Sweatman antiretroviral therapy Flashcards
Primary means by which we treat HIV
> antimetabolite inhibitors of viral RT and
inibitors of viral aspartate protease
*3 or more drugs before symptoms appear=best outcome
Name the NRTI’s
ABACAVIR LAMIVUDINE (3-TC) TENOFOVIR DISOPROXIL ZIDOVUDINE (AZT) EMTRICITABINE didanosine (ddI) stavudine (D4T)
NRTI’s MOA
prodrugs that must be converted by HOST kinases to trinucleotides in the body–>competitively inhibit dNTP bind site and cause chain termination
*lack 3’ hydroxyl group–next attachment is therefore impossible
resistance to NRTI’s occurs thru
mutations in the pol gene
guanisine analog NRTI
abacavir
*slow resistance
NRTI contraindicated in pregnancy and young pt.’s, renal.heaptic dysfunction
Emtricitabine
common side effect of emtricitibine
asthenia, gi distress, hyperpigmentation of the palms
lamivudine excretion
excusively kidney
*adjust dose if kidney problems
lamivudine NRTI is also useful against
HBV
Nucleotide that acts as a NRTI
tenofovir
tenofovir aslo useful against..
HBV
oral F of tenofovir
25-40%
- half life is 60 hrs
- renal elimination
tenofovir contraindicated if…
concurrent acyclovir. ganciclovir tx.
fanconi’s anemia
lamivudine aka
3-tc
zidovudine (zdv) formerly known as
azt
prototype NRTI
zidovudine
Distribution of ZDV
most tissues including CNS
elimination of ZDV
hepatic metabolism to glucuronides and renal excretion
DOsage reduction of ZDV indicated if
uremic pt.’s and those with cirrhosis
primary toxicity of ZDV
bone marrow supression–> leading to anemia and neutropenia possibly requiring transfusions
drugs that increase the concentration of ZDV
azoles, and protease inhibitors
drugs that decrease concentration of ZDV
rifampin increases clearance
NRTI’s taken with other antiretroviral agents may cause
lactic acid acidemia and sever hepatomegaly with steatosis
Name the NNRTI’s
Efavirenz
Nevirapine
used to prevent vertical transmission of HIV during childbirth
nevirapine an NNRTI
NNRTI MOA
bind to a site on RT that is NOT the active site–> p66 of RT causing a conformational change (inhibit it)