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74 Cards in this Set
- Front
- Back
What drugs are NRTIs
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Didanosine
Lamivudine Tenofovir Zidovudine Emtricitabine |
|
MOA NRTIs
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Nucleoside analogs
become involved in DNA process & inhibit reverse transcriptase |
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What drugs are NNRTIs
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Efavirenz
Nevirapine |
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MOA NNRTIs
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directly inhibit reverse transcriptase
|
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What drugs are protease inhibitors
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Ritonavir
Atazanavir Darunavir Indinavir Nalfinavir |
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MOA Protease inhibitors
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Prevent viral protein products from being cleaved to form functional structures
(gag-pol-env) |
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What drug is a fusion inhibitor
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Enfuvirtide
|
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MOA fusion inhibitor
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Prevent fusion of HIV to host target cell
Via binding to gp41 |
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What drug is an integrase inhibitor
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Raltegravir
|
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MOA integrase inhibitor
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Prevents integration and insertion of HIV DNA into human DNA
|
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What drug is CCR5 antagonist? MOA?
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Maraviroc
block CCR5 co-receptor on WBC which is targeted by HIV --> preventing entry into host cell |
|
SE Maraviroc (CCR5 antagonist)
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Hepatoxic
Increase risk of infection and malignancies Systemic allergic Rxn CV events |
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At what point is HIV tx started
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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 |
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What is the HIV ART regimen
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2 NRTIs + (1 boosted PI or 1 II or 1 CCR5 antagonist)
|
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How do you tx HIV in pregnant women?
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2 NRTIs + 1 PI
(lopinavir + zidovudine + lamivudine) & do C-section for delivery |
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What is acute retroviral syndrome & tx?
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Mononucleosis-like syndrome which occurs in 1st few wks HIV infection
Tx - optional |
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DOC CMV retinitis (HIV +)? Given with? How long?
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Ganciclovir w/ valganciclovir
daily x 2-3 wk |
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DOC tx Cryptococcal meningitis (HIV+)
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Amp B + Flucytosine
(clinically stable) --> transitioned to Fluconazole (x8 wks and until CD4 100-200 >6mos) |
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Prophylaxis Cryptococal meningitis (HIV+)
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CD4 < 50
Fluconazole |
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DOC tx Mycobacterium avium complex (HIV+)
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Clarithromycin & Ethambutol
(Ethambutol - nephrotoxic, optic neuritis) Preferred management add 2 more drugs - Streptomycin & Rifabutin |
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Prophylaxis mycobacterium avium complex (HIV+) drugs? criteria?
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Azithromycin or Clarithromycin
Started - CD4 <50, considered CD<100 D/C CD4 >100 x 3 mos |
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DOC tx/prophylaxis Pneumocystis & prophylaxis Toxoplasmosis (HIV+)
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TMP-SMX
|
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Prophylaxis Pneumocystis (HIV+) drugs? criteria?
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TMP-SMX
Started - CD4 <200 or current/recurrent oropharyngeal candidiasis |
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DOC tx Toxoplasmosis (HIV+)
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TMP-SMX or
Pyrimethamine + Sulfadiazine + Leucovorin |
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Prophylaxis coccidioidomycosis (HIV+) drugs? criteria?
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Fluconazole or Itraconazole
Start (must have all) - live in endemic area (SW US), + IgM or IgG titers, CD4 <250 |
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Prophylaxis Histoplasmosis (HIV+) drug? Criteria?
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Itraconazole
Start - CD4 < 150 & live in endemic area (E & central US) |
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Antibiotics that interfere with 50s ribosomal subunit of bacteria
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50s CEC
Chloramphenicol Erythromycin Clindamycin |
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Antibiotics that interfere with 30s ribosomal subunit of bacteria
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30s TA
Tetracycline AG |
|
MOA AG & active against
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Block initial steps in protein synthesis
Gram (-) aerobes **require O2-dependent transport across membranes |
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Toxicity of AG
|
Ototoxic
Nephrotoxic Neurotoxic |
|
MOA Tetracycline
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Block acceptor site for incoming aminoacyl tRNA
|
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What are the tetracyclines
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Tetracycline
Demeclocycline Oxytetracycline Minocycline Doxycycline |
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SE tetracyclines
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Photosensitivity
Promote devel. Pseudotumor cerebri |
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Who do you avoid tetracycline in?
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< 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) |
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SE Chloramphenicol
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Very toxic
Inhibits P450 Bone marrow toxic Grey baby syndrome |
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MOA Erythromycin (macrolides)
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Blocks translocation - aa cannot be shifted
|
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Erythromycin DOC for
|
ppl allergic to penicillin
Mycoplasma pneumoniae |
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SE Erythromycin
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QT prolongation (torsades)
A lot of drug interactions |
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Clindamycin DOC for
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anaerobic infections above the diaphragm
|
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MOA Pyrimethamine
|
inhibits folate utilization
|
|
Use Pyrimethamine
|
Tx - Toxoplasmosis
(Alt prophylaxis - Pneumocystis & Toxoplasmosis) |
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MOA Trimethoprim
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Same is pyrimethamine
(used in combo w/ sulfa drug) |
|
Use of Trimethoprim
|
Tx & prophylaxis - Pneumocystis
Prophylaxis - Toxoplasmosis |
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MOA Sulfa drugs
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Inhibit Folate synthesis
|
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Use of Sulfa drugs
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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
|
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SE Dapsone
|
Megaloblastic anemia
|
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MOA 6-mercaptopurine
|
(thio-IMP) inhibits de novo purine synthesis
(thio-GMP) incorporated into RNA --> dysfunctional |
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6-mercaptopurine used for
|
ALL
|
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SE 6-mercaptopurine
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Hepatotoxic
Bone marrow suppression |
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MOA Cytarabine
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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) |
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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)
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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
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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 |
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SE Actinomycin
|
(Dose limiting)
Severe tissue necrosis BM suppression Alopecia Stomatitis Overall immunosuppression |
|
Use of actinomycin
|
CA lung, breast
ALL Lymphoma |