Ap-Hiv Drugs

Front 1

HIV drugs

What are the three major adverse effects of nucleoside analogs?

Back 1

Nucleoside analogs:
1.lactic acidosis
2. pancreatitis
3. hepatic failure

Front 2

HIV drugs

Six major nucleoside analogs:

Back 2

NA "SAD TZ"

1. Stavudine: peripheral neuropathy, pancreatitis, lipodystrophy, preg C

2. Abacavir: fatal hypersensitivity reactions (never be rechallenged), pregC

3. Didanosine: peripheral neuoropathy, pancreatitis, take on empty stomach, preg B

4. Tenofovir: renal dysfunction, preg B

5. Zidovudine: headache, anemia (high MCV), neutropenia, take every 12 hrs, preg C

Front 3

HIV drugs

What are the three non-nucleoside analogs?

Back 3

NNRTI's

1. Efavirenz: 1st choice, CNS (insomnia, confusion, abnL dreams), take on an empty stomach, PREG D!!

2. Nevirapine: rash (very bad), hepatoxicity (necrosis), preg C (best of NNRTI's)

3. Atriplia: first drug that is triple therapy, preg D

Front 4

HIV drugs
VIP

What four drugs have the least mitochondrial toxicity?

Back 4

"TEAL" - nucleoside analogs

1. Tenofovin
2. Emtricitabin
3. Abacavir
4. Lamivudine

Front 5

HIV drugs

Six major protease inhibitors (not including combo)?

Back 5

PI's "FIN DAR"

1. Fosamprenavir: rash, increase lipids, increase LFT's
2. Indinavir: nephrothilasis (must drink alot of water), take every 8 hrs on empty stomach, increase LFT's
3. Nefinavir: (we don't boost) diarrhea, increase LFT, take with food

4. Darunavir: rash with sulfa moiety, take with ritonavir, only for treatment experienced
5. Atazanavir: indirect hyperbilirubinemia, prolonged PR interval, causes less lipid problems (give to those with high lipids)
6. Ritonavir: paresthesias, increase LFT's, drug interactions, it is a booster, take with food.

Front 6

HIV drugs

What three drugs cause a rash?

Back 6

1. Nevirapine (NNRTI)
2. Darunavir - sulfa moiety (PI)
3. Fosamprenavir (PI)

Front 7

HIV drugs

What PI's are combined? (4 sets)

Back 7

Set 1
Lopinavir + Ritonavir (no side effects other than increase LFT)

Set 2
Darunavir (rash/sulfa) + Ritonavir (paresthesias/drug interactions)

Set 3:
Saquinavir + Ritonavir

Set 4:
Tipranavir (tx experienced) + Ritonavir

Front 8

HIV drugs

What drugs must you take on an empty stomach?

Back 8

1. Indinavir (PI) - nephrolithiasis
2. Didanosine (NRTI) - periphreal neuropathy, pancreatitis

3. Efavirenz (NNRTI): CNS, abnL dreams, teratogenic

Front 9

HIV drugs

What is the one fusion inhibitor?

Back 9

Fusion inhibitor:

Enfuviritide: given subQ

Causes local injection site reactions (pain, erythema, induration)

Preg B

Front 10

HIV drugs

Do any HIV drugs help the CD4 cells already infected?

Back 10

NO!

Front 11

HIV drugs

Do any of the NNRTI's require dosage adjustments in renal insufficiency?

Back 11

NO (but Atripla should not be used in patients with a CrCl < 50ml/min

Front 12

HIV drugs

What drugs are contraindicated when using Efavirenz?

Back 12

Midazolam and triazolam

Front 13

HIV drugs

Why does Nevirapine interact with other drugs?

Back 13

Nevirapine (NNRTI - rash and hepatox)
Because it induces metabolism of other drugs

Front 14

HIV drugs

What does Delavirdine do to other drugs?

Back 14

It inhibits drug metabolism

Front 15

HIV drugs

What does Efavirenz do to other drugs?

Back 15

Efavirenz (NNRT - first choice, CNS and abnl dreams, teratogenic)
It can either promote or inhibit the metabolism of other drugs

Front 16

HIV drugs

If a patient is on Rifampin along with either Nevirapine, Delaviridine, or Efavirenz - how must you change the drug concentrations? Why?

Back 16

Rifampin induces p450 (decrease the drug available) -

Have to increase the dose all all three HIV medications

Front 17

HIV drugs

What two drugs does Zidovudine interact with?

Back 17

Zidovudine (NRTI - anemia, neutropenia, headache)

Interacts with:
1. Co-trimoxazole (bactrum)
2. Ganciclovir (for CMV)

Front 18

HIV drugs

What nine drugs does Didanosine interact with?

Back 18

Didanosine (NRTI, take on an empty stomach, peripheral neuropathy, pancreatitis from mito tox)

Interacts with:
Pentamidine
Ethanol
Stavudine
Dapsone
Ketoconazole, Itraconazole
Quinolones
Atazanvir, indinavir

Front 19

HIV drugs

What two drugs are contraindicated with the use of any PI?

Back 19

Midazolam and triazolam

Front 20

HIV drugs

Should you use Rifampin with protease inhibitors?

Back 20

No, renders them inactive

Front 21

HIV drugs

Do we use Simvastatin and Lovastatin to combat hyperlipidemia in patients on PI's?

What can you use instead?

Back 21

NO - Simvastatin and Lovastatin are contraindicated.

Can use instead: Atorvastatin or Pravastatin.

Front 22

HIV drugs

What is the preferred regimen of NNRTI's, PI's, and NRTI's?

Back 22

NNRTI: Efavirenz

PI: Either atazanivir, fosamprenavir, or lopinavir (all boosted with RITONAVIR)

NRTI:
tenofovir/emtricitabine
-or-
zidovudine/lamivudine

Front 23

HIV drugs
VIP

What are all protease inhibitors associated with? (4)

Back 23

Protease inhibitors:
1. development of hyperglycemia
2. fat maldistribution
3. lipid abnormalities
4. increase in bleeding episodes in patients with hemophilia.

Front 24

HIV drugs

Regardless of antepartum ART regimen, what drug is recommended during the intrapartum period and for the newborn?

Back 24

Zidovudine

Front 25

HIV drugs

What is the treatment goal in HIV-infected pregnant women?

Back 25

To reduce the HIV viral load to <1,000 copies/mL and prevent the transmission of HIV from mother to child

Front 26

HIV drugs

In HIV infected pregnant women, when should Zidovudine be initiated to mom? When to the newborn?

Back 26

Start mom on Zidovudine (NRTI, anemia, neutropenia, headache) - 14-34 wks gestation (and during labor)

Newborn: begin 8-12hrs after birth for the first 6wks of life.

Front 27

HIV drugs

In an HIV patient receiving ARTs when should CD4 count be measured?

Back 27

Measure: 2-8wks after starting therapy

Then every 3-4 mths

Front 28

HIV drugs

What do most experts agress is the goal of therapy?

Back 28

To maintain the virus load below the limits of detection (<50-80 copies/mL)

Front 29

HIV drugs

When changing drugs how do you do it?

Back 29

Do not change a single drug or add a single drug.

Instead use at least 3 new drugs and preferably an entire new regimen.

Front 30

HIV drugs

Compare HIV infection to AIDS:

Back 30

HIV: patient with a CD4 count of >200 cells and no signs of opportunistic infections

AIDS: patient with a CD4 count of <200 OR with an opportunistic infection OR AIDS indicator conditions (regardless of CD4 counts)

Front 31

HIV drugs

What CD4 count is associated with the development of opportunistic infections?

Back 31

CD4 < 500

Front 32

HIV drugs
VIP

What are the two surrogate markers that are used to determine the indications for antiretroviral treatment and are used to monitor effectiveness of therapy?

Back 32

CD4 cell count
&
Plasma HIV viral load

Front 33

HIV drugs

What are two types of inhibitors of reverse transcriptase and how to they work?

Back 33

Inhibitors of Reverse Transcriptase:
1. Nucleoside analogs (NRTI) - interfere with reverse trans to prevent further builidng of proviral DNA from RNA (incorporate into DNA to terminate chain elongation)
*require dosage adjustment in renal insuff (except acyclovir)

2. Non-nucleoside analogs (NNRTIs) - act as false nucleotides and bind adjacent active sites of reverse transcriptase inducing conformational changes that inactivate the enzyme. (combined with NRI and do NOT require a dosage adjustment in renal insufficiency)

Front 34

HIV drugs

What NNRT should not be used in patients with a CrCl < 50?

Back 34

Atripla

Front 35

HIV drugs

MOA of inhibitors of HIV protease?

Back 35

MOA of Protease inhibitors:

HIV protease is needed for processing and assembly of viral core and polymerase proteins to produce infectious virions.

Protease inhibitors bind reversibly to the active site of the protease enzyme to prevent the protease enzyme from cleaving the viral precursor proteins into funcitonal units and thus block viral maturation.
They decrease infected cell pool by halting production of infectious virions.

Do not require dosage adjustments in renal dysfunction but can in liver dysfunction

Front 36

HIV drugs

MOA of fusion inhibitors?

Back 36

Fusion inhibitors prevent the entry of HIV into suseptible cells by inhibiting the fusion of viral and cellular mechanisms.

Efuviritide does not require dosage adjustment in the presence of renal insufficiency.