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First Aid: Microbiology > HIV Therapy > Flashcards

HIV Therapy Flashcards

1
Q

when is highly active antiretroviral therapy (HAART) initiated?

A
  • AIDS-defining illness
  • low CD4 cell counts (<500 cells/mm3)
  • high viral load
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2
Q

HAART regimen

A

3 drugs to prevent resistance

  • 2 NRTIs plus…
    • 1 NNRTI or 1 protease inhibitor or 1 integrase inhibitor
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3
Q

protease inhibitors

A

“-navir”

  • Atazanavir
  • Darunavir
  • Fosamprenavir
  • Indinavir
  • Lopinavir
  • Ritonavir
  • Saquinavir
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4
Q

protease inhibitors

mechanism

A
  • assembly of virions depends on HIV-1 protease (pol gene)
    • cleaves polypeptide products of HIV mRNA
  • **prevents maturation of new viruses **
  • Ritonavir “boosts” other drug conc (inhibits CYP450)
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5
Q

protease inhibitors

toxicity

A
  • hyperglycemia
  • GI intolerance (nausea, diarrhea)
  • lipodystrophy
  • indinavir
    • nephropathy
    • hematuria
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6
Q

NRTIs

A
  • Abacavir (ABC)
  • Didanosine (ddl)
  • Emtricitabine (FTC)
  • Lamivudine (3TC)
  • Stavudine (d4T)
  • Tenofovir (TDF)
  • Zidovudine (ZDV, formerly AZT)
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7
Q

NRTIs

mechanism

A
  • competitively inhibit nucleotide binding to reverse transcriptase & terminate DNA chain (lack a 3’ OH group)
  • Tenofovir is a nucleoTide (rest are nucleosides)
  • ZDV
    • general prophylaxis
    • pregnancy (decrease fetal transmission)
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8
Q

NRTIs

toxicity

A
  • bone marrow suppression
    • reversed w/ G-CSF & erythropoietin
  • peripheral neuropathy
  • lactic acidosis (nucleosides)
  • rash (non-nucleosides)
  • anemia (ZDV)
  • pancreatitis (didanosine)
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9
Q

NNRTIs

A
  • Efavirenz
  • Nevirapine
  • Delavirdine
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10
Q

NNRTIs

mechanism

A
  • bind to reverse transcriptase at site different from NRTIs
  • do not require phosphorylation to be active or compete w/ nucleotides
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11
Q

NNRTIs

toxicity

A
  • rash & hepatotoxicity
  • efavirenz - vivid dreams & CNS symptoms
  • contraindicated in pregnancy: delavirdine & efavirenz
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12
Q

Integrase inhibitors

A

Raltegravir

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13
Q

Integrase inhibitors

mechanism

A
  • inhibits HIV genome integration into host cell chromosome
  • reversibly inhibits HIV integrase
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14
Q

intregrase inhibitors

toxicity

A

hypercholesterolemia

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15
Q

Fusion inhibitors

A
  • Enfuvirtide
  • Marviroc
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16
Q

Fusion inhibitors

mechanism

A
  • Enfuvirtide
    • binds gp41
    • inhibits viral entry
  • Maraviroc
    • binds CCR5 on surface of Tcells/monocytes
    • inhibits interaction w/ gp120
17
Q

Fusion inhibitors

toxicity

A

skin rxn at injection sites

18
Q

interferons

mechanism

A
  • glycoproteins normally synthesized by virus-infected cells
  • wide range of antiviral & antitumoral properties
19
Q

interferons: clinical use

  • IFN-α
  • IFN-ß
  • IFN-γ
A
  • IFN-α
    • chronic HepB & C
    • Kaposi sarcoma
    • hairy cell leukemia
    • condyloma acuminatum
    • renal cell carcinoma
    • malignant melanoma
  • IFN-ß
    • multiple sclerosis
  • IFN-γ
    • chronic granulomatous disease
20
Q

interferons

toxicity

A
  • neutropenia
  • myopathy
21
Q

antibiotics to avoid in pregnancy

A

SAFe Children Take Really Good Care

  • Sulfonamides
  • Aminoglycosides
  • Fluoroquinolones
  • Clarithromycin
  • Tetracyclines
  • Ribavirin (antiviral)
  • Griseofulvin (antifungal)
  • Chloramphenicol
22
Q

antibiotics to avoid in pregnancy

sulfonamides

A

kernicterus

23
Q

antibiotics to avoid in pregnancy

aminoglycosides

A

ototoxicity

24
Q

antibiotics to avoid in pregnancy

fluoroquinolones

A

cartilage damage

25
Q

antibiotics to avoid in pregnancy

clarithromycin

A

embryotoxic

26
Q

antibiotics to avoid in pregnancy

tetracyclines

A
  • discolored teeth
  • inhibition bone growth
27
Q

antibiotics to avoid in pregnancy

ribavirin (antiviral)

A

teratogenic

28
Q

antibiotics to avoid in pregnancy

griseofulvin (antifungal)

A

teratogenic

29
Q

antibiotics to avoid in pregnancy

chloramphenicol

A

“gray baby” syndrome

First Aid: Microbiology (13 decks)

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