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HIV drugs Flashcards

1
Q

Abacavir SEs

A

Hypersensitivity and increase MI risk

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2
Q

What INSTI based regimens are recommended for initial treatment 8

A
  1. Biktarvy
  2. Triumeq
  3. Tivicay (dolutegravir) + Truvada (emtricitabine +tenofovir diso)
  4. Tivicay + Descovy (emtricitabine + teno alfenamide)
  5. Stribild
  6. Genvoya
  7. Isentress (raltegravir) + truvada
  8. Isentress + descovy
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3
Q

Atazanavir

A

Nephrolithiasis and indirect hyperbili

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4
Q

NNRTI based

Complera

Ripped Elephants Take workers COMP

A

Rilpivirine

Emtricitabine

tenofovir disoproxil

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5
Q

PI based

Symtuza

WIth or without food?

Dont Count Every Tornado Symtom

A

Darunavir

Cabicistat

Emtricitabine

Tenofovir Alfenamide

With food, orginal container

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6
Q

Key features of NRTIs 6

A
  • Renal adjustments required for all except abacavir
  • No CYP interaction
  • Take without regard to meals except for didanosine
  • Warning: Lactic acidosis and hepatomegaly with steatosis (zidovudine, stavudine, didanosine > other NRTIs
  • Abacavir- hypersensitivity reactions test HLA*B5701
  • TEnofovir tox: nephro, osteoporosis, fanconi syndrome, thought to be decrreased with teno alfenamide
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7
Q

Prezista

Dosing

Warnings

SEs

Notes

A
  • Darunavir PI
  • Treatment naive: 800 mg daily
  • Warnings: Drug induced hepatitis, serioud skin reactions (SJS/TEN), use caution in patients with sulfa allergy
  • SEs: N/V/D, rash increased LFTs, HA
  • Must be given with ritonavir or cobicistat
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8
Q

Diagnosis of DM

A
  • Symptoms of hyperglycemia or crisis, and random plasma >=200
  • FPG >+ 126 no calories 8 hours
  • or 2 hour >= 200 after 75 mg OGTT or
  • A1C >=6.5%
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9
Q

INSTI based

Stribild

Difference from genvoya?

Elves Comb Elephants Tents

A

Elvetegravir

cobicistat

emtricitabine

tenofovir diso

With food original container

Genvoya is the same but Tenofovir Alfenamide instead

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10
Q

INSTI based

Triumeq

A

Dolutegravir

abacavir

Lamivudine

Original container

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11
Q

INSTI based

Biktarvy

Big Elephant Tents Also

A

Bictegravir

Emtricitabine

tenofovir alfenamide

Original container

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12
Q

PG 366 medications that should be dispensed in the original container

A
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13
Q

Pis class effects

A

Metabolic abnormalities

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14
Q

NNRTI based

Atripla

Trip Efery Empty Tent

A

Efavirenz, Emtricitabine, Tenofovir disoproxil

Without food original container

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15
Q

Raltegravir

A

Increase CPK

myopathy

Rhabdo

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16
Q

Stribild

A

Elvitegravir/cobicistat/emtricitabine/tenofovir diso

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17
Q

Op infection tx

Candidiasis (oropharyngeal or esophageal)

A

Fluconazole

  • Alt itraconazole
  • No secondary prophylaxis
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18
Q

Why is leucovorin added to some medication regimens to treat oppurtunistic infection?

A

Added with pyrimethamine for? Added to reduce the risk of myelosuppression associated with pyrimethamine. Added as a rescue

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19
Q

Saquinavir

A

Nausea

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20
Q

Tivicay + Descovy

A

Dolutegravir + emtricitabine

Tenofovir alafenamide

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21
Q

Sustiva

Dosing, generic, warnings, SEs,

A
  • Efavirenz NNRTI
  • Warnings: Serious psychiatric symptoms (suicidal ideation, depression), CNS symptoms (generally resolved in 2-4 wks), convulsions QT prolongation, hepatotoxicity
  • SEs: CNS effects, (impaired concentration, abnormal dreams, confusion, dizziness) , rash
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22
Q

PCP

Treatment not prophylaxis

A

Bactrim + prednisone or methylprednisolone for 21 days

alt: pentamidine IV

Bactrim as secondary prophylaxis

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23
Q

Nelfinavir

Brand name

SE

Other

A

Viracept

Diarrhea big

Boosting with ritonavir not recs

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24
Q

Pneumocystitis Pneumonia (PCP)

Indication cut-off

Preferred treatment

Criteria for discontinuation

A
  • CD4 count < 200
  • or orpharyngeal candidiasis or other AIDS-defining illness
  • Preferred: Bactrim DS tab PO daily or SS PO daily
    • Alt: Bactrim DS 3 x per week
    • Or dapsone
    • Or Dapsone + pyrimethamine + leucovorin (added to reduce myelosuppression from pyrimethamine)
  • DC when CD4 count >= 200 for >= 3 months on ART
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25
Drug interactions with NNRTIs
Class interactions: avoid with st johns wart, avanafil, Viekra Pak, Viekira KR Efavirenz moderate inhibitor of 2C8/2C9 and 2C19 moderate inducer of CYP3A4, avoid carbamazepine, flibanserin, itraconazole, ketoconazole, midazolam, posaconazole, simprevir, zepatier if used with voriconazole both drugs need adjustmetns EtravirineL inhibitor of 2C9 and 2C19, inducer of 3A4 and substrate of 2C9, 2C19. avoid with clopidogrel, phenobarb, phenytoin, Nevirapine: 3A4 substrate: contraindicated with strong 3A4 inducers, and PPIs Methadone levels can be decreased by efavirenz and niverapine, monitor for methadone withdrawal Horomonal contraceptives: levels can be decreased by efavirenz and nevirapine
26
DOlutegravir Rilpivirine Complete regimen with only two drugs nor for initial treatment
INSTI based Juluca Dont Rip First
27
Emtricitabine + teno diso
NRTI based Truvada True Elephant Tents
28
NRTI combination Epzicom Epson has Awful Laminators
Abacavir + Lamivudine
29
Ritonavir
N/V/D
30
NRTI based Truvada True Elephant Tents
Emtricitabine + teno diso
31
INSTI based HIV regimens 4 brand and generic
* Stribild with food : Elvitegravir+ cobicistat\_ emtricitabine + tenofovir diso * Genvoya with food: Elvitegravir+ cobicistat + emtricitabine + tenofovir alfenamide * Triumeq: DOlutegravir + abacavir + lamivudine * Juluca with food, complete regimen with only two drugs not for intitial treatment: Dolutegravir + rilpivirine
32
NNRTI based Odefsey Ripped Elephants Take Alfa Odesseys
Rilpivirine emtricitabine tenofovir alfenamide
33
* Efavirenz 400 instead of 600 * Lamivudine * Tenofovir diso
NNRTI Based Symfi Lo Symfiny Eats Lamb Tail
34
Abacavir + Lamivudine
NRTI combination Epzicom Epson has Awful Laminators
35
Elvitegravir Cobicistat Emtricitabine Tenofovir alfenamide with food original container
INSTI Based Genvoya Elves Comb Elephants Tents Also
36
Tipranavir Must be given with?
* Must be given with ritonavir * Boxed: clinical hepatitis and hepatic decompensation, intracranial hemorrage * Caution with sulf allergy * N/V/D * Monitor LFTs, blood glucose, lipids *
37
1. Biktarvy 2. Triumeq 3. Tivicay (dolutegravir) + Truvada (emtricitabine +tenofovir diso) 4. Tivicay + Descovy (emtricitabine + teno alfenamide) 5. Stribild 6. Genvoya 7. Isentress (raltegravir) + truvada 8. Isentress + descovy
What INSTI based regimens are recommended for initial treatment 8
38
Indinavir
Nephrolithiasis and urolithiasis
39
NNRTI Based Symfi Lo Symfiny Eats Lamb Tail
* Efavirenz 400 instead of 600 * Lamivudine * Tenofovir diso
40
What is epivir and what are the key features you need to know?
Lamivudine NRTI DO not use epivir HBV for the treatment of HIV it contains lower doses * Boxed warning for severe acute exacerbation of HBV * SE: N/V/D * Monitor renal function, LFTs, HBV status * Avoid in combination with emtricitabine, antagonistic drug interactions
41
INSTI Based Genvoya Elves Comb Elephants Tents Also
Elvitegravir Cobicistat Emtricitabine Tenofovir alfenamide with food original container
42
Efavirenz, Emtricitabine, Tenofovir disoproxil Without food original container
NNRTI based Atripla Trip Efery Empty Tent
43
Norvir generic
* Ritonavir * Boxed: Interact with many meds, including arrythmics, ergot alkaloids * Has antiretroviral activity * Enzymes: 3A4, 2C8 (inhibition strong) * Other inhibitors 2D6, 2C9, 2C19, BCRP * Inducer of 2C9 weak/moderate * Take with food, solution contains alcohol * Contraindicated with: Alfuzosin, amiodarone, carbamazepine, lovastatin, phenobarb, phenytoin, rifampin, st johns wort (all of these are also for cobicistat)
44
Toxoplasma gondii criteria, treatment and DC
* Toxo IgG postiive pt with CD4 \< 100 * Bactrim DS PO daily * dapsone + pyrimethamine _ leucovorin * CD4 \> 200 for \> 3 months on ART
45
Triumeq
Dolutegravir, abacavir, lamivudine
46
Didanosine
Pancreatitis (sometimes fatal) peripheral neuropathy, increased amylase increase LFTs, pruritis rash
47
Toxo Treatment regimen not prophylaxis
Pyrimethamine + leucovorin + sulfadiazine Alt: Bactrim Same as tx but at reduced dose
48
Nelfinavir
Diarrhea
49
NRTI drug interactions * Ribavirin should not be used with? * What combination should be avoided? * What other combination? * Allopurinol can increase? * What other combo should be avoided? * Methadone can increase? * Avoid tenofovir elfenamide with?
* with didansoine increase liver failure risk, rabivirin and zidovudine as well * Avoid didanosine and stavudine combination increased risk of peripheral neuropathy * Allopurinol can increase levels of didanosine * didanosine and tenofovir combination cause resistance * avoid emtricitabine and lamiduvine combination * methadone can increase zidovudine levels * TAF is a p-gp substrate: avoid rifampin, st johns, wort with descovy, genvoya, odesfey and symtuza.
50
Zidovudine SEs
Macrocystic anemia and myopathy
51
Cytomegalovirus
Valgan or Ganciclovir If resistant or toxicities use foscarnet, cidofovir No secondary prophylaxis reccomended keep CD4 \> 100
52
Single tablet regimens have no flexibility in renal dosing and are based on individual compoenents Stribild cut off: Triumeq cut off Genvoya/biktarvy cut off
* 70 * 50 * 30
53
For PIs what does the generic name end in? Drug interactions? Dose adjustments? Toxicity and highest with? What is it taken with? What abnormalities? Increased risk? Take with? What events? Changes in? SKin?
* End in navir * CYP inducers * No renal adjustments * Hepatotoxicity * Taken with booster * Metabolic abnormalities, hyperlipidemia, insulin resisstance * Increased CVD risk lowest with atazanavir and darunavir * GI upset take with food * Bleeding events in patients with hemophilia * ECG changes * Rash (SJS/TEN)
54
Rilpivirine SEs
Depression and insomnia
55
Nucleuside reverse transcriptase inhibitors 5 brand and generic
Abacavir (zaigen) Lamivudine (epivir) Emtricitabine (Emtriva) Tenofovir diso ( Viread) Tenofovir Alfendamide (TAF) Ziduvudine (Retrovir) Stravudine (Zerit) Didanosine (videx)
56
Reyataz generic?
Atazanavir
57
Dolutegravir
Increase Scr and affecting GFR
58
Rilpivirine Emtricitabine tenofovir disoproxil
NNRTI based Complera Ripped Elephants Take workers COMP
59
Darunavir brand?
Prezista
60
Single tablet regimens for HIV NNRTI based: 5 total brand and generic
* Atripla: efavirenz, emticitabine, tenofovir diso * Symfi: Efavirenz, lamivudine, tenofovir diso * Complera: Rilpivirine. lamivudine, tenofovir diso
61
Dolutegravir abacavir Lamivudine Original container
INSTI based Triumeq
62
Cryptococcal meningitis
Ampho B + flucytosine Secondary prophylaxis low dose fluconazole
63
HIV meds that should be taken without food 6 Are Eggs Symple Forms of Donut Ingredients?
* Atripla * Efavirenz * Symfi or Symfi lo * Fosamprenavir * Didanosine * Indinavir (unboosted)
64
Adult targets for DM
A1C\<7% Preprandial plasma 80-130 Peak post \<180
65
What medication should be used with caution in patients with renal impairment?
Tenofovir disoproxil
66
INSTI based Juluca Dont Rip First
DOlutegravir Rilpivirine Complete regimen with only two drugs nor for initial treatment
67
Darunavir Cabicistat Emtricitabine Tenofovir Alfenamide With food, orginal container
PI based Symtuza WIth or without food? Dont Count Every Tornado **Sym**tom
68
Non-nucleoside reverse transcriptase inhibitors `
No renal adjustment needed avoid Atripla and Complera if CrCl\<50 Primarily CYP450 inducers (exception efavirenz is an inducer \> inhibitor) * Hepatotoxicity and rash including SJS/TEN * Nevirapine\> other NNRTIs * Monitor for erythema, facial edema, skin necrosis, blisters tongue swelling * Food requirements * With food etavirine, rilpivirine * Without food evafirenz * Efavirenz- CNS effects decrease by giving at bedtime on an empty stomach * Rilpivirine QT prolongation, depression suicide
69
Reyetaz Drug info 3 points
Atazanavir * PR interval prolongation, severe skin reaction, hypebilirubinemia, hepatotox, nephrolithiasis and cholelithiasis * SE: Indirect hyperbili (juandice), cholethiasis, HA, N/V/D, skin reaction, depression, myalgia * Caution with acid suppresive agents, can reduce absorption
70
Stavudine
oral solution is stable for 30 days in the refridgerator shake well SEs: N/V/D, peripheral neuropathy can be irreversible, Increased LFTs, hyperbilirubinemia, lipoatrophy
71
Fosamprenavir
Rash
72
Fosamprenavir
Use caution in pts with sulfa allergy
73
Tenofovir SEs
renal tox, fanconci syndrome and decrease BMD
74
What medication has higher rates of failure when viral load is \> 100,000 and CD4 \< 200?
Rilpivirine: Enurant NNRTI
75
Didanosine Drug Interactions 4
1. Dont use with Ribavirin 2. COmbo with Stravudine increase peripheral neuropathy 3. Allopurinol can increase levels 4. Tenovir combo increase resistance
76
Viread
300 mg daily * Boxed Severe HBV exacerbation * Warning: renal tox or fancoci syndrome osteomalacia and decreased bone mineral density * Tenofovir alfenamide has lower rates of renal and bone toxicity
77
Emitricitabine and Lamivudine SEs
HA
78
NRTI class SE
Lactic acidosis
79
Elvetegravir cobicistat emtricitabine tenofovir diso With food original container Genvoya is the same but Tenofovir Alfenamide instead
INSTI based Stribild Difference from genvoya? Elves Comb Elephants Tents
80
Key notes for PK boosters 2 boosters
* Many drug interactions CYP3A4 inhibition * Know which formulations contain these medications * Rememebr stribild and genvoya contain these
81
Efavirenz, lamivudine, tenofovir disproxil Without food original container
NNRTI based Symfi Symfiny Eats Lamb Tail
82
Zidovudine What is a special situation where this should be administered?
NRTI: Hematologic toxicity (neutropenia/anemia) Prolonged use has been associated with myopathy SEs: myopathy, macrocytic anemia, increase LFTs Monitor: MCV * IV should be given in the setting of pts in labor with viral load \> 1,000 copies
83
Lopinavir/ritoniavir
Hyper TGs
84
Lopinavir + ritonavir
800/200 daily or 400/100 BID Soluttion take with food refridgerate contains 42% EtOH SEs: Hyperlipidemia, especially TGs, N/V/D
85
Biktarvy
Bivetagravir, emtricitabine, tenofovir alfenamide
86
Tivicay + Truvada
* Dolutegravi+ emtricitabine * Tenofvovir disoproxil
87
NNRTIs class effect
Rash
88
Genvoya
Elvitegravir/cobisistat/emticitabine/ tenofovir alafenamide
89
MAC crtieria treatment and DC
* CD4 \< 50 must rule out active disseminated DX * Preferred Azithromycin 1200 mg PO weekly * CD4 \> 100 for \>= 3 months on ART
90
Elvitegravir
HA and Insomnia
91
Isentress + descovy
Raltegravir+ emtricitabine Tenofovir alafenamide
92
Invirase Invirasequence Notes and SEs
Saquinavir Must be given with ritonavir QT prolongation Nausea
93
What tests are needed when using abacavir?
HLA-B\* 5701 allele if positive cannot use
94
Diagnosis of preDM
Fasting 100-125 or 2 hr plasma glucose 140-199 after 75 g oral glucose tolerance
95
Protease inhibitors/Pharmacokinetic boosters What are the two boosting agents?
* Cobsicat * Ritonavir
96
Bictegravir Emtricitabine tenofovir alfenamide Original container
INSTI based Biktarvy Big Elephant Tents Also
97
NNRTI based Symfi Symfiny Eats Lamb Tail
Efavirenz, lamivudine, tenofovir disproxil Without food original container
98
Nevirapine SEs
Hepatotoxicity and hypersensitivity
99
Indinavir
Take with food due to ritonavir component with 48 oz of water Warnings: nephroliathis/urolithiasis SEs: N/V/D, HA, nephrolithiasis
100
MAC
Clarithromycin or Azithromycin + ethambutol secondary prophylaxis is the same as primary tx
101
Rilpivirine emtricitabine tenofovir alfenamide
NNRTI based Odefsey Ripped Elephants Take Alfa Odesseys
102
Viramune DOsing, boxed warnings, Contraindications, Notes When should therapy not be initiated?
* NNTRI, Nevirapine * Requires 14 day lead in period which ma decrease the risk of rash and hepatotoxicity * Boxed: hepatotoxicity (liver failure, death) risk is higher during first 6wks, SJS/TEN * Increased LFTs * Do not initiate therapy in women with CD4 \> 250 or in men CD4 \> 400 due to increased risk of hepatotoxicity.
103
CCR5 antagonist Brand/generic Key points
* Miraviroc Selzentry * must get tropism test * only works with patients with CCR5 tropic dx must be negative for CXCR4 or dual mixed * Boxed: hepatotoxicity
104
Didanosine SEs Stavudine
Pancreatitis and peripheral neuropathy
105
Key drugs that can raise Blood Glucose 9
1. Beta-blockers 2. Diuretics 3. Immunosuppressants 4. Niacin 5. PIs 6. Quinolones 7. Second gen atypicals 8. Statins 9. Systemic steroids
106
Emtriva what is it and what are the key features? dosing?
* Dosing cap 200 mg daily * Emtricitabine * Boxed for severe exacerbation of HBV * Truvada is used for preexposure prophylaxis: this is only for patients that have confirmed HIV negative prior to initiation and every 3 months
107
Etravirine Main side effect
SJS/TEN
108
Add drug interactions for PIs Page 358
109
Isentress + Truvada
* Raltegravir + emtricitabine * Tenofovir disproxil
110
EfavirenZ SEs
CNS effects, abnormal dreams
111
Sustiva: generic
Efavirenz
112
Integrase Strand Transfer inhibitors 4 Key features: 7
Elvitegravir, Bictegravir, Dolutegravir (tivicay) , Raltegravir (isentress) * End in tegravir * Do not start stribild \<70 crcl * Dont start biktarvy or genvoya \< 30 * No major CYP interactions * Increase CPK raltegravir \> * HA, Insomnia * Interaction with polyvalent cations, must separate
113
Edurant: generic Dosing Absorption requirements Contraindications Warnings SEs Notes
* NNRTI: Rilpivirine * Contraindication: Concurrent use with PPIs, rifampin , rifepentine, carbamazepine * Warnings: QT prolongation, serioud skin reactions * SEs: Depressive disorder, mood changes, insomnia, * Notes: higher rates of failure with viral load \> 100,000 copies and or CD4 count \< 200
114
Taprinavir
Intracrannial hemmorrage
115
Darunavir SE
HA

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