HSV, PHN, HIV drugs Lugo

Question 1

Treatment of Herpes Simplex Viral infections

also works for shingles, and varicella

Answer 1

Acyclovir
Valacyclovir
Famciclovir

Question 2

In order for acyclovir to work, the virus must have

Answer 2

thymidine kinase

if it doesn’t have thymidine kinase, the drug is useless

Question 3

Adverse effects of acyclovir

Answer 3

Headache- most common
N/V- next most common
Diarrhea
Local irritation

Question 4

Acyclovir routes

Answer 4

oral- bad biovailability so better to use IV for severe cases
IV
buccal tab
topical cream ointment- for labialis only

Question 5

What’s the difference between acyclovir and valcyclovir/famciclovir?

Answer 5

val and fam only come in oral tabs

but they have same MOA

Question 6

What’s special about famciclovir?

Answer 6

** 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)

Question 7

Acyclovir/Valcyclovir/Famciclovir May decrease response to varicella and zoster vaccines–why?

Answer 7

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

Question 8

Oral HSV lesions should be treated _____ rather than systemically
IV acyclovir is used in

Answer 8

topically

severe infection, such as HSE (herpes simplex encaphalitis)

Question 9

What’s used to tx postherpetic neuralgia? and what’s the MOA

Answer 9

Gabapentin & Pregabalin

MOA is unknown for both

Question 10

biggest side effect of gabapentin?

Answer 10

dizziness/fall risk in elderly

Question 11

what are the 2 formulations of gabapentin called?

Answer 11

neurontin & gralise

Gabapentin- generic
Neurontin- not generic
Gralise- ER

Question 12

How long is someone going ot be on this gabapentin/

Answer 12

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

Question 13

drug interactions with gabapentin worth noting?

Answer 13

antacids, alcohol

Question 14

Pregabalin works the same way as

Answer 14

Gabapentin

Question 15

Drug interactions worth noting for pregabalin?

Answer 15

ACE inhibitors - increased risk of angioedema

alcohol or anything causing CNS depression

Question 16

3 primary genes in HIV

Answer 16

GAG, POL, ENV

Question 17

NRTI’s treat what?

and what does it stand for?

Answer 17

HIV

Nucleoside Reverse Transcriptase Inhibitors

Question 18

What are the 2 NRTI’s we should know

Answer 18

Stavudine

Emtricitabine

Question 19

How are NRTIs activated?

Answer 19

Drugs are activated by VIRAL thymidine kinase

Question 20

Side effects of Stavudine & Emtricitabine (NRTIs for HIV)

Answer 20

Stavudine: hyperlipidemia, osteoporosis
Emtricitabine: Hyperpigmentation of palms and soles of feet

Question 21

What is an NNRTI? (with an extra N)
they tx
the one we should know

Answer 21

Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI)
HIV
Efavirenz

Question 22

Side effects of Efavirenz (NNRTI for HIV tx)

Answer 22

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

Question 23

What is Enfuvirtide used to tx?

how does it work?

Answer 23

HIV
Fusion Inhibitor (blocks the actions of gp41)

Question 24

What is cobistat?

important fact:

Answer 24

a booster to tx HIV

CYP3A4 inhibitor

Question 25

When you tx someone for HIV, how many meds should you use?

Answer 25

3- to avoid resistance

Question 26

PEP for HIV

Answer 26

emtricitabine