Antiretroviral therapy for HIV Flashcards Preview

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Flashcards in Antiretroviral therapy for HIV Deck (44):
1

MOA of NRTI

competitive inhibition of reverse transcriptase to prevent formation of viral DNA from viral RNA
*DNA chain termination

2

ADRs of NRTIs

potential for lactic acidosis, hepatic steatosis, lipodystrophy
*No significant drug interactions

3

zidovudine (AZT)

nucleoside RTI
ADR: marrow suppression

4

didanosine (ddI)

nucleoside RTI
ADR: pancreatitis, neuropathy

5

stavudine (D4T)

nucleoside RTI
ADR: all shared ADRs of NRTIs increased; neuropathy

6

lamivudine (3TC)

nucleoside RTI
ADR: headache

7

emtricitabine (FTC)

nucleoside RTI
ADR: headache, diarrhea

8

abacavir (ABC)

nucleoside RTI
ADR: hypersensitivity reaction

9

tenofovir (TDF)

*nucleotide RTI
ADR: diarrhea, n/v, Fanconi syndrome (dz of prox renal tubules -> glucose, amino acids, uric acid, phosphate, bicarb passed into urine, instead of reabsorbed)

10

MOA of NNRTI

direct, non-nucleoside inhibitors of RT; doesn't require metabolic conversion, not incorporated into viral DNA, additive effect to NRTI

11

ADR of NNRTI

rash, may -> Stevens-Johnson syndrome
significant drug interactions

12

nevirapine

NNRTI
ADR: rash, SJS, hepatotoxicity (esp CD4 > 250), modest CYP 3A4 inducer, may precipitate withdrawal in methadone maintenance patients

13

delaviridine

NNRTI
ADR: rash, SJS, HA, strong CYP 3A inhibitor
*rarely used d/t low potency

14

efavirenz

NNRTI
ADR: rash, SJS, neuropsych reaction, mod CYP 3A4 inducer, teratogenic

15

etravirine

NNRTI
ADR: rash, SJS, hyperlipidemia, modest CYP 3A4 inducer; CYP 2C9 and 2C19 inhibitor

16

rilpivirine

NNRTI
ADR: rash, HA, prolonged QT interval

17

MOA protease inhibitors

prevents viral protease from forming functional viral proteins necessary to mature viral particle and viral replication

18

ADR of protease inhibitors

GI distress, hyperglycemia, insulin resistance, hyperlipidemia, CAD, fat accumulation, hepatotoxicity
Metabolism by and inhibits CYP 3A4 (ritonavir most)
Metabolism induced by rifampin and phenytoin
Absorption reduced with rising gastric pH d/t H2-blockers and PPIs

19

saquinavir

PI
ADR: n/v/d

20

darunavir

PI
ADR: n/v, rash

21

indinavir

PI
ADR: n/v, nephrolithiasis

22

nelfinavir

PI
ADR: nausea, diarrhea

23

fosamprenavir

PI
ADR: nausea, rash

24

atazanavir

PI
ADR: increased bilirubin

25

Kaletra

AKA lopinavir + ritonavir
PI used to boost levels of other PIs
ADR: GI distress, hyperlipidemia

26

enfuviratide

fusion inhibitor; binds TM GP to prevent fusion of viral particle with CD4 cell membrane
ADR: injection site rxn and HS rxns

27

maraviroc

entry inhibitor; antagonist of CCR5-R on CD4 necessary for HIV entry; active if resistance to other drug classes
ADR: cough, rash, infections, substrate of CYP 3A4 (intx w PIs)

28

MOA integrase inhibitors

blocks integrase enzyme necessary for integration of viral DNA into cellular DNA
INSTI = integrase strand transfer inhibitor

29

ADR integrase inhibitors

diarrhea, nausea, HA, myositis (monitor CPK)

30

Truvada

2NRTIs
emtricitabine + tenofovir

31

Combivir

2 NRTIs
AZT + lamivudine

32

Epizicom

2 NRTIs
ABC + lamivudine

33

Trizivir

3NRTIs (not recommended)
AZT + lamivudine + ABC

34

Atripla

NNRTI + 2NRTI
efavirenz + emtracitibine + tenofovir

35

Complera

NNRTI + 2NRTI
rilpivirine + emtracitibine + tenofovir

36

Who to test for HIV drug resistance and what to test for?

All HIV-infected people when they enter care
Genotype testing for ARV-naive patients
Look for mutations in RT and protease genes and INSTI resistance

37

Regimen for pregnant women

lopinavir/ritonavir (Kaletra) + AZT/lam (Combivir)
*PI may increase hyperglycemia risk

38

When is transmission of HIV from pregnant woman to infant most likely?

During labor/delivery

39

Regimen for infant of HIV+ mother

AZT for first 6 weeks of life

40

Teratogenic ARV drug

efavirenz

41

Pre-exposure prophylaxis for high-risk adults

Truvada

42

Post-exposure prophylaxis for occupational exposure

3 or more drugs
for all exposures

43

Post-exposure prophylaxis for non-occupational exposure (sex, drugs)

3 or more active drugs if source patient known to be HIV+ or exposure event high risk for transmission

44

When to start post-exposure prophylaxis

Within 72 hours of exposure and continue for 4 weeks
with follow-up HIV-Ab testing for 4-6 months post-exposure