Sketchy Pharm: NRTIs

Question 1

How do NRTIs work?

Answer 1

They lack a hydroxyl group at the 3’ end necessary for chain elongation (a là Sanger sequencing).

(Think of King Arthur slamming the nucleotide down with the missing 3’ piece.)

Question 2

The NRTIs require __________ for activation.

Answer 2

phosphorylation

Think of the P on the seal.

Question 3

What are some adverse effects of NRTIs?

Answer 3

Mitochondrial toxicity (like the woodgrain table) 
Lactic acidosis (sour milk on table)

Question 4

A couple of the NRTIs can cause peripheral neuropathy: _________________.

Answer 4

lamivudine, stavudine, and didanosine

Note: many of the NRTIs end in the -dine suffix, so the Sketch has the knights DINing.

Question 5

Lamivudine and ____________ can also be used for hepatitis B.

Answer 5

tenofovir

(Think of TristaN riding the tide out –tide because tenofovir is already phosphorylated.)

(To remember hepatitis B, think of the HiPpie poster.)

Question 6

The antiretroviral that is given to pregnant women has what side effects?

Answer 6

Myelosuppression and central redistribution of fate

(Think of Izolde –who represents zidovudine –eating off the bone-shaped plate next to the hour glass; she’s also next to the horse with the weirdly skinny legs.)

Question 7

Zidovudine shares a side effect profile with what other drug?

Answer 7

stavudine (like STeVe next to zidovudine)

Note: stavudine also causes peripheral neuropathy, just like lamivudine and didanosine.

Question 8

Pancreatitis is a unique effect of _____________.

Answer 8

didanosine (like sir DAN squeezing the pancreas sponge next to lamivudine Lancelot)

Question 9

Which antiretroviral can cause a type 4 hypersensitivity reaction?

Answer 9

Abacavir

Think of the red spots on the arms of Merlin saying “ABrACAdabra!”

Question 10

______________ can cause hyperpigmentation of the palms and soles.

Answer 10

Emtricitabine (represented by King Arthur’s sword ExCAllibur; also, remember Arthur’s bad ass dark leather gloves)