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HIV > HIV Medications: Antiretroviral Therapy > Flashcards

HIV Medications: Antiretroviral Therapy Flashcards

1
Q
  • CD4 count should usually be:

- Name the opportunistic IFX and medication for Px with Landmark CD4 counts of:

A

-usually around 1000 cells/mm3

-

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2
Q

Name the categories of antiviral therapy (6).

A
  • CCR5 antagonist
  • fusion inhibitors
  • NNRTI’s
  • NRTI’s
  • Integrase inhibitors
  • Protease inhibitors
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3
Q

Atripla (three drugs tripled)

  • combination
  • interesting side effects
  • regimen
A
  • efavirenz, emtricitabine, tenofovir
  • efavirenz causes night terror, CNS
  • MID, empty stomach
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4
Q

Complera

  • combination (3)
  • contraindication (think of starting a new pt on therapy)
A
  • rilpivirine*, emtricitabine, tenofovir

* not as effective with viral load over 100K, which many pts present with. Starts with Atripla

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5
Q

Stribild

  • combination (*quad pill)
  • interesting caveat
A
  • elvitegravir, cobicstat, emtricitabine, tenofovir

* used for treatment naive patients (must be the first drug we use)

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6
Q

Combivir

  • combination
  • regmien
A
  • lamivudine, zidovudine

- BID

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7
Q

Cobicistat (Tybost)

  • how is this drug used?
  • which CYP does it inhibit?
  • which drugs does it potentiate?
A
  • Boosts (Ty-boost) the activity of other drugs, part of the quad pill
  • CYP3A
  • enhances the effect of atazanavir or darunavir
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8
Q

Maraviroc (Selzentry)

  • MOA
  • indication
  • adverse effects
A
  • binds CCR5 receptor of CD4 cell (cell’s entry)
  • restricted to HIV pts infected with CCR5 (M tropic) virus
  • rash, ab pain, URIs, dizziness, MSK sxs
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9
Q

Enfuvirtide (Fuzeon)

  • administration
  • hallmark side effects
  • MOA, what exactly does it bind to?
A
  • subQ injection
  • localized nodules at injection sites
  • usually second or third line because of this
  • Inhibits fusion by binding to BR1 in the gp41 subunit of the envelope glycoprotein
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10
Q

NNRTI’s

-name the drugs (there are 5)

A
  1. Delavirdine
  2. Efavirenz
  3. Etravirine
  4. Nevirapine
  5. Rilpivirine
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11
Q

NNRTI’s

  • MOA
  • Side Effects
  • SJS highest incidence with which drug?
  • which drug causes neuropsychiatric sxs?
  • viral mechanism of resistance (think about stopping therapy)
  • how to avoid resistance
A
  • directly bind to reverse transcriptase
  • RASH, transaminases
  • SJS highest incidence with Nevirapine
  • neuropsychiatric sxs with Efavirenz
  • non-compliance leads to exclusive stay in the system because of their land half lives, this allows the virus to gain resistance to essentially a monotherapy
  • use in combination
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12
Q

Name the NRTI’s (there are 7 of them)

-Most of these are nucleosides. Which is a nucleoTide?

A
  • Abacavir
  • Didanosine
  • Emtricitabine
  • Lamivudine
  • Stavudine
  • Tenofovir
  • Zidovudine
  • T-enofovir
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13
Q

Hallmark Side Effects for:

  • Abacavir
  • Didanosine
  • Stavudine
  • Zidovudine
A
  • Abacavir causes hypersensitivity! Pre-screen the pt for HLA-b*5701
  • Didanosine can cause peripheral neuropathy MI pancreatitis
  • Stavudine also causes peripheral neuropathy
  • myelosuppression, lipoatrophy and myopathy
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14
Q

Tenofovir

  • What sets this guy apart from the rest of the NRTI’s
  • adverse reactions (3)
A
  • It is a nucleotide, so it has a slightly different mechanism
  • lactic acidosis, decrease bone density, exacerbation of hepatitis
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15
Q

Integrase Inhibitors

  • Members
  • MOA
  • Inidication
A
  • Raltegravir, Elvitegravir, Dolutegravir
  • no integration to host DNA
  • anybody
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16
Q

Protease Inhibitors:

  • MOA
  • Which is “the booster of all booster?”
  • hallmark side effects (endocrine type)
  • indinavir special side effect
A
  • inhibit HIV-1 protease
  • Ritonavir, allows a lower pill burden
  • hyperlipidemia, fat maldistribution, insulin resistance, osteonecrosis
  • nephrolithiasis, increased SCR, pyuria, hydronephrosis
17
Q

Post-exposure Px

-name 2

A
  • raltegravir

- Truvada

18
Q

PrEP

A

-Truvada

19
Q

After starting therapy, how is the viral load used to monitor?

A

-The viral load is taken regularly and should be steadily decreasing.

20
Q

Antiretroviral therapy is recommended for:
-pts. with a history of _____
-Which types of women?
-Persons with which type of infections?
There are different levels of recommendation depending on the pts CD4 count. (i.e. CD4 count 500

A

-AIDS defining illnesses
-Pregnant women
-Hepatitis B co-infection
CD4 500=Level BIII

21
Q

Nevirapine has special considerations for females with CD4>250 and Males>400. Why?
-how do you decrease the side effects?

A
  • Nevirapine causes severe liver toxicity, which outweighs the benefit unless the pt has lower numbers than these.
  • two week dose escalation
22
Q

Name the other booster beside Tybost.

A

Ritonavir

23
Q 
NRTIS:
-MOA
-Don't forget that these have a variable metabolism and renal excretion.
Which of the following have an AUC effected by food?
-Abacavir
-Didanosine
-Lamivudine
-Zidovudine
A
  • MOA: look like RNA and DNA nucleosides, get phosphorylated in the cell and incorporate into the chain to block reverse transcriptase
  • Food effects: Didanosine and Zidovudine
24
Q

Efavirenz

  • class
  • side effects
A
  • NNRTI

- night terrors and teratogen

25
Q

Which treatment is used for pregnant women?

A

-IV zidovudine

26
Q

HIGH YIELD

  • Screen for HLA-B*5701
  • Bone marrow suppression
  • Nail pigmentation
  • Skin pigmentation
  • Pancreatitis
  • Peripheral neuropathy
A
  • Abacavir
  • Zidovudine
  • Zidovudine
  • Emtricitabine
  • Didanosine
  • Didanosine, Stavudine

HIV (2 decks)

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