Nucleoside Reverse Transcriptase Inhibitors and Non-Nucleoside REverse Transcriptase inhibitors (NRTIs + NNRTIs)

Question 1

What are the NRTIs nucleoside analogs

Answer 1

Tenofovir alafenamide, tenofovir disoproxil, abacavir, lamivudine, emtricitabine

Question 2

What are the combination NRTIs

Answer 2

Descovy, Truvada, Epzicom

Question 3

What is the MOA of NRTIs

Answer 3

Competitive inhibitor of HIV reverse transcriptase and terminator of viral DNA synthesis

Question 4

How doe viral RNA become DNA, how does the ds viral dna get into the cell, how does the virus enzymes become active

Answer 4

Reverse transcritpase, Viral intergrase, Viral protease

Question 5

Which NtRTI is already phosphorylated and is active against HIV and Hep B, what is it an analog of

Answer 5

Tenofovir disoproxil, Adenosine

Question 6

What are the serious side effects of Tenofovir, what is monitored

Answer 6

Nephrotoxicity and Decrease in BMD/ Scr, glucosuria, proteinuria

Question 7

T/F: Tenofovir alafenamide fumarate is a produrg converted intracelluralarly with the goal of having high metabolite concentration in target cells and low plasma tenofovir exposure along with no renal or bone toxicity

Answer 7

True

Question 8

What enzyme converts TAF to Tenofovir D

Answer 8

Cathepsin A

Question 9

T/F: TAF is worth than TDF

Answer 9

False: TAF is safer, just as efficacious, has activity against Hep B as well

Question 10

When are the only times TDF would be preffered over TAF

Answer 10

Pre-exposure prophylaxis or if a patient is taking rifabutin

Question 11

What is the NRTI that is hepatically metabolized and has a risk of causing Hypersensitivity REaction

Answer 11

Abacavir (ABC)

Question 12

T/F: Patients that hav an abacavir allergy should never be rechallenged because they could potentially die

Answer 12

True

Question 13

What is the Genetic screening that should be done to see if Abacavir is safe in an HIV patient

Answer 13

HLA-B*5701

Question 14

What NRTi has little to no side effect while having activity against HIV and HBV but HBV has built up resistance/ what is the sister analog with better activity against Hep B and is renally eliminated

Answer 14

Lamivudine, Emtricitabine

Question 15

What is a class side effect of NRTI, why

Answer 15

Mitochondrial toxicity, inhibition of mitochondrial DNA

Question 16

What is the ranking for the combination NRTIs

Answer 16

Descovy, Epzicom, Truvada

Question 17

What are the NNRTIs, MOA

Answer 17

Efavirenz, Etravirine, Rilpivirine, Doravirine/ directly bind RT causing a conformation change preventing viral DNA synthesis

Question 18

Which NNRTI was an early potent and daily dosing single tablet, what is a key drug interaction, adverse effect unique to the drug

Answer 18

Efavirenz, CYP3A4, Central Nervous system such as dizziness, vivid dreams

Question 19

What NNRTI was developed to treat EFV-resitant virus and NOT used in treatment for NAIVE patients

Answer 19

Etravine (intelience)

Question 20

What NNRT is approved for Tx naive and people who have taken drugs before and has no hepatic drug metabolism, smallest antiretroviral tablet, and is ok in preganancy

Answer 20

Rilprivirine

Question 21

What are disadvantages of using Rilprivirine

Answer 21

Must take with food (preferably the largest meal of the day), contraindicated with PPIs (separate 12 hours. Not the most potent ART (shouldn’t be used in patients with Viral load higher than 100000 or CD4 less than 200)

Question 22

What is the newest NNRTs that is used in resistance profiles, hepatically eliminated and will have to double the dose to 100 mg BID who are taking Rifabutin

Answer 22

Doravirine

Question 23

What is the only FDA approved drug used for patients at high risk for HIV contraction

Answer 23

Truvada

Question 24

2NRTIs plus another agent from another class is a three active drug that is recommended for HIV treatment naive patients

Answer 24

True