Miscellaneous Flashcards
1
Q
What is the BBW of NRTIs?
A
lactic acidosis
hepatomegaly
steatosis
2
Q
What is MOA of NRTIs?
A
terminates RNA to DNA reverse transcriptase
3
Q
What is the brand of elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate?
A
Stribild
4
Q
What is the brand os elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide?
A
Genvoya
5
Q
A HLA-B*5701 + patient should not use which medication? why?
A
abacavir
increased risk of hypersensitivity reaction
6
Q
emtricitabine is interchangeable with?
A
lamivudine
7
Q
Stribild should be used in which CrCl?
A
> =70
8
Q
Genvoya should be used in which CrCl?
A
> =30
9
Q
Which ART requires boosting?
A
protease inhibitors with ritonavir
10
Q
What are the recommended NRTI combos in HIV naive preggers?
A
abacavir/lamivudine
tenofovir disoproxil fumarate/emtricitabine OR lamivudine
11
Q
What are the recommended PI in HIV naive preggers?
A
atazanavir/ritonavir
darunavir/ritonavir
12
Q
What is the recommended INSTI in HIV naive preggers?
A
raltegravir
13
Q
Adherence of at least how many % is required for ART to be successful?
A
> =95%
14
Q
When should HIV home tests be used and why?
A
at least 3 months after onset of symptoms b/c home tests only test for Ab which may take 4-8 weeks or as long as 6 months in some people. May lead to false negative.
15
Q
What is the recommended regimen?
A
2 NRTIs + a PI w/ booster or INSTI
16
Q
Which NRTIs have the greatest risk of BW of lactic acidosis, hepatomegaly w/ steatosis?
A
zidovudine, stavudine, didanosine
17
Q
Which NRTI should be taken w/ food?
A
didanosine
18
Q
Which NRTI does not require renal dose adjustment?
A
abacavir
19
Q
Do NRTIs have any CYP interactions?
A
No
20
Q
tenofovir toxicities
A
nephrotoxicity
osteoporosis
Fanconi syndrome
though to be less w/ alafenamide
21
Q
Which NRTI will be removed from the market?
A
delavirdine
22
Q
abacavir brand
A
Ziagen
23
Q
abacavir + lamivudine
A
Epzicom
24
Q
abacavir + lamivudine + dolutegravir
A
Triumeq
25
Patients taking abacavir receive what in addition to a ned guide?
a warning card summarizing symptoms of hypersensitivity reactions
26
What is the brand of lamivudine?
Epivir
27
BBW of lamivudine
do not use Epivir-HBV in HIV pts b/c lower dose pf lamuvidine may cause resistance
28
common SE of Epivir?
N/V/D
29
Emtriva generic
emtricitabine
30
Truvada generic
Emtricitabine
| tenofovir disoproxil fumarate
31
Descovy generic
emtricitabine
| tenofovir alafenamide
32
Complera generic
emtricitabine
tenofovir disoproxil
rilpivirine
33
Odefsey generic
emtricitabine
tenofovir alafenamide
rilpivirine
34
Atripla generic
emtricitabine
efavirenz
tenofovir disoproxil
35
All NRTIs including combos are qdaily except which ones?
Trizivir: lamivudine + zidovudine + abacavir
Combivir: lamivudine w/ zidovudine
36
How should Atripla be taken?
w/ food
| preferable at bedtime
37
Which NRTI combos are taken w/ food?
Complera
Odefsey
Stribild
Genvoya
38
AE of emtricitabine containing meds
```
dizziness
HA
N/V/D
rash
hyperpigmentation of soles and palms typically in children
```
39
tenofovir disoproxil fumarate brand
Viread
40
What is the dose of Viread?
300mg daily
41
BW for tenofovir alafenamide
not approved for HBV treatment
42
warnings for tenofovir
renal toxicity
Fanconi syndrome
osteomalacia
decreased BMD
43
common SE w/ tenofovir alafenamide
nausea
44
Which tenofovor containing product requires medguide?
Truvada
45
BW zidovudine
```
hematologic toxicities (anemia and neutropenia)
prolonged use associated w/ symptomatic myopathy
```
46
AE zidovudine
myopathy, macrocytic anemia, increasing LFTs
47
zidovine should not be used w/ which NRTI? why?
stavudine b/c both are thymidine analogs
48
emtricitabine should be be used w/ which NRTI? why?
lamivudine b/c both are cytosine analogs
49
rank risk of lipoatrophy among NRTIs
stavudine > zidovudine > others
50
When is IV zidovudine used?/
pregnant HIV pts undergoing labor and viral count >1000 or unknown
51
What should be monitored in zidovudine pts?
MCV
| if MCV not elevated them may mean poor adherence
52
How long is the oral soln of stavudine stable in refrigerator?
30 days and shake vigorously before use
53
What AE of stavudine?
```
lipoatrophy
N/V/D
increasing LFTs
peripheral neuropathy
hyperbilirubinemia
```
54
which NRTIs have a BBW of pancreatitis
stavudine and didanosine
55
Which NRTIs are taken on an empty stomach?
Atripla
| didanosine
56
AE didanosine
peripheral neuropathy
increasing amylase
N/V/D
57
Why should didanosine and stavudine not be given together?
increased risk of pancreatitis, lactic acidosis and peripheral neuropathy
58
contraindications didanosine
allopurinol and ribavirin
59
why should didanosine not be used w/ tenofovir products?
resistance and increased didanosine concentrations
60
why should didanosine and zidovudine not be used together?
increased risk and severity of anemia
61
methadone can increase conc. of which NRTI?
zidovudine
62
tenofovir alafenamide should be avoided with which drugs and why?
st. johns wart and rifampin
P-gp substrate
watch our for combos
63
efavirenz brand
Sustiva
64
Whats the dose of efavirenz?
600mg daily
65
How should efavirenz be taken?
empty stomach in the evening
66
BBW efavirenz
CNS toxicities, QT prolongation, convulsions
67
efavirenz and CYP?
CYP inducer more than inhibitor
68
rilpivirine and CYP?
substrate
69
Do NNRTIs require renal dose adjustment?
No
70
Common SE with NNRTIs
hepatotoxicity
rash
SJS/TENs
nelvirapine > NNRTIs
71
Which NNRTIs should be taken with food?
rilpivirine (with food)
| etravirine (after food)
72
rilpivirine brand
Edurant
73
how should rilpivirine be stored?
in original container away from light
74
Edurant contraindication
PPIs and strong CYP3A4 inducers
75
What kind of environment does Edurant need for absorption
acidic
| space from H2RAs and antacids
76
AE Edurant
depressive disorders, mood changes, insomnia
77
Why does nevirapine need a 14 day lead in period?
may reduce rash and hepatotoxicity
78
BBW nevirapine
hepatotoxicity
rash
SJS/TENs
79
nevirapine should not be initiated in which HIV pts?
CD4 > 400 in F
CD4 > 200 in M
increases risk of hepatotoxicity
80
methadone and hormonal contraceptives may be decreased by which NNRTIs?
nevirapine and efavirenz
81
Do PIs have to be renally adjusted?
No
82
PIs and CYP?
CYP450 inhibitors
83
BW of PIs
hepatotoxicity
84
which PIs have least risk for hyperlipidemia and lipohypotrophy?
atazanavir
| ritonavir
85
which PIs have highest risk of insulin resistance/hyperglycemia?
indinavir
| lopinavir/ritonavir
86
which PI has least CVD risk
atazanavir
| darunavir
87
PI should be taken w/ food except?
fosamprenavir
| lopinavir/ritonavir
88
darunavir brand
Prezista
89
Which PI should be used w/ caution in pts w/ sulfa allergy?
darunavir
90
warnings darunavir
drug-induced hepatitis
| SJS/TENS
91
which booster is FDA approved with darunavir for once daily dosing?
cobicistat
92
Which booster with PI should not be used w/ tenofovir disoproxil if CrCl <70?
cobicistat
93
How is Evotaz given?
once daily
94
Evotaz generic
atazanavir + cobicistat
95
Prezcobix generic
darunavir + cobicistat
96
warnings Reyataz
```
severe skin reactions
hyperbilirubinemia
cholelithiasis
nephrolithiasis
prolonged P-R interval
hepatotoxicity
```
97
which drug is associated with"bananavir". why?
atazanavir b/c jaundice and scleral ictus
98
SE Reyataz
```
cholelithiasis
hyperbilirubinemia
myalgia
depression
severe skin reactions
```
99
Which PIs do you monitor for ECG changes?
atazanivir
lopinavir
saquinavir
100
which ART do you need to watch out with acid suppressive agents?
atazanavir
| rilpivirine
101
Warnings fosamprenavir
sulfa allergy
102
AE fosamprenavir
rash
103
Lexiva generic
fosamprenavir
104
Reyataz generic
atazanavir
105
how to take PIs with ritonavir component?
w/ food and 48 oz. of water
106
warnings indinavir
nephrolithiasis/urolithiasis
107
AE indinavir
N/V/D
HA
nephrolithiasis
108
How should indinavir be dispensed?
in original container w/ dessicant
109
Crixivan generic
indinavir
110
Kaletra generic
lopinavir/ritonavir
111
dose of Kaletra
naive:
800/200 daily
OR 400/100 BID
112
How should Kaletra solution be taken?
with food
113
How should Kaletra solution be stored?
refrigerator x 2 months
114
Kaletra solution contains what?
42% alcohol content
115
AE Kaletra
N/V/D
| hyperlipidemia especially TG
116
Kaletra should be avoided in what?
carbamazepine
phenytoin
phenobarbital
pregnancy
117
Nelfinavir warning
diarrhea (up tp 20%)
118
nelfinavir boosting?
No, reaches adequate conc. on its own
119
nelfinavir administration
take w/ food
120
DDI nelfinavir
PPIs
121
Which PIs must be given w/ ritonavir?
saquinavir
lopinavir
tipranavair
122
AE saquinavir
nausea
123
BW tipranavir
intracranial hemorrhage
hepatitis
hepatic decompensation
124
which antiarrythmics are contraindicated w/ PIs?
dronedarone w/ all
| amiodarone w/ some
125
which antiplatelets/anticoagulants should be avoided w/ PIs?
adoxaban edoxaban rivaroxaban ticagrelor
126
Which direct-acting antiviral is contraindicated w/ PIs?
simeprevir
127
Alfuzosin is contrraindicated w/ which ART class?
PI
128
PI and warfarin
decrease INR because of 2C9 induction
129
hormonal contraceptives with these two active ingredients are particularly susceptible to DDI w/ PIs.
ethinyl estradiol and norethindone
130
PDE5 inhibitors w/ PIs
can increase PDE5 inhibitor levels may increase causing toxicity
sildenafil used for PAH is contraindicated
131
Which statins are contraindicated with PIs?
simvastatin and lovastatin
132
which statins are preferred with PIs?
atorvastatin
| rosuvastatin
133
which drugs can have their conc. decreased by PI mainly due to induction?
methadone
warfarin
hormonal contraceptives
134
cobicistat brand
Tybost
135
ritonavir brand
Norvir
136
AE Tybost?
increasing SCr
137
does cobicistat have ARV activity?
No
138
What does ritonavir solution contain and must be shaken well?
43% alcohol
139
Do INSTIs require renal dose adjustment?
no
140
Any major CYP interactions with INSTI?
no
141
which INSTI has the greatest risk of increasing CPK?
raltegravir
142
INSTI can be taken w/o regards to food except?
elvitegravir
143
What is the dosing of Stribild and Genvoya?
one tablet daily
144
What are the SE of elvitegravir?
proteinuria, headache, insomnia
145
Dolutegavir brand?
Tivicay
146
CI Tivicay?
coadministration w/ dofetilide
147
SE Tivicay
insomnia, headache, increasing SCr w/o affecting GFR
148
raltegravir brand
Isentress
| Isentress HD
149
dosing frequency of Isentress and Isentress HD
Isentress is BID
| Isentress HD is once daily
150
SE raltegravir?
increasing CPK
myopathy
rhabdomyolysis
151
INSTI and polyvalent cations
take 2 hours before or 6 hours after
152
CCR5 antagonist
maraviroc (Selzentry)
153
Before taking Maraviroc, pts must take a tropism test to test for what?
CCR5-tropic disease NOT for CXCR4 or dual/mixed-tropic disease
154
BBW for Maraviroc
hepatotoxicity
155
Fusion inhibitor
Enfuvirtide (Fuzeon)
156
How is Fuzeon administered
SC
157
SE of Fuzeon
98% of pts get injection site reactions
