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Pharm - HIV Flashcards

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1
Q

HAART

A

Highly Active Antiretroviral Therapy

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2
Q

Strongest indication for use of HAART

A

low CD4+ count

high viral load

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3
Q

3 drug regimen (goal of combos)

A

prevent resistance

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4
Q

3-drug regimen (actual drugs)

A

2 NRTIs and 1 of the following

NNRTI or protease inhibitor or integrase inhibitor

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5
Q

NRTIs and ADME - what is their involvement with cytochrome P450?

A

virtually none

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6
Q

CYP3A4 neutral

A

NRTIs

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7
Q

route of admin for NRTIs

A

oral

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8
Q

route of metabolism for Abacavir

A

metabolized by alcohol dehydrogenase

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9
Q

Abacavir - potential interactants

A

wild turkey 101, jack daniels, dickel, four roses, woodford, jim beam, early times, johnny walker, patron, RBVs, pipe bombs, gin + juice, jager bombs …

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10
Q

you have counseled your patient not to drink alcohol while one this drug. What drug did ou prescribe?

A

Abacavir

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11
Q

route of admin for NNRTIs

A

oral

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12
Q

NNRTIs involvement with CYP metabolism

A

substrate, inhibitor,or inducer

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13
Q

Woman of childbearing age just got prego while taking an oral contraceptive. What drugs could have potentially allowed this?

A

Efavirenz and Nevirapine

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14
Q

Efavirenz and Nevirapine involvement with CYP

A

induce 3A4

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15
Q

How are oral contraceptives metabolized

A

3A4

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16
Q

oral contraceptives are effective unless…

A

they are effective as long as they are not metabolized too quickly

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17
Q

what does any drug that is inducer of 3A4 put the pt at risk for

A

failure of oral contraceptives

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18
Q

what else is a potential interactant with Abacavir?

A

bud diesel, nasty light, silver bullets, busch, steel reserve, cobra 40, high life, keystone

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19
Q

If you are giving pt Efavrienz, what two drugs would you need to increase their dose if giving concurrently

A

rifampin and rifabutin

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20
Q

why do you need to increase the dose of some drugs given concurrently with Efavirenz

A

rifampin and rifabutin –> metabolized by 3A4, so need to generate clinically relevant levels

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21
Q

Protease inhibitors and ADME

A

all involved with CYP somehow

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22
Q

what 2 drugs would be contraindicated with Protease inhibitors

A

rifampin and rifabutin -

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23
Q

Protease inhibitors and 3A4

A

they all inhibit

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24
Q

drug to give to “boost” other drugs (buzz word)

A

Ritonavir

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25
reason for giving ritonavir with other drugs to "boost"
Ritonavir inhibits 3A4, 2D6, pgp, UGT --> help to keep levels of other drugs high, drugs that are metabolized by 3A4
26
what drugs did Sweatman mention specifically for giving with Ritonavir to "boost"
Arunavir, Lopinavir
27
What is the only drug (HIV)that is not given orally
Enfuviritide
28
route of admin for Enfuviritide
subQ
29
Drug that is not an antiviral that is given to "boost" (buzz word pt 2)
Cobicistat
30
Cobicistat MOA
Cyp3A4 inhibitor
31
methodology of Cobicistat
same idea as Ritonavir boosting -
32
advantage of Cobicistat
may avoid some of the toxicitiy you could see with Ritonavir boosting
33
What 2 drugs specifically are mentioned to use with Cobicistat
Darunavir and Atazanavir
34
Why do you worry about you pt stopping or starting the use of another drug?
that is when the serum drug levels of your drug can change
35
pts w/ HIV are susceptible to what (generalities here)
opportunistic infections
36
drugs used to treat fungal opportunistic infections
Azoles
37
Azoles and ADME
Cyp3A4 - potential for interaction
38
Voriconzaole does what (ADME wise)
inhibits 2C9 and 3A4
39
pt has TB, that comes up after imuunosuppression - you got to your script pad - what do you write them?
Rifampin
40
what should you have chekced for before writing that script?
potential drug interactions - Rifampin is a 3A4 inducer
41
Atripla
tenofovir, emtricitabine, efavirenz
42
There are only 2 combos we talked about in class that are once daily pills that constitute a complete regimen
Atripla, Stribild
43
there is another HIV combo drug in the notes that is listed as once daily that constitutes a complete regimen
Complera
44
class wide side effect of NRTIs
hepatic disease, lactic acidosis
45
class wide effect of NRTIs - might manifest how
pancreatitis ("elevation of enzyme levels, pain radiating to back")
46
neutropenia (NRTI)
Zidovudine
47
neuropathy (NRTI)
Stavudine >> didanosine
48
something that can occur (more likely in women, especially fat ones) due to chronic prolonged exposure to these HIV regimens
obesity and prolonged exposure --> hepatic problems and lactic acidosis - more frequent in this population
49
Didanosine - counsel your patients to not do what
coldbeers
50
why cannot pts taking Didanosine not drink coldbeer?
b/c it has potential for hepatic toxicity
51
what other NRTIs can the pt not drink while on?
mentions stavudine, probably all of them - they all have some risk for hepatic disease
52
NNRTIs
Nevirapine has all the BBWs - Rash and hepatotoxicity, and hepatitis
53
who is more prone to hepatic problems with nevirapine?
hello ladies
54
Nevirapine should not be used if you have a CD4 count of what or higher?
250
55
vivid dreams and CNS symptoms
efavirenz
56
contraindicated during pregnancy
Delaviridine and efavirenz
57
Protease inhibitors
GI intolerance - pts don't like them
58
Protease inhibitors - fat
lipodystrophy - bufallo hump
59
protease inhibitors inhibit what else (not a CYP thing)
Glut4 - lead to hyperglycemia
60
Protease inhibitors also dyslipidemia - what is this bad for
predispose pt to CV issues
61
peripheral neuropathy
NRTIs Stavudine>>didanosine
62
what else causes neuropathy
HIV itself - can confound in a pt being tx with NRTI
63
lipodystrophy
protease inhibitors
64
lipodystropy most common
Atazanivir (PI)
65
HAART in pregnancy
drugs can produce some mitochondrial dysfunction - can do so in developing neonate
66
But, advantage of HARRT in pregnancy
can prevent the transmission of infection maternal-fetal in pregnancy
67
NRTI recommended agents for HAART in pregnancy
lamivudine, zidovudine
68
NNRTIs and pregnancy
nevirapine
69
PIs and pregnancy
lopinavir, ritonavir
70
tx for CMV
valganciclovir - b/c has ganciclovir has shitty bioavailability - so give it as oral pro drug instead
71
M of resistance for valganciclovir
mutation in viral kinase (1st step of activation)
72
if mutation forms in viral kinase, what can you use as back up
foscarnet
73
elimination of valganciclovir
renal - glomerular filtration and active RTS
74
potential problems with valganciclovir and the fact that it goes through the kidney RTS (2)
1) competitive inhibition of RTS with another drug specific for same mech 2) renal failure
75
side effects of valganciclovir
renal toxicity, leukopenia, thrombocytopenia, neutropenia
76
Foscarnet - soluble or nah?
nahhhh
77
Foscarnet - what do you need pt to be
hydrated - can give saline
78
route of admin for Foscarnet
infusion pump - if you slam the IV, it will precipitate out in the blood
79
toxicity of Foscarnet
nephrotoxic
80
EBV
Vidarabine
81
route of admin for Vidarabine
to treat EBV of eye - topically
82
bioavailability of Vidarabine
poor - it is topical
83
risk of systemic effects w/ Vidarabine
low
84
Kaposi Sarcoma
Cidofovir
85
route of admin of Cidofovir
IV
86
clearance of Cidofovir
renal
87
toxicity of Cidofovir
nephrotoxicity
88
What can't patient drink while on Abacavir
ALCOHOL

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