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First Aid: Microbiology > HIV Therapy > Flashcards

Flashcards in HIV Therapy Deck (29):
1

when is highly active antiretroviral therapy (HAART) initiated?

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

2

HAART regimen 

3 drugs to prevent resistance 

  • 2 NRTIs plus...
    • 1 NNRTI or 1 protease inhibitor or 1 integrase inhibitor 

3

protease inhibitors 

"-navir"

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

4

protease inhibitors 

mechanism 

  • 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)

5

protease inhibitors 

toxicity 

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

6

NRTIs

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

7

NRTIs

mechanism 

  • 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)

8

NRTIs

toxicity 

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

9

NNRTIs

 

  • Efavirenz
  • Nevirapine
  • Delavirdine 

10

NNRTIs

mechanism 

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

11

NNRTIs 

toxicity 

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

12

Integrase inhibitors 

Raltegravir 

13

Integrase inhibitors 

mechanism 

  • inhibits HIV genome integration into host cell chromosome 
  • reversibly inhibits HIV integrase 

14

intregrase inhibitors 

toxicity 

hypercholesterolemia 

15

Fusion inhibitors 

  • Enfuvirtide 
  • Marviroc 

16

Fusion inhibitors 

mechanism 

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

17

Fusion inhibitors 

toxicity 

skin rxn at injection sites

18

interferons

mechanism 

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

19

interferons: clinical use 

  • IFN-α
  • IFN-ß
  • IFN-γ

  • 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

interferons 

toxicity 

  • neutropenia
  • myopathy 

21

antibiotics to avoid in pregnancy 

SAFe Children Take Really Good Care

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

22

antibiotics to avoid in pregnancy 

sulfonamides 

kernicterus 

23

antibiotics to avoid in pregnancy 

aminoglycosides

ototoxicity 

24

antibiotics to avoid in pregnancy 

fluoroquinolones 

cartilage damage 

25

antibiotics to avoid in pregnancy 

clarithromycin

embryotoxic 

26

antibiotics to avoid in pregnancy 

tetracyclines

  • discolored teeth
  • inhibition bone growth 

27

antibiotics to avoid in pregnancy 

ribavirin (antiviral)

teratogenic

28

antibiotics to avoid in pregnancy 

griseofulvin (antifungal) 

teratogenic 

29

antibiotics to avoid in pregnancy 

chloramphenicol 

"gray baby" syndrome