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ID 1183 > HIV drugs > Flashcards

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
Q

Drug interactions with NNRTIs

A

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

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26
Q

DOlutegravir

Rilpivirine

Complete regimen with only two drugs nor for initial treatment

A

INSTI based

Juluca

Dont Rip First

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27
Q

Emtricitabine + teno diso

A

NRTI based

Truvada

True Elephant Tents

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28
Q

NRTI combination

Epzicom

Epson has Awful Laminators

A

Abacavir + Lamivudine

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29
Q

Ritonavir

A

N/V/D

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30
Q

NRTI based

Truvada

True Elephant Tents

A

Emtricitabine + teno diso

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31
Q

INSTI based HIV regimens 4 brand and generic

A
  • 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
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32
Q

NNRTI based

Odefsey

Ripped Elephants Take Alfa Odesseys

A

Rilpivirine

emtricitabine

tenofovir alfenamide

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33
Q
  • Efavirenz 400 instead of 600
  • Lamivudine
  • Tenofovir diso
A

NNRTI Based

Symfi Lo

Symfiny Eats Lamb Tail

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34
Q

Abacavir + Lamivudine

A

NRTI combination

Epzicom

Epson has Awful Laminators

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35
Q

Elvitegravir

Cobicistat

Emtricitabine

Tenofovir alfenamide

with food original container

A

INSTI Based

Genvoya

Elves Comb Elephants Tents Also

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36
Q

Tipranavir

Must be given with?

A
  • 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
    *
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37
Q
  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
A

What INSTI based regimens are recommended for initial treatment 8

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38
Q

Indinavir

A

Nephrolithiasis and urolithiasis

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39
Q

NNRTI Based

Symfi Lo

Symfiny Eats Lamb Tail

A
  • Efavirenz 400 instead of 600
  • Lamivudine
  • Tenofovir diso
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40
Q

What is epivir and what are the key features you need to know?

A

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
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41
Q

INSTI Based

Genvoya

Elves Comb Elephants Tents Also

A

Elvitegravir

Cobicistat

Emtricitabine

Tenofovir alfenamide

with food original container

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42
Q

Efavirenz, Emtricitabine, Tenofovir disoproxil

Without food original container

A

NNRTI based

Atripla

Trip Efery Empty Tent

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43
Q

Norvir generic

A
  • 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)
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44
Q

Toxoplasma gondii criteria, treatment and DC

A
  • Toxo IgG postiive pt with CD4 < 100
  • Bactrim DS PO daily
  • dapsone + pyrimethamine _ leucovorin
  • CD4 > 200 for > 3 months on ART
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45
Q

Triumeq

A

Dolutegravir, abacavir, lamivudine

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46
Q

Didanosine

A

Pancreatitis (sometimes fatal)

peripheral neuropathy, increased amylase increase LFTs, pruritis rash

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47
Q

Toxo

Treatment regimen not prophylaxis

A

Pyrimethamine + leucovorin + sulfadiazine

Alt: Bactrim

Same as tx but at reduced dose

48
Q

Nelfinavir

49
Q

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?
A
  • 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
Q

Zidovudine SEs

A

Macrocystic anemia and myopathy

51
Q

Cytomegalovirus

A

Valgan

or

Ganciclovir

If resistant or toxicities use foscarnet, cidofovir

No secondary prophylaxis reccomended keep CD4 > 100

52
Q

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

53
Q

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?

A
  • 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
Q

Rilpivirine SEs

A

Depression and insomnia

55
Q

Nucleuside reverse transcriptase inhibitors 5 brand and generic

A

Abacavir (zaigen)

Lamivudine (epivir)

Emtricitabine (Emtriva)

Tenofovir diso ( Viread)

Tenofovir Alfendamide (TAF)

Ziduvudine (Retrovir)

Stravudine (Zerit)

Didanosine (videx)

56
Q

Reyataz generic?

A

Atazanavir

57
Q

Dolutegravir

A

Increase Scr and affecting GFR

58
Q

Rilpivirine

Emtricitabine

tenofovir disoproxil

A

NNRTI based

Complera

Ripped Elephants Take workers COMP

59
Q

Darunavir brand?

60
Q

Single tablet regimens for HIV NNRTI based: 5 total brand and generic

A
  • Atripla: efavirenz, emticitabine, tenofovir diso
  • Symfi: Efavirenz, lamivudine, tenofovir diso
  • Complera: Rilpivirine. lamivudine, tenofovir diso
61
Q

Dolutegravir

abacavir

Lamivudine

Original container

A

INSTI based

Triumeq

62
Q

Cryptococcal meningitis

A

Ampho B + flucytosine

Secondary prophylaxis low dose fluconazole

63
Q

HIV meds that should be taken without food 6

Are Eggs Symple Forms of Donut Ingredients?

A
  • Atripla
  • Efavirenz
  • Symfi or Symfi lo
  • Fosamprenavir
  • Didanosine
  • Indinavir (unboosted)
64
Q

Adult targets for DM

A

A1C<7%

Preprandial plasma 80-130

Peak post <180

65
Q

What medication should be used with caution in patients with renal impairment?

A

Tenofovir disoproxil

66
Q

INSTI based

Juluca

Dont Rip First

A

DOlutegravir

Rilpivirine

Complete regimen with only two drugs nor for initial treatment

67
Q

Darunavir

Cabicistat

Emtricitabine

Tenofovir Alfenamide

With food, orginal container

A

PI based

Symtuza

WIth or without food?

Dont Count Every Tornado Symtom

68
Q

Non-nucleoside reverse transcriptase inhibitors `

A

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
Q

Reyetaz

Drug info 3 points

A

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
Q

Stavudine

A

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
Q

Fosamprenavir

72
Q

Fosamprenavir

A

Use caution in pts with sulfa allergy

73
Q

Tenofovir SEs

A

renal tox, fanconci syndrome and decrease BMD

74
Q

What medication has higher rates of failure when viral load is > 100,000 and CD4 < 200?

A

Rilpivirine: Enurant

NNRTI

75
Q

Didanosine Drug Interactions 4

A
  1. Dont use with Ribavirin
  2. COmbo with Stravudine increase peripheral neuropathy
  3. Allopurinol can increase levels
  4. Tenovir combo increase resistance
76
Q

Viread

A

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
Q

Emitricitabine and Lamivudine SEs

78
Q

NRTI class SE

A

Lactic acidosis

79
Q

Elvetegravir

cobicistat

emtricitabine

tenofovir diso

With food original container

Genvoya is the same but Tenofovir Alfenamide instead

A

INSTI based

Stribild

Difference from genvoya?

Elves Comb Elephants Tents

80
Q

Key notes for PK boosters

2 boosters

A
  • Many drug interactions CYP3A4 inhibition
  • Know which formulations contain these medications
  • Rememebr stribild and genvoya contain these
81
Q

Efavirenz, lamivudine, tenofovir disproxil

Without food original container

A

NNRTI based

Symfi

Symfiny Eats Lamb Tail

82
Q

Zidovudine

What is a special situation where this should be administered?

A

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
Q

Lopinavir/ritoniavir

84
Q

Lopinavir + ritonavir

A

800/200 daily or 400/100 BID

Soluttion take with food refridgerate contains 42% EtOH

SEs: Hyperlipidemia, especially TGs, N/V/D

85
Q

Biktarvy

A

Bivetagravir, emtricitabine, tenofovir alfenamide

86
Q

Tivicay + Truvada

A
  • Dolutegravi+ emtricitabine
  • Tenofvovir disoproxil
87
Q

NNRTIs class effect

88
Q

Genvoya

A

Elvitegravir/cobisistat/emticitabine/ tenofovir alafenamide

89
Q

MAC crtieria treatment and DC

A
  • CD4 < 50 must rule out active disseminated DX
  • Preferred Azithromycin 1200 mg PO weekly
  • CD4 > 100 for >= 3 months on ART
90
Q

Elvitegravir

A

HA and Insomnia

91
Q

Isentress + descovy

A

Raltegravir+ emtricitabine

Tenofovir alafenamide

92
Q

Invirase

Invirasequence

Notes and SEs

A

Saquinavir

Must be given with ritonavir

QT prolongation

Nausea

93
Q

What tests are needed when using abacavir?

A

HLA-B* 5701 allele if positive cannot use

94
Q

Diagnosis of preDM

A

Fasting 100-125 or 2 hr plasma glucose 140-199 after 75 g oral glucose tolerance

95
Q

Protease inhibitors/Pharmacokinetic boosters

What are the two boosting agents?

A
  • Cobsicat
  • Ritonavir
96
Q

Bictegravir

Emtricitabine

tenofovir alfenamide

Original container

A

INSTI based

Biktarvy

Big Elephant Tents Also

97
Q

NNRTI based

Symfi

Symfiny Eats Lamb Tail

A

Efavirenz, lamivudine, tenofovir disproxil

Without food original container

98
Q

Nevirapine SEs

A

Hepatotoxicity and hypersensitivity

99
Q

Indinavir

A

Take with food due to ritonavir component with 48 oz of water

Warnings: nephroliathis/urolithiasis

SEs: N/V/D, HA, nephrolithiasis

100
Q

MAC

A

Clarithromycin or Azithromycin + ethambutol

secondary prophylaxis is the same as primary tx

101
Q

Rilpivirine

emtricitabine

tenofovir alfenamide

A

NNRTI based

Odefsey

Ripped Elephants Take Alfa Odesseys

102
Q

Viramune DOsing, boxed warnings, Contraindications, Notes

When should therapy not be initiated?

A
  • 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
Q

CCR5 antagonist

Brand/generic

Key points

A
  • 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
Q

Didanosine SEs

Stavudine

A

Pancreatitis and peripheral neuropathy

105
Q

Key drugs that can raise Blood Glucose 9

A
  1. Beta-blockers
  2. Diuretics
  3. Immunosuppressants
  4. Niacin
  5. PIs
  6. Quinolones
  7. Second gen atypicals
  8. Statins
  9. Systemic steroids
106
Q

Emtriva what is it and what are the key features? dosing?

A
  • 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
Q

Etravirine

Main side effect

108
Q

Add drug interactions for PIs

Page 358

109
Q

Isentress + Truvada

A
  • Raltegravir + emtricitabine
  • Tenofovir disproxil
110
Q

EfavirenZ SEs

A

CNS effects, abnormal dreams

111
Q

Sustiva: generic

112
Q

Integrase Strand Transfer inhibitors

4

Key features: 7

A

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
Q

Edurant: generic

Dosing

Absorption requirements

Contraindications

Warnings

SEs

Notes

A
  • 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
Q

Taprinavir

A

Intracrannial hemmorrage

115
Q

Darunavir SE

ID 1183 (19 decks)

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