HSV, PHN, HIV drugs Lugo Flashcards
Treatment of Herpes Simplex Viral infections
also works for shingles, and varicella
Acyclovir
Valacyclovir
Famciclovir
In order for acyclovir to work, the virus must have
thymidine kinase
if it doesn’t have thymidine kinase, the drug is useless
Adverse effects of acyclovir
Headache- most common
N/V- next most common
Diarrhea
Local irritation
Acyclovir routes
oral- bad biovailability so better to use IV for severe cases
IV
buccal tab
topical cream ointment- for labialis only
What’s the difference between acyclovir and valcyclovir/famciclovir?
val and fam only come in oral tabs
but they have same MOA
What’s special about famciclovir?
** has approval to be used in pts with HIV (whereas acyclovir and valacyclovir don’t but lugo says they could probs also be used in pts with HIV)
Acyclovir/Valcyclovir/Famciclovir May decrease response to varicella and zoster vaccines–why?
b/c these are live attenuated vaccines. So if we give someone an antiviral that is specific, it may not give you good results with a varicella or zoster vaccine
Oral HSV lesions should be treated _____ rather than systemically
IV acyclovir is used in
topically
severe infection, such as HSE (herpes simplex encaphalitis)
What’s used to tx postherpetic neuralgia? and what’s the MOA
Gabapentin & Pregabalin
MOA is unknown for both
biggest side effect of gabapentin?
dizziness/fall risk in elderly
what are the 2 formulations of gabapentin called?
neurontin & gralise
Gabapentin- generic
Neurontin- not generic
Gralise- ER
How long is someone going ot be on this gabapentin/
Almost eveyrone is going to have 1mo of pain, some people have 3mos of pain. But some pts have pain for a year or more.
If pt is still on drug for a year, need to take them off by tapering and reassess their pain to see if they can get off drug now
drug interactions with gabapentin worth noting?
antacids, alcohol
Pregabalin works the same way as
Gabapentin
Drug interactions worth noting for pregabalin?
ACE inhibitors - increased risk of angioedema
alcohol or anything causing CNS depression
3 primary genes in HIV
GAG, POL, ENV
NRTI’s treat what?
and what does it stand for?
HIV
Nucleoside Reverse Transcriptase Inhibitors
What are the 2 NRTI’s we should know
Stavudine
Emtricitabine
How are NRTIs activated?
Drugs are activated by VIRAL thymidine kinase
Side effects of Stavudine & Emtricitabine (NRTIs for HIV)
Stavudine: hyperlipidemia, osteoporosis
Emtricitabine: Hyperpigmentation of palms and soles of feet
What is an NNRTI? (with an extra N)
they tx
the one we should know
Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI)
HIV
Efavirenz
Side effects of Efavirenz (NNRTI for HIV tx)
Neuropsychiatric side effects so if a person already has a neuropsychiatric side effect, it can really exaserbate it
Avoid ETOH
Neural tube defects in 1st trimester
Taken on empty stomach
What is Enfuvirtide used to tx?
how does it work?
HIV Fusion Inhibitor (blocks the actions of gp41)
What is cobistat?
important fact:
a booster to tx HIV
CYP3A4 inhibitor
