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Pharmacology (Dale Turley) > Pharmacology HIV Tx > Flashcards

Pharmacology HIV Tx Flashcards

1
Q

There are __ antiretroviral medications from _ major classes currently available for the management of HIV-infected patients.

A

25

6

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2
Q

The use _ nucleoside reverse transcriptase inhibitor (NRTI) agents plus a ___ active drug from a different class, is most effective in suppressing HIV RNA, minimizing drug toxicity, and/or reducing HIV-related morbidity and mortality.

A

2

3rd

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3
Q

Classes of antiretroviral drugs most commonly used in initial regimens include:

A

Nucleoside (and nucleotide) reverse transcriptase inhibitors (NRTIs)

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Protease inhibitors (PIs)

Integrase strand transfer inhibitors (INSTIs)

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4
Q

Treatment for patients w/o cormid conditions?

A

dolutegravir

plus either

tenofovir-emtricitabine or abacavir-lamivudine

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5
Q

What is HLA-B

A

major histocompatibility complex, class I, B) is a human gene that provides instructions for making a protein that plays a critical role in the immune system

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6
Q

An adverse effect from abacavir is a ___________________, which can be severe and potentially life-threatening.

A

treatment-limiting hypersensitivity reaction

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7
Q

Why do you want to test HLA-B*5701 testing?

A

A test to predict who will develop a severe allergic reaction to the anti-HIV drug abacavir

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8
Q

____________________ has been associated with the presence of the major histocompatibility complex class I allele HLA-B*5701.

A

Abacavir-induced hypersensitivity reaction

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9
Q

A screening test for the HLA-B*5701 allele can assist clinicians to identify patients who are at risk of developing a hypersensitivity reaction to ________.

A

abacavir.

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10
Q

When is Abacavir contraindicated?

A

Abacavir is contraindicated in patients who are positive for HLA-B*5701.

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11
Q

_________ is generally avoided in individuals with reduced kidney function. Thus, regimens that do not use a first-line nucleoside combination should be considered

A

Tenofovir

tenofovir-emtricitabine recomended

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12
Q

We administer a regimen using tenofovir-emtricitabine as the nucleoside combination in patients who have what two things?

A

chronic hepatitis B virus (HBV) infection and normal kidney function.

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13
Q

Prefer a regimen using _________________ as the nucleoside combination in patients who have a history of, or who are at high risk for, ______ _______.

A

tenofovir-emtricitabine

heart disease.

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14
Q

_______ may have a modest effect on lowering ______.

A

Tenofovir

lipids

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15
Q

Osteoporosis patients on Abacavir-lamivudine have a great risk of what?

A

greater loss of bone density unless HLA-B*5701 positive

Prefer a regimen that uses tenofovir-emtricitabine

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16
Q

Patients who are being treated for __ with a rifampin-containing regimen, we prefer _________.

A

TB

efavirenz

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17
Q

_______________ enable decreased pill burdens which can improve patient adherence

A

Coformulations

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18
Q

Truvada is?

A

Tenofovir-emtricitabine (Truvada)

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19
Q

Epzicom is ?

A

Abacavir-lamivudine (Epzicom)

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20
Q

Combivir is?

A

Zidovudine-lamivudine (Combivir)

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21
Q

____________ genes help the immune system recognize and respond to foreign substances

A

Human leukocyte antigen (HLA)

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22
Q

HLA-B*57:01 allele has been associated with hypersensitivity to ___________?

A

abacavir ( NNRTI)

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23
Q

Patient with symptoms suggestive of a hypersensitivity reaction to abacavir confirmed by _______________ had a positive HLA-B*5701 test

A

skin-patch testing

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24
Q

Abacavir hypersensitivity reaction that occurs in between ___________ of patients treated with the drug due to the positive HLA-B 5701

A

5% - 8%

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25
Q

Fusion inhibitors examples?

A

Enfuvirtide (Fuzeon

Aplaviroc

Vicriviroc

Maraviroc (CCR% and gp120 inhibitors,

Injection site pain, allergic reactions

26
Q

Entry inhibitors examples?

A

CCR5 antagonist) (Maraviroc

hepatitis, rash

27
Q

NRTIs examples?

A

Tenefovir / Emtricitabine

Abacavir / Lamivudine

28
Q

NNRTIs examples?

A

Efavirenz

29
Q

Integrase inhibitors examples?

A

Dolutegravir, Raltegravir, Elvitegravir

hepatitis, rash

30
Q

Protease inhibitors examples?

A

Darunavir

primary therapy

31
Q

Fusion Inhibitor class?

A

CCR5 antagonist class

32
Q

Fusion Inhibitors block the _________ site?

A

Blocks gp120 site

33
Q

The antiviral effect of _____ and ______ is essentially the same

A

NRTIs and NNRTIs

34
Q

______ act on viral DNA synthesis where the process is halted, known as chain termination

A

NRTI’s

35
Q

________ block reverse transcriptase by binding directly to the enzyme

A

NNRTI’s

36
Q

NRTIs and NNRTIs both act in similar sites within the ____ cell

A

CD4 cell

37
Q

Integrase inhibíos work where?

A

nucleus

38
Q

Integrase Inhibitors MOA?

A

block the action of integrase enzyme

39
Q

Integrase Inhibitors : Less integration of provirus = ?

A

less CD4 damage

40
Q

Protease Inhibitors
?

A

Viral budding at envelope as exits from CD4 cell ( exit point?)

41
Q

NRTI-sparing?

A

PI + NNRTI

42
Q

Tenefovir / Emtricitabine / Dolutegravir?

A

(NRTI) + (Integrase Inhibitor)

43
Q

Tenefovir / Emtricitabine / Raltegravir?

A

(NRTI) + (Integrase Inhibitor)

44
Q

Tenefovir / Emtricitabine / Darunavir / Ritonavir ?

A

(NRTI) + (Protease inhibitor + booster)

*blocks the metabolizing enzyme in the liver - Ritonavir**

45
Q

Tenefovir / Emtricitabine / Elvitegravir /cobicistat (inhibits liver enzymes) ?

A

(NRTI) + (Integrase Inhibitor / booster)

46
Q

Abacavir / Lamivudine / Dolutegravir ?

A

(NRTI) + (Integrase Inhibitor)

47
Q

Truvada ?

A

Tenefovir / Emtricitabine

48
Q

Epzicom ?

A

Abacavir / Lamivudine

49
Q

Stribild ?

A

Tenefovir / Emtricitabine / Cobicistat / Elvitegravir

50
Q

Triumeq ?

A

Abacavir / Lamivudine / Dolutegravir

51
Q

HIV primary medications generally prefer tenofovir - emtricitabine over ______-_______

A

abacavir-lamivudine

52
Q

There is a greater body of evidence supporting the safety and tolerability of _________________

A

tenofovir-emtricitabine

53
Q

HIV Drugs core?

A

NRTI’s

54
Q

Baseline NRTI Strategies?

A

tenofovir-emtricitabine (Truvada)

abacavir-lamivudine (Epzicom)

zidovudine-lamivudine (Combivir)

55
Q

NNRTI based Naive tx?

A

Efavirenz / tenofovir / emtricitabine

Rilpivirine / tenofovir / emtricitabine

56
Q

Protease Inhibitor Based Biave tx?

A

Atazanavir + (cobicistat or ritonavir) + tenofvir / emtricitabine

Darunavir + cobicistat or ritonavir) + abacavir / lamivudine

Darunavir / cobicistat + tenofovir / emtricitabine

57
Q

HIV: who to treat?

A

Recommend antiretroviral therapy (ART) be offered to HIV-infected patients, including asymptomatic individuals, regardless of their immune status.

Newer medications have fewer side effects and more safe

Stratigies for pregnancy, diabetics, HBV, HIVAN, high risk of transmitting virus to others

58
Q

When to start HIV tx?

A

ART should be offered to those at risk of transmitting to:

  1. heterosexual partner
  2. other transmission risk groups
59
Q

Patients with HIV starting ART should be willing and able to commit to tx and should understand the ________/_____ of therapy and importance of adherence

A

benefits / risks

60
Q

Benefits of early HIV tx?

A
  1. Maintaining higher CD4 count to prevent damage to the immune system
  2. Decrease risk of HIV associated complications: Opportunistic infections, underlying inflammation

Decrease risk of transmission

Pharmacology (Dale Turley) (31 decks)

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