HIV DRUGS Flashcards
What is an opportunistic infection?
When does it hit?
opportunistic infections are secondary infections
and often occur on STAGE 4
HIV ORGAN SYSTEM INVOLVEMENT
A 54 year old M patient is scheduled for surgery. You have noticed a history of AIDS. You noticed ground-glass opacities on his Xray what may this be and how will you treat it?
what may you order to confirm xray finding?
Pneumocystis jirovecci pneumonia
may order CT
Tx of choice: HIGH DOSE BACTRIM
SYSTEMIC STEROID FOR PERSISTENT HYPOXEMIA
REVERSE TRANSCRIPTASE INHIBITOR
Nucleoside/nucleotide (NRTI)
AND SIDEFFECTS
Abacavir
Didanosine
Emtricitabine
Lamvidune
Stavudine
Zidovudine
MOA: binds to evolving viral DNA and prevents completion of reverse transcription
Abacavir: distributive shock in patients expressing human leukocyte antigen, MYOCARDIAL INFARCTION
Didanosine: pancreatitis
Emtricitabine
Lamivudine
Stavudine: pancreatitis
Zidovudine: Bone marrow suppression
–>LACTIC ACIDOSIS WITH MITOCHONDRIAL DYSFUNCTION
NON-NUCLEOTIDE (NNRTI)
and SE
MOA: binds to reverse transcriptase interfering with transcriptional activity
Delavirdine
Efavirenz: LFT, CNS [insomnia, unable to concentrate, nightmares, mania]
Etravirine
Nevirapine: LFT
Tenofovir: lactic acidosis
SE: LFTs,
Protease Inhibitor
“VIR”
Parasthesias, Qtc prolongation, heart block, hyperbilirubinemia
–please Qt, heartblock hyper B–
Entry Inhibitors
Fusion Inhibitor
Pneumonia
local injection site reaction
CCR 5 antagonist
hepatotoxicity
hypotension
Infection
INTEGRASE INHIBITORS
RALTEGRAVIR
CPK ABNORMALITIES
POSSIBLE RHABDO
GRAB A CPK BASELINE
– muscular folks, long cases not uncommon for CPK to increase, if a patient already has an increase baseline its better to monitor –
What do Protase Inhibitors inhibit?
What is the effect of NNRTIS?
how can this impact your pain management?
Protase Inhibitors: inhibit CYP3A4
RITONAVIR is a strong INHIBITOR
NNRTIs
INDUCES CYP3A4
except
DELAVIRDINE: INHIBITS 3A4
- depending on the medication the patient is on, patient migh require more pain medicine intra/post op –
Drug Interactions
of PIs and NNRTIS with antiarrhythmics
What do you do with the anti-retrovirals before or after the case?
WHY?
If possible continue if patient is able to take drugs orally.
PARTIAL CONTINUATION OF DRUGS SHOULD ABSOLUTELY PROHIBITED
ALL OR NOTHING
MAY INCREASE VIRAL RESISTANCE (LIFE LONG)
consult ID
Your patient is NPO except meds. will you give your patient atazanavir or rilpivirine?
NO. Avoided in patients not eating
Avoid acid suppressant agents
