S47(3) NRTI's and INTSI's

Question 1

Nucleos(t)ide Reverse Transcriptase Inhibitors (NRTIs) Class

Answer 1

Abacavir (Ziagen)
Emtricitabine (Emtriva)
Lamivudine	(Epivir)
Tenofovir disoproxil (Viread)
Tenofovir alafenamide (Vemlidy)

Question 2

Non- Nucleos(t)ide Reverse Transcriptase Inhibitors (NRTIs) Class

Answer 2

Efavirenz (Sustiva)
Rilpivirine (Edurant)
Doravirine (Pifeltro)

Question 3

Integrase Strand Transferase Inhibitor (INSTIs)

Answer 3

Raltegravir (Isentress)
Dolutegravir (Tivicay)

Bictegravir - ONLY IN COMBO as BICTARVY
Bictarvy is bictegravir/emtricitabime/tenofovir alofenamide

Question 4

Protease Inhibitors

Answer 4

Darunavir (Prezista)

Ritonavir (Norvir)

Question 5

Nucleos(t)ide Reverse Transcriptase Inhibitors (NRTIs) Class are the backbone of therapy – ALWAYS HAVE TWO OF THESE!

MOA:

Answer 5

DNA analogue that prohibit reverse transcriptase of viral RNA to viral DNA thus stopping the life cycle and preventing further virions

Question 6

Tenofovir (adenosine analogue), Abacavir (guanosine analogue)
Emtricitabine and lamivudine are both cytosine analogues

Answer 6

Use adenosine with cytosine

OR

Use guanosine with cytosine

Question 7

If Abacavir is selected as drug to use what must be done prior?

Answer 7

Must get HLA 5701*B testing PRIOR to initiation

Significant hypersensitivity reaction

If allele is present, mark as drug allergy and NEVER challenge patient

Question 8

Which patient should abacavir be avoided in?

Answer 8

Avoid if viral load > 100,000 copies
Avoid in patients with high cardiac risk

Be careful in patients with a sulfonamide allergy

Question 9

Tenofovir disoproxil fumarate (TDF)

Answer 9

Renal impairment
Bone demineralization
Decrease in lipids
Available as a generic drug

Question 10

Tenofovir alafenamide (TAF)

Answer 10

Weight gain especially when combined with an INSTI

Increase in lipids because it doesn’t decrease lipids like TDF

Only available in brand

Question 11

Integrase Strand Transferase Inhibitor (INSTIs)

MOA:

Answer 11

Inhibits integrase enzyme within the nucleus in order to prevent viral DNA from inserting itself into host DNA

DDI w/ polyvalent cations

Question 12

Bictarvy

Answer 12

Separate from cations by two hours before or six hours after

Risk for neural type defects for women of child bearing potential unknown

Weight gain

Question 13

Dolutegravir

Answer 13

Separate from cations by two hours before or six hours after

Risk for neural type defects for women of child bearing potential

Weight gain

DDI with Rifampin

Question 14

Cabotegravir

Answer 14

New drug awaiting approval

could be game changer as it is an IM formulation and shown to be superior to some other treatments