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HEME > Pharm - HIV > Flashcards

Pharm - HIV Flashcards

1
Q

HAART

A

Highly Active Antiretroviral Therapy

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2
Q

Strongest indication for use of HAART

A

low CD4+ count

high viral load

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3
Q

3 drug regimen (goal of combos)

A

prevent resistance

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4
Q

3-drug regimen (actual drugs)

A

2 NRTIs and 1 of the following

NNRTI or protease inhibitor or integrase inhibitor

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5
Q

NRTIs and ADME - what is their involvement with cytochrome P450?

A

virtually none

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6
Q

CYP3A4 neutral

A

NRTIs

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7
Q

route of admin for NRTIs

A

oral

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8
Q

route of metabolism for Abacavir

A

metabolized by alcohol dehydrogenase

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9
Q

Abacavir - potential interactants

A

wild turkey 101, jack daniels, dickel, four roses, woodford, jim beam, early times, johnny walker, patron, RBVs, pipe bombs, gin + juice, jager bombs …

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10
Q

you have counseled your patient not to drink alcohol while one this drug. What drug did ou prescribe?

A

Abacavir

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11
Q

route of admin for NNRTIs

A

oral

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12
Q

NNRTIs involvement with CYP metabolism

A

substrate, inhibitor,or inducer

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13
Q

Woman of childbearing age just got prego while taking an oral contraceptive. What drugs could have potentially allowed this?

A

Efavirenz and Nevirapine

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14
Q

Efavirenz and Nevirapine involvement with CYP

A

induce 3A4

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15
Q

How are oral contraceptives metabolized

A

3A4

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16
Q

oral contraceptives are effective unless…

A

they are effective as long as they are not metabolized too quickly

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17
Q

what does any drug that is inducer of 3A4 put the pt at risk for

A

failure of oral contraceptives

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18
Q

what else is a potential interactant with Abacavir?

A

bud diesel, nasty light, silver bullets, busch, steel reserve, cobra 40, high life, keystone

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19
Q

If you are giving pt Efavrienz, what two drugs would you need to increase their dose if giving concurrently

A

rifampin and rifabutin

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20
Q

why do you need to increase the dose of some drugs given concurrently with Efavirenz

A

rifampin and rifabutin –> metabolized by 3A4, so need to generate clinically relevant levels

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21
Q

Protease inhibitors and ADME

A

all involved with CYP somehow

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22
Q

what 2 drugs would be contraindicated with Protease inhibitors

A

rifampin and rifabutin -

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23
Q

Protease inhibitors and 3A4

A

they all inhibit

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24
Q

drug to give to “boost” other drugs (buzz word)

A

Ritonavir

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25
Q

reason for giving ritonavir with other drugs to “boost”

A

Ritonavir inhibits 3A4, 2D6, pgp, UGT –> help to keep levels of other drugs high, drugs that are metabolized by 3A4

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26
Q

what drugs did Sweatman mention specifically for giving with Ritonavir to “boost”

A

Arunavir, Lopinavir

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27
Q

What is the only drug (HIV)that is not given orally

A

Enfuviritide

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28
Q

route of admin for Enfuviritide

A

subQ

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29
Q

Drug that is not an antiviral that is given to “boost” (buzz word pt 2)

A

Cobicistat

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30
Q

Cobicistat MOA

A

Cyp3A4 inhibitor

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31
Q

methodology of Cobicistat

A

same idea as Ritonavir boosting -

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32
Q

advantage of Cobicistat

A

may avoid some of the toxicitiy you could see with Ritonavir boosting

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33
Q

What 2 drugs specifically are mentioned to use with Cobicistat

A

Darunavir and Atazanavir

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34
Q

Why do you worry about you pt stopping or starting the use of another drug?

A

that is when the serum drug levels of your drug can change

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35
Q

pts w/ HIV are susceptible to what (generalities here)

A

opportunistic infections

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36
Q

drugs used to treat fungal opportunistic infections

37
Q

Azoles and ADME

A

Cyp3A4 - potential for interaction

38
Q

Voriconzaole does what (ADME wise)

A

inhibits 2C9 and 3A4

39
Q

pt has TB, that comes up after imuunosuppression - you got to your script pad - what do you write them?

40
Q

what should you have chekced for before writing that script?

A

potential drug interactions - Rifampin is a 3A4 inducer

41
Q

Atripla

A

tenofovir, emtricitabine, efavirenz

42
Q

There are only 2 combos we talked about in class that are once daily pills that constitute a complete regimen

A

Atripla, Stribild

43
Q

there is another HIV combo drug in the notes that is listed as once daily that constitutes a complete regimen

44
Q

class wide side effect of NRTIs

A

hepatic disease, lactic acidosis

45
Q

class wide effect of NRTIs - might manifest how

A

pancreatitis (“elevation of enzyme levels, pain radiating to back”)

46
Q

neutropenia (NRTI)

A

Zidovudine

47
Q

neuropathy (NRTI)

A

Stavudine&raquo_space; didanosine

48
Q

something that can occur (more likely in women, especially fat ones) due to chronic prolonged exposure to these HIV regimens

A

obesity and prolonged exposure –> hepatic problems and lactic acidosis - more frequent in this population

49
Q

Didanosine - counsel your patients to not do what

50
Q

why cannot pts taking Didanosine not drink coldbeer?

A

b/c it has potential for hepatic toxicity

51
Q

what other NRTIs can the pt not drink while on?

A

mentions stavudine, probably all of them - they all have some risk for hepatic disease

52
Q

NNRTIs

A

Nevirapine has all the BBWs - Rash and hepatotoxicity, and hepatitis

53
Q

who is more prone to hepatic problems with nevirapine?

A

hello ladies

54
Q

Nevirapine should not be used if you have a CD4 count of what or higher?

55
Q

vivid dreams and CNS symptoms

56
Q

contraindicated during pregnancy

A

Delaviridine and efavirenz

57
Q

Protease inhibitors

A

GI intolerance - pts don’t like them

58
Q

Protease inhibitors - fat

A

lipodystrophy - bufallo hump

59
Q

protease inhibitors inhibit what else (not a CYP thing)

A

Glut4 - lead to hyperglycemia

60
Q

Protease inhibitors also dyslipidemia - what is this bad for

A

predispose pt to CV issues

61
Q

peripheral neuropathy

A

NRTIs Stavudine»didanosine

62
Q

what else causes neuropathy

A

HIV itself - can confound in a pt being tx with NRTI

63
Q

lipodystrophy

A

protease inhibitors

64
Q

lipodystropy most common

A

Atazanivir (PI)

65
Q

HAART in pregnancy

A

drugs can produce some mitochondrial dysfunction - can do so in developing neonate

66
Q

But, advantage of HARRT in pregnancy

A

can prevent the transmission of infection maternal-fetal in pregnancy

67
Q

NRTI recommended agents for HAART in pregnancy

A

lamivudine, zidovudine

68
Q

NNRTIs and pregnancy

A

nevirapine

69
Q

PIs and pregnancy

A

lopinavir, ritonavir

70
Q

tx for CMV

A

valganciclovir - b/c has ganciclovir has shitty bioavailability - so give it as oral pro drug instead

71
Q

M of resistance for valganciclovir

A

mutation in viral kinase (1st step of activation)

72
Q

if mutation forms in viral kinase, what can you use as back up

73
Q

elimination of valganciclovir

A

renal - glomerular filtration and active RTS

74
Q

potential problems with valganciclovir and the fact that it goes through the kidney RTS (2)

A

1) competitive inhibition of RTS with another drug specific for same mech
2) renal failure

75
Q

side effects of valganciclovir

A

renal toxicity, leukopenia, thrombocytopenia, neutropenia

76
Q

Foscarnet - soluble or nah?

77
Q

Foscarnet - what do you need pt to be

A

hydrated - can give saline

78
Q

route of admin for Foscarnet

A

infusion pump - if you slam the IV, it will precipitate out in the blood

79
Q

toxicity of Foscarnet

A

nephrotoxic

80
Q

EBV

A

Vidarabine

81
Q

route of admin for Vidarabine

A

to treat EBV of eye - topically

82
Q

bioavailability of Vidarabine

A

poor - it is topical

83
Q

risk of systemic effects w/ Vidarabine

84
Q

Kaposi Sarcoma

85
Q

route of admin of Cidofovir

86
Q

clearance of Cidofovir

87
Q

toxicity of Cidofovir

A

nephrotoxicity

88
Q

What can’t patient drink while on Abacavir

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