Pharmacology: HIV Flashcards
Who gets to receive HIV treatment
ALL HIV + patients
Name 3 instances when you delay HIV treatment
- Cryptococcal meningitis (give 4-6 weeks anti-fungals)
- TB meningitis (give 8 weeks TB meds)
- Non- neurological TB (CD4+ T <50 2 weeks & >50 8 weeks)
What is the 4 purposes of the treatment
- Suppress viral load
- Preserve immune function
- Decrease morbidity & mortality
- Increase & improve QOL
Name 3 people to who you give preventative treatment
Sexual exposure
Occupational exposure
MTCT
What is the ARV regimen called & consists of
HAART- highly active antiretroviral therapy
Combination of 3 drugs= 2 NRTI + PI/NNRTI/InSTI
Life long therapy
What drugs does pre exposure prophylaxis consist of & when do you drink it
2 drugs, tenofovir & emtricitabine, for duration of exposure
How does post exposure prophylaxis work
3 drugs (TLD) for 28 days w/i 72 hrs of exposure
Give 2 reasons why is adherence important & what should be considered when starting treatment
Important for viral suppression & preventing resistance
Treat depression/substance abuse & educate patient on importance of adherence
What are the 5 drug classes of ARV
- Nucleoside RTI (NRTI)
- Non-nucleoside RTI (NNRTI)
- Integrase strand inhibitor (InSTI)
- Protease inhibitor (PI)
- Entry blockers (CCR5 blocker)
NRTI mechanism of action, medication & side effects
Mechanism:
Competitive inhibition of RT
Nucleoside still has to be phosphorylation
Medication:
Zidovudine, lamivudine & tenofovir
Side effects:
Zidovudine: anaemia, neutropenia
Tenofovir: renal dysfunction & osteopenia
NNRTI mechanism of action, medication & side effects
Mechanism:
Allosteric site binding & inhibition of RT (change shape)
Nucleotide not required to be phosphorylated
Medication:
Efavirenz & niverapine
Side effects:
Efavirenz: rash, hepatotoxcity & neuropsychiatric
Niverapine: rash & hepatotoxicity
InSTI mechanism of action, medication & side effects
Mechanism:
Inhibit fusion of viral & host DNA
Medication:
Dolutegravir
Side effects:
Insomnia
PI mechanism of action, medication & side effects
Mechanism:
Inhibit enzyme by binding to active site & not able to produce peptides
Medication:
Lopinavir, ritonavir & atazanavir
Side effects:
Lopinavir & Ritonavir: D, hyperTG & - cholesterol
Atazanavir: unconjugated hyperbilirubinanaemia
Entry inhibitors mechanism of action, medication & side effects
Mechanism:
Enfuvirtide: binds to gp41 on virus preventing fusion (injection)
Maraviroc: binds to CCR4 receptors on cells & prevent fusion
Medication:
Enfuvirtide & Maraviroc
Side effects:
Enfuvirtide: pain & infection at site of injection
Maraviroc: D, muscle & joint pain
What drug is given for PI boosting, why & what it can lead to
Ritonavir is a cytochrome p450 inhibitor meaning it slows down metabolism, increasing the concentration of drugs present & reducing times medication should be taken
It can lead to toxicity if [ ] is to high
