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T&D 1 > HIV drugs > Flashcards

HIV drugs Flashcards

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1
Q

Antiretroviral therapy reccommended in CD4 count

A

less than 350 cells/mm3

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2
Q

CD4

A

CMV/MAC

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3
Q

CD4

A

Pneumocystis carinii pneumonia (PCP)

Bactrim DS - daily or 3/day

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4
Q

CD4

A

Toxoplasmosis

positive serology – Bactrim daily

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5
Q

Nevirapine requires

A

gender
pretreatment CD4 count

don’t start if CD4 count:
females > 250
males >400

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6
Q

what is the ADR seen with nevirapine

A

high levels of liver toxicity

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7
Q

who has higher risk of liver toxicity with nevirapine

A

males

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8
Q

Abacavir requires

A

allergy screening with HLA B*5701

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9
Q

Co-morbities of therapy

A

TB, pregancy

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10
Q

Atripla

A

efavirenz, emitricitabine, tenofovir

1 tab daily, preferably QHS and empty stomach

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11
Q

Complera

A

rilpivirine, emitricitabine, tenofovir

1 tab daily

watch if high viral load > 100 K viral load

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12
Q

Stribild

A

“Quad Pill”: Elvitegravir, Cobicistat, emitricitabine, tenofovir

1 tab daily: treatment naiive ptns

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13
Q

Cobicistat

A

Booster

  • always in combo
  • no antiviral activity
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14
Q

inh cyt p450 3A

A

Cobicistat

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15
Q

Cobicistat enhances

A

atazanavir

darunavir

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16
Q

Cobicistat utilized with

A

Elvitegravir

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17
Q

what are common in Atripla, complera, stribild

A

emitricitabine, tenofovir

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18
Q

number 1 cause of chronic renal failure in HIV ptns

A

nephropathy

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19
Q

Nevirapine requires

A

gender
pretreatment CD4 count

females > 250
males >400

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20
Q

who has higher risk of liver toxicity with nevirapine

A

males

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21
Q

Abacavir requires

A

allergy screening with HLA B*5701

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22
Q

Co-morbities of therapy

A

TB, pregancy

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23
Q

What is affected by food

A

NRTI

  • didanosine - acidity
  • zidovudine - high fat meal

Protease inhibitor

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24
Q

Complera

A

rilpivirine, emitricitabine, tenofovir

1 tab daily

watch if high viral load > 100 K viral load

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25
Stribild
"Quad Pill": Elvitegravir, Cobicistat, emitricitabine, tenofovir 1 tab daily: treatment naiive ptns
26
Cobicistat
Booster - always in combo - no antiviral activity
27
inh cyt p450 3A
Cobicistat
28
Cobicistat enhances
atazanavir | darunavir
29
Cobicistat utilized with
Elvitegravir
30
what are common in Atripla, complera, stribild
emitricitabine, tenofovir
31
CCR5 antagonist
- restricted to CCR5 tropic virus
32
Fusion inhibitor
binds heptad repeat in gp41 Injection site irritation: nodules, erythema SQ INJ
33
NNRTI vs NRTI need phosphorylation
NRTI
34
Which PI linked to nephrolithiasis
Indinavir Hydrate!! inc SCR pyuria Hydronephrosis
35
Long half life - double edge
NNRTI - monotherapy - Resistance
36
RASH RASH RASH
NNRTI
37
Good for PI resistant virus
Darunavir, Tipranivir - cross sensitivity with Sulfa rash
38
how to decrease hepatic effects and risk of rash in nevirapine (NNRTI)
2 wk dose escalation
39
MOA NRTI
similar to building blocks of RNA/DNA - Posphorylated intra-cellular - incorporate themselves to block reverse transcriptase
40
What is affected by food
NRTI - didanosine - acidity - zidovudine - high fat meal
41
Stavudine ADR
NRTI - peripheral neuropathy - lipoatrophy - lactic acidosis/hepatomegaly w/ hepatic steatosis
42
Didanosine + Stavudine
peripheral neuropathy toxic pancreatitis hyperprolactemia
43
Booster in protease inhibitor
Ritonavir
44
what does Ritonavir do
booster - allows lower doses, less pill burden inc LDL, TG (esp), HDL
45
Endocrine type side effects
Hyperlipidemia fat maldistribution insuline resistance/DM osteonecrosis
46
endocrine type side effects seen with
Preotease inhibitors
47
Hallmark ADR of PIs
endocrine type side effects
48
The booster of all boosters
Ritonavir
49
ADR of PI in addition to endocrine type side effects
- spontaneous bleeding - inc hepatitis risk - MI/stroke
50
highest incidence of drug-drug intrxn
PI | - tipranavir -- inc hepatitis
51
Which PI linked to nephrolithiasis
Indinavir Hydrate!! inc SCR pyuria Hydronephrosis
52
ADR Atazanavir
- PI - Hyperbilirubinemia --> jaundice - prolonged QT
53
Taste disturbance --> anorexia (ADR)
Ritonavir (PI) - also paresthesias
54
Good for PI resistant virus
Darunavir, Tipranivir - rash
55
Combinations to avoid for 1st trimester of pregnancy/childbearing potential
Efavirenz - teratogenic
56
avoid in pregnancy
nelfinavir - ethyl methanesulfonate - carcinogen
57
pharmacologic antagonism
Stavudine + Zidovudine
58
additive hyperbilirubinemia
Atazanavir + Indinavir
59
Didanosine + Stavudine
toxic peripheral neuropathy pancreatitis hyperprolactemia
60
IV Zidovudine in pregnancy
- omit if maternal HIV RNA 400 copies/ml at delivery but continue combination ART during labor
61
Postpartum management of ARVs and NNRTIs
NNRTIs should be stopped first while continuing ARVs for at least 7 days to avoid effective monotherapy
62
Post exposure prophylaxis for
- percutaneous expo - mucous membrane and non-intact skin expo - start w/in 2 hrs of expo - DONT DELAY - 28 days
63
PEP regimen
Raltegravir - 400 mg BID | Truvada daily
64
Pre- exposure px
- lowers risk by 90% only TRUVADA approved
65
Truvada is a combo of
Tenofovir | Emtricitabine
66
Bone marrow suppression
Zidovudine
67
Pigmentation: Nail
Zidovudine
68
Pigmentation: Skin
Emtricitabine
69
Pancreatitis
Didanosine
70
NNRTIs : examples
Delvaridine Efavirenz Etravirine Nevirapine
71
Lactic acidosis w/ hepatic steatosis
Tenofovir | All NRTIs
72
NRTIs: examples
``` Abacavir Didanosine Emtricitabine Lamivudine Stavudine Zidovudine ```
73
Lipid abnormalities
Protease Inhibitors
74
Protease Inhibitors: example
``` Atazanavir Darunavir Fosamprenavir Indinavir Nelfinavir Ritonavir Saquinavir Tipranavir ```
75
Paresthesias
Fosamprenavir, Ritonavir
76
booster without antiviral activity
cobicistat
77
Insulin Resistance/ DM
PIs
78
Injection site reaction/irritation
Enfuvirtide
79
Restricted to treatment experienced HIV ptns and causes CPK elevation/Pyrexia
Raltegravir
80
CPK elevation
muscle weakness | rhabdo
81
why should screen if woman is pregnant before prescribing efavirenz?
Neural tube defect in 5-6 wks but pregnancy isn't detected until 4-6 wks
82
what do you give a baby post partum? for how long?
zidovudine +/- nevirapine | 6 wks

T&D 1 (7 decks)

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