 folds
Reyataz
Atazanavir (AZT)
Dose: Qd w/ FOOD
Acid needed for ABSORPTION: Seperate from PPI’s and ANTACIDS
PRECAUTIONS: ^ MONITOR EKG
1) Nephrolithiasis/ cholelithiasis
Benefit: IMPROVE LIPID PROFILES THAN OTHER PPI’s
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Inducers: RIFAMPIN/ st JOHNS WORT/ SUSTIVA
DECREASE REYATAZ LEVELS
VIREAD CAN DECREASE REYATAZ LEVELS AND REYATAZ CAN INCREASE VIREAD LEVELS
REDUse CLARITHROMYCIN BY 50%
Viracept
NELFINAVIR (PPI)
MAJOR GI ISSUES
WITH FOOD. Cannot he boosted
PrezistA
Darunavir (SULFA DRUG)
W/ ritonavir or cobistat
Combos:
Symtuza: darunavir; cobistat; emtricitabine/ TAF
PRECOBIX: darunavir plus cobicistat
Combivir
Zidovudine + lamivudine
Trizivir
Zidovudine + lamivudine + Abacavir
Epizicom
Abacavir + Lamivudine
Triumeq
Abacavir + Lamivudine + DoluteGRAVIR
Atripla
Efavirenz + emtricitabine + tenofovir
QD on EMPTY STOMACHE
Complera
Rilpivirine + TDF + Emtricitabine
1 tab W/ FOOD
Odefsey
Rilpirivine + TAF + Emtricitabine
Stribild
Elvitegravir + cobicistat + emtricitabine + TDF**
1 tab w/ FOOD
Genvoya
Elvitegravir + cobicistat + TAF + emtricitabine
1 tab W/ FOOD
