HIV - Drugs/ADEs Flashcards
Protease Inhibitors
- SEs
- DDIs
SEs
- N/V/D/Flatulence
- Lipodystrophy - SQ fat wasting
- Hyperglycemia/insulin resistance
- Hyperlipidemia: avoid lovastatin & simvastatin
- Hepatotoxicity
- Incr transaminase elevation
- Incr risk of myocardial infarction
- Incr bleeding
DDIs
- 3A4 Inhibitors
Indinavir - Crixivan
- SEs
- How to take it
- Contact MD if
- Storage
- Kidney stone = nephrolithiasis
- Take on empty stomach or light meal
=> Drink > 1.5L of water/d - Contact MD if FLANK pain
- Storage: very sensitive to moisture. MUST store in desiccant in container. W/o desiccant, capsules are good for 3 days
Kaletra
- Forms
- Storage
- Take with
- Which contain EtOH
Lopinavir + Ritonavir
Film coated tablet
- With or w/o food
- DO NOT REFRIGERATION
PO Sol'n - With Food - Refrigeration => throw away after 2 mo if @ RT - Contain 42% EtOH
With Food
- All PI except Indinavir
- Zidovudine - Retrovir
- Rilpivirdine - Edurant
- Tenofovir - Viread
- Fosamprenavir - Lexiva: PO susp in children
- Complera - Emtricitabine + Tenofovir + Rilpivirine
- Stribild: Elvitegravir + cobicistat + emtricitabine + tenofovir disoproxil fumarate
- Ganciclovir - Cytovene
Kaletra - Lopinavir + Ritonavir
- SEs
- Pancreatitis
- Severe migraine like HA
- Rash
Contain Alcohol
- Kaletra - Lopinavir + Ritonavir: Susp Sol’n
- Ritonavir - Norvir
- Tiprinavir - Aptivus
Cause explosive diarrhea
- Nelfinavir - Veracept
Refrigeration
- Kaletra - Lopinavir + Ritonavir:
- Ritonavir - Norvir:
- Retrovir - Zidovudine:
- Tiprinavir - Aptivus:
- Emtricitabine - Emtriva:
- Enfuvirtide - Fuzeon:
- Didanosine - Videx:
- Viracept - Nelfinavir:
- Stavudine - Zerit:
- Kaletra - Lopinavir + Ritonavir: Susp Sol’n
- Ritonavir - Norvir: Cap needs fridge => OFF THE MARKET but not sol’n
- Retrovir - Zidovudine: Use dilution w/in 8H if refrigerated
- Tiprinavir - Aptivus: Cap fridge b/4 use
- Emtricitabine - Emtriva: Oral sol’n. At RT, use w/in 3M
- Enfuvirtide - Fuzeon: Fridge reconstitution sol’n & use w/n 24H
- Didanosine - Videx: Ped powder after mixing, refrigerate & use w/in 1M
- Viracept - Nelfinavir: PO powder if not use, need fridge
- Stavudine - Zerit: PO powder after reconstitute, need to fridge
Ritonavir - Norvir
- SE
- Storage
SEs
- Severe GI => taper up to prevent n/v
- Paresthesias: numbness
- Hyperlipidemia: highest among all PIs
Storage
- Cap: refrigerate or @ RT 30 days
- So’n/tablet: no refrigerate
Which drug contains:
Contain lactose => increase frequency of GI SEs
Saquinavir (Invirase)
Saquinavir (Invirase)
- SEs
- CI
SEs
- Contains lactose => increase GI SE
- HA
- Fatal hepatotoxicity
- Life threatening cardiac when used w/ Norvir
CI
- Rifampin => severe hepatotoxicity
Fatal hepatotoxicy
- Saquinavir (Invirase)
- Tiprinavir - Aptivus
Tiprinavir - Aptivus
- SEs
- CI
- BBW
- Fatal hepatotoxicity
- Intracranial bleeding
- Sulfa, rash
- Hemophilia
CI
- Hepatic failure
BBW
- Intracranial hemorrhage
=> It’s imp to report any unusual bleeding especially if they are taking any blood thinner
A Prodrug
FoSAMprenavir (Lexiva)
- Prodrug of amprenavir
FoSAMprenavir (Lexiva)
- SEs
- Steven Johnson
- Rash
- Sulfa allergy
- Hemophilia
- Depression
Drugs cause hemophilia
- Tiprinavir - Aptivus
- FoSAMprenavir (Lexiva)
The only PI that has not been ass with increases in TC or fasting TG
Atazanavir - Reyataz
Protease Inhibitors
- Inhibitor of which CYP 450
- What need to monitor Q3M
- Inhibitor of 3A4
Monitor Q3M
- LFT
- Glucose
- Cholesterol
- Look for fat redistribution
Abavavir - Ziagen
- SEs
- Generic Screening for
SEs
- Severe hypersensitivity => can be fatal HLA B5701
- Lactose acidosis
Generic screen
- HLA-B5701
Empty Stomach
- Indinavir - Crixivan
- Didanosine - Videx
- Efavirenz - Sustiva
- Fosamrenavir - Lexiva: oral susp in adults
- Atripla - Efavirenz + Emtricitabine + Tenofovir
Didanosine - Videx
- SEs
=> DAN Pham
- Pancreatitis
- Peripheral neuropathy
- Retinal Pigmentation
- Lactic acidosis
Cause eye problem
- Didanosine - Videx
Zidovudine - Retrovir
- SEs = do = red
=> Take with food to decrease nausea
- Myelosuppression => Anemia: Epogen => Neutropenia: Neupogen - Purple toe - HA - Myopathy - Lactic acidosis
Emtricitabine - Emtriva
- SEs
- Lactic acidosis
- Flare up hepatitis B
- Darkening of palm and soles which will resolve
NRTI
- Class SEs
- Without food
- With food
Class SEs
- HA
- Lactic acidosis, hepatic steatosis
Without food
- Didanosine - Videx => at least 1H prior/2H after meal
With food
- Zidovudine - Retrovir to decrease N/V
- Tenofovir - Viread
NNRTI
- Class SEs
SEs
- Rash
- Hepatotoxicity
=> All take with foods
False cannabinoid test
- Efavirenz - Sustiva
Tenofovir - Viread
- SEs
- Lactic acidosis
- Hepatotoxicity
- Renal: acute renal failure/Fanconi syndrome
Fanconi syndrome
- Tenofovir - Viread
- Elvitegravir (part of Stribild)
Abacavir & Tenofovir
- Which class
- NRTI
Pregnant patient
- Zidovudine: 300 mg PO BID or 200 mg PO TID
During label
- Zidovudine: 2mg/kg IV LD in 1H => 1mg/kg continuous infusion
Infant
- Zidovudine syrup: 2mg/kg PO Q6H for 1st 6 weeks of life
- Starting within 8-12H of life
DO NOT COMBINE
SEE BOOK PG 15 HIV
Recommend regimen for post-exposure prophylaxis
- Truvada + Raltegravir
Recommend Vaccination
- Hep A
- Hep B
- Influenza
- Pneumococus
- DPT
- MMR: NOT OK w/ AIDs but ok w/ asymptomatic HIV with CD4 > 200
Vaccination NOT rec
- Varicella - Varivax
- Smallpox vaccine
- Live influenza (FluMist)
- HPV for W < 26 y.o
- Attenuated Polio but inactivated polio is OK
Pneumocystis Pneumonia (PCP)
- DOC
- Alternative
- Sulfa allergy
DOC
- Bactrim + Prednisolone x 21d
Alternative
- Dapsone + Pentamidine + Leukovorin
Sulfa allergy
- Clinda + Primaquine + Prednisone x 21d
Toxoplasmosis
- 1st line:
- Alternative:
1st line
- Bactrim 1 DS PO QD
Alternative: Combo of 3 drugs
- Pyrimethamine (Daparim): Inhibits parasitic dihydrofolate reductase
- Leucovorine
- Sulfadiazine - Dapsone
MAC
- DOC
Macrolides
- Clarithromycin 500 mg PO BID
- Azithromycin 1200mg PO QW
M. Kansasii
- DOC
=> Same as MAC
Macrolides
- Clarithromycin 500 mg PO BID
- Azithromycin 1200mg PO QW
Treatment of CMV
- Foscarnet - Foscarvir: Nephrotoxic, seizure
- Ganciclovir - Cytovene: Renal, sz
- Ganciclovir implants - Vitrasert:
- Cidofovir - Vistide: Renal
- Fomivirsen - Vitravene
Treatment regimen for latent PPD+
- INH (isoniazid) 300 mg + Pyridoxime (vit B6) 50 mg PO QD x 9M
OR
- INH 900 mg PO + Pyridoxine 100 mg BW x 9M
Treatment for diarrhea caused by:
- Salmonellosis
- Campylobacteriosis
- Shigellosis
- Salmonellosis
DOC: Ciprofloxacin x 2-4wks. May continue QD thereafter - Campylobacteriosis
Azithromycin or cipro x 7d - Shigellosis
DOC: quinolones
