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74 Cards in this Set

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What drugs are NRTIs
Didanosine
Lamivudine
Tenofovir
Zidovudine
Emtricitabine
MOA NRTIs
Nucleoside analogs
become involved in DNA process & inhibit reverse transcriptase
What drugs are NNRTIs
Efavirenz
Nevirapine
MOA NNRTIs
directly inhibit reverse transcriptase
What drugs are protease inhibitors
Ritonavir
Atazanavir
Darunavir
Indinavir
Nalfinavir
MOA Protease inhibitors
Prevent viral protein products from being cleaved to form functional structures
(gag-pol-env)
What drug is a fusion inhibitor
Enfuvirtide
MOA fusion inhibitor
Prevent fusion of HIV to host target cell
Via binding to gp41
What drug is an integrase inhibitor
Raltegravir
MOA integrase inhibitor
Prevents integration and insertion of HIV DNA into human DNA
What drug is CCR5 antagonist? MOA?
Maraviroc

block CCR5 co-receptor on WBC which is targeted by HIV --> preventing entry into host cell
SE Maraviroc (CCR5 antagonist)
Hepatoxic
Increase risk of infection and malignancies
Systemic allergic Rxn
CV events
At what point is HIV tx started
Any of the following (HIV(+))
-w/ AIDS-defining illness
-w/ CD4 count < 350 cl/microL
-w/ HIV associated nephropathy
-w/ current HBV infection
-w/ pregnant
What is the HIV ART regimen
2 NRTIs + (1 boosted PI or 1 II or 1 CCR5 antagonist)
How do you tx HIV in pregnant women?
2 NRTIs + 1 PI

(lopinavir + zidovudine + lamivudine)
& do C-section for delivery
What is acute retroviral syndrome & tx?
Mononucleosis-like syndrome which occurs in 1st few wks HIV infection

Tx - optional
DOC CMV retinitis (HIV +)? Given with? How long?
Ganciclovir w/ valganciclovir
daily x 2-3 wk
DOC tx Cryptococcal meningitis (HIV+)
Amp B + Flucytosine
(clinically stable) --> transitioned to Fluconazole
(x8 wks and until CD4 100-200 >6mos)
Prophylaxis Cryptococal meningitis (HIV+)
CD4 < 50

Fluconazole
DOC tx Mycobacterium avium complex (HIV+)
Clarithromycin & Ethambutol
(Ethambutol - nephrotoxic, optic neuritis)
Preferred management add 2 more drugs - Streptomycin & Rifabutin
Prophylaxis mycobacterium avium complex (HIV+) drugs? criteria?
Azithromycin or Clarithromycin

Started - CD4 <50, considered CD<100
D/C CD4 >100 x 3 mos
DOC tx/prophylaxis Pneumocystis & prophylaxis Toxoplasmosis (HIV+)
TMP-SMX
Prophylaxis Pneumocystis (HIV+) drugs? criteria?
TMP-SMX

Started - CD4 <200 or current/recurrent oropharyngeal candidiasis
DOC tx Toxoplasmosis (HIV+)
TMP-SMX or
Pyrimethamine + Sulfadiazine + Leucovorin
Prophylaxis coccidioidomycosis (HIV+) drugs? criteria?
Fluconazole or Itraconazole

Start (must have all) - live in endemic area (SW US), + IgM or IgG titers, CD4 <250
Prophylaxis Histoplasmosis (HIV+) drug? Criteria?
Itraconazole

Start - CD4 < 150 & live in endemic area (E & central US)
Antibiotics that interfere with 50s ribosomal subunit of bacteria
50s CEC

Chloramphenicol
Erythromycin
Clindamycin
Antibiotics that interfere with 30s ribosomal subunit of bacteria
30s TA

Tetracycline
AG
MOA AG & active against
Block initial steps in protein synthesis

Gram (-) aerobes
**require O2-dependent transport across membranes
Toxicity of AG
Ototoxic
Nephrotoxic
Neurotoxic
MOA Tetracycline
Block acceptor site for incoming aminoacyl tRNA
What are the tetracyclines
Tetracycline
Demeclocycline
Oxytetracycline
Minocycline
Doxycycline
SE tetracyclines
Photosensitivity
Promote devel. Pseudotumor cerebri
Who do you avoid tetracycline in?
< 8 yo - permanent staining of teeth
Pregnant

*avoid antacid, iron, Ca for 2 hrs after taking
MOA Chloramphenicol
Blocks the action of peptidyl transferase

(aerobes)
SE Chloramphenicol
Very toxic
Inhibits P450
Bone marrow toxic
Grey baby syndrome
MOA Erythromycin (macrolides)
Blocks translocation - aa cannot be shifted
Erythromycin DOC for
ppl allergic to penicillin
Mycoplasma pneumoniae
SE Erythromycin
QT prolongation (torsades)
A lot of drug interactions
Clindamycin DOC for
anaerobic infections above the diaphragm
MOA Pyrimethamine
inhibits folate utilization
Use Pyrimethamine
Tx - Toxoplasmosis
(Alt prophylaxis - Pneumocystis & Toxoplasmosis)
MOA Trimethoprim
Same is pyrimethamine

(used in combo w/ sulfa drug)
Use of Trimethoprim
Tx & prophylaxis - Pneumocystis
Prophylaxis - Toxoplasmosis
MOA Sulfa drugs
Inhibit Folate synthesis
Use of Sulfa drugs
Pro & tx - Toxo & Pneumocystis

DOC empiric tx UTI (TMP-SMX)
What are the sulfa drugs
Sulfadiazine
Sulfisoxazole
Sulfamethoxazole
MOA Dapsone
Inhibit dihydropteroate synthetase --> decreased DNA synthesis
SE Dapsone
Megaloblastic anemia
MOA 6-mercaptopurine
(thio-IMP) inhibits de novo purine synthesis
(thio-GMP) incorporated into RNA --> dysfunctional
6-mercaptopurine used for
ALL
SE 6-mercaptopurine
Hepatotoxic
Bone marrow suppression
MOA Cytarabine
Inhibits reduction of CDP to dCDP --> terminates DNA chain elongation
Cytarabine used to tx
non-lymphocytic leukemia
SE cytarabine
Hepatotoxic
Bone marrow suppression
"Cytarabine syndrome"
(fever, malaise, myalgia, bone pain, conjunctivitis, rash, CP)
MOA 5-fluorouracil
Inhibits thymidine synthesis
Use of 5-fluorouracil
Slow-growing solid tumors
(breast, colorectal, gastric)
SE 5-fluorouracil
Bone marrow suppression
MOA Actinomycin D (dactinomycin)
Sm groove of DNA --> interferes w/ DNA-dependent RNA Poly
HD = inhibits DNA synthesis

Transcription inhibitor
When can you NOT use actinomycin
Active chickenpox or shingles
MOA Doxorubicin (Adriamycin)
ROS --> DNA breaks
Intercalcates b/t base pairs
Binds plasma membrane --> decrease IP3
SE Doxorubicin
CARDIOTOXIC
Red urine
BM suppression
Severe tissue necrosis
MOA Bleomycin
(similar to actinomycin)
ROS
SE Bleomycin
Nephrotoxic
Hepatoxic
Toxic to skin
Fibrosis of lung
What are the FQ
Ciprofloxacin
Levofloxacin
Moxifloxacin
Gemifloxacin
MOA FQ
Inhibit bacterial DNA gyrase

-enter via porins
(active against G(+) & G(-)
SE & CI FQ
QT prolongation
< 16 yo - joint cartilage injury
> 60yo - tendinopathy (Achilles tendon rupture)

*False + opiates on UA
Rifampin used for
Mycobacterium
(leprosy, TB, atypical mycobacterial infection)
Contact prophylaxis - N. meningitidis & H. influenzae meningitis
SE Rifampin
Hepatotox (CI in liver dz)
BM suppression (esp. thrombocytopenia)
Use Rifapentine
Alt TB
Use Rifabutin
Mycobacterium avium complex

(1 DOC in the 4-drug tx regimen)
MOA Alpha-amanitin
(found in poison mushrooms)
Inhibition of mRNA production in eukaryotes
SE Actinomycin
(Dose limiting)
Severe tissue necrosis
BM suppression
Alopecia
Stomatitis
Overall immunosuppression
Use of actinomycin
CA lung, breast
ALL
Lymphoma