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56 Cards in this Set
- Front
- Back
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HIV |
retrovirus that depletes the helper T-lymphocytes (CD4 cells) resulting in continued destruction of hte immune system |
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AIDS |
HIV with CD4 cell count <200 cells/mm3 or a history of opportunistic infections |
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MEdications used to treat HIV/AIDS |
1) nucleoside reverse transcriptase inhibitors (NRTIs) 2) Non-nucleoside Reverse Transcriptase Inhibtors (NNRTIs) 3) Protease Inhibitors 4) Entry Inhibitors 5) Integrase inhibitors |
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Nucleoside Reverse Transcriptase Inhibitors |
1. Zidovudine (AZT, ZDV) - Retrovir 2. Lamivudine (3TC) - Epivir 3. Avacavir (ABC) - Ziagen 4. Didanosine (ddI) - Videx 5. Stavudine (d4T) - Zerit 6. Tenofovir (TDF) - Viread 7. Emtricitabine (FTC) - Emtriva |
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NRTI not used during first trimester of pregnancy or in women of child bearing age |
Efavirenz |
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NRTI used with caution in renal insufficiency |
Tenofivir |
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NRTI based regimens |
1) Efavirenz/tenofivir/Emtricitabine |
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PI-based regimen |
Atazanavir + ritonavir + tenofovir/emtricitabine |
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INSTI based regimen |
Raltegravir + tenofovir/emtricitabine |
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Zidovudine (AZT, ZDV) - Retrovir |
NRTI ADRs: bone marrow suppression, GI intolerance, headache, insomnia, HLD, insulin resistance, myopathy INRX: ribavirin, stavudine, methadone, Bactrim MONITOR: CBC, LFTs **take without regard to meals |
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Lamivudine (3TC) - Epivir |
NRTI ADRs: minimal toxicity, severe acute hep INRX: none MONOITOR: none *take without regard to meals |
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Abacavir (ABC) |
NRTI ADRs: rash, fever, nausea (hypersensitivity) INRX: alcohol **take without regard to meals |
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NRTI that must be HLA_B5701negative |
Abacavir |
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Didanosine (ddI) |
NRTI ADRs: pancreatitis, peripheral neuropathy, retinal changes, optic neuritis, N/V INRX: methadone, ribavirin, tenofovir, allopurinol MONITOR: CBC, LFTs, amylase, uric acid **take 1/2 hour before or 2 hrs after meals |
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Stavudine (d4T) |
NRTI ADRs: pancreatitis, peripheral neuropathy, lipoatrophy, HLD, insulin resistance INRX: didanosine *take without regards to meals |
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Tenofovir (TDF) |
NRTI ADRs: renal insufficiency, Fanconi syndrome, osteomalacia, decrease bone mineral density INRX: didanosine, atazanvir MONITOR: renal function *take without regards to meals (except Complera-combo) |
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Emtricitabine (FTC) |
NRTI ADRs: minimal toxicity, skin discoloration, severe acute hep \INRX: none **take without regards to meals (except Complera-combo) |
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MOA of NRTIs |
interfere with HIV viral RNA-dependent DNA polymerase, resulting in chain termination & inhibition of viral replication |
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NRTIs that are weight based |
1) didanosine 2) stavudine 3) lamivudine |
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Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) |
1) Efavirenz (EFV) - Sustiva 2) Nevirapine (NVP) - Viramune 3) Rilpivirine (RPV) - Edurant 4) Etravirine (ETR) - Intelence |
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MOA of NNRTIs |
competitively inhibit reverse transcriptase which results in inhibition of HIV replication **dose adjust for hepatic insufficiency** |
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One-Step mutation (K103N) leads to resistance of which NNRTIs |
1st generation 1) efavirenz 2) nevirapine 3) delavirdine |
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Efavirenz (EFV) |
NNRTI ADRs: neuropsychiatric symptoms, rash, increased LFTs AVOID: pimozide, midazolam/triazolam, Ergot, St johns wort **take on empty stomach |
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Nevirapine (NVP) |
NNRTI ADRs: rash (SJS), symptomatic hepatitis AVOID: St Johns wort, ketoconazole **take without regards to meals |
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Rilpivirine (RPV) |
NNRTI ADRs: rash, depression, insomnia, headache, prolonged QT AVOID: rifampin, st johns wort, carbamazepine, phenobarb, phenytoin, clopidogrel **take with a meal |
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Etravirine (ETR) |
NNRTI ADRs: rash (SJS), nausea, hypersensitivity AVOID: rifampin, PPIs, st johns wort, carbamazepine, oxcarb, phenobarb, phenytoin **take following a meal |
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Protease Inhibitors |
1) Indinavir (IDV) - Crixivan 2) Lopinavir + ritonavir (LPV/r) - Kaletra 3) Nelfinavir (NFV) - Viracept 4) Ritonavir (RTV) - Norvir 5) Squinavir (SQV) - Invirase 6) Tipranavir (TPV) - Aptivus 7) Atazanavir (ATV) - Reataz 8) Darunavir (DRV) - Prezista 9) Fosamprenavir (FPV) - Lexiva |
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MOA of protease inhibitors |
inhibits protease, which prevents the cleavage of HIV polyproteins and subsequently induces the formation of immature noninfectious viral particles **dose adjust for hepatic impairment |
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Most potent PI that is primarily used for intensification of other PIs |
Ritonavir |
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PIs that require normal acid levels in the stomach & are associated with kidney stones & bilirubin increases |
1) atazanavir 2) indinavir |
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PIs that contain sulfa and should be used with caution (sulfa allergy) |
1) Darunavir 2) Fosamprenavir 3) Tipranavir |
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Atazanavir (ATV) |
ADRs: indirect hyperbilirubinemia, prolonged PR interval, skin rash, nephrolithiasis STORE: room temp **normal GI acid - NO PPIs/H2RAs |
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Darunavir (DRV) |
ADRs: rash (SJS, erythema multiforme -sulfa), hepatotoxicity, GI intolerance, headahce *take with food STOER: room temp |
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Fosamprenavir (FPV) |
ADRs: skin rash (sulfa), GI intolerance, headache, nephrolithiasis STORE: room temperature **take tablet without regard to food (no ritonavir); take with food (with ritonavir) |
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Indinavir (IDV) |
ADRs: nephrolithiasis (drink LOTS of water), GI intolerances, headache, blurred vision, metallic taste STOER: room temperature **with ritonavir - without regards to meals **1hr before or 2hrs after meals |
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Lopinavir + ritonavir (LPV/r) |
ADRs: GI intolerance, pancreatitis, asthenia, QT prolongation (torsades) STORE: tablet-room temp; soln - fridge *tablet-without regards to meals; soln-with food |
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Nelfinavir (NFV) |
ADRs: diarrhea, increased LFTs STORE: room temp *dissolve tablets in small amount of water, mix well, consume immediately *take with food |
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Ritonavir (RTV) |
ADRs: GI intolerance, paresthesias, hep, taste perversion STORE: tab/soln-room temp; caps-fridge *take with food *used as PK booster |
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Saquinavir (SQV) |
ADRs: GI intolerance, QT prolongation (torsades) STORE: room temp *not recommended unboosted *take with meals or within 2hrs after a meal |
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Tipranavir (TPV) |
ADRs: hepatotoxicity, skin rash, intracranial hemorrhage (rare) STORE: soln-room temp; caps-fridge *unboosted not recommended *with food |
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Entry Inhibitors |
1)Enfuvirtide (T20) - Fuzeon 2) Maraviroc (Selzentry) |
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Enfuvirtide (T20) - Fuzeon |
MOA: binds to glycoprotein 41 on HIV surface; thus inhibiting HIV binding to CD4 cell ADRs: injection-site reactions, bacterial pneumonia, hypersensitivity *reserved for deep salvage (used with at least 2 other agents) *take without regards to meals |
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Maraviroc (Selzentry) |
MOA: binds to CCR5 receptors on the CD4 cell surface which inhibitors HIV binding and entry into the CD4 cell **must complete Trofile testing - patient must be CCR5 tropic ADRs: ab pain, cough, dizziness, musculoskeletal symptoms, rash, URTIs *used with at least 2 other active drugs |
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MOA of Integrase Inhibitors (INSTIs) |
block activity of the integrase enzyme which prevents HIV DNA from meshing with the CD4 cell DNA chelate with cations and should be separated from medications that contain them |
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Integrase Inhibitors (INSTis) |
1) Raltegravir (RAL) - Isentress 2) Elvitegravir (EVG) - Stribild 3) Dolutegravir (DTG) - Tivicay |
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Raltegravir (RAL) |
ADRs: nausea, headache, diarrhea, pyrexia INRX: rifampin STORE: room temp FOOD: with or without |
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Elvitegravir (EVG) |
ADRs: GI side effects, renal dysfunction, proteinuria INRX: separate from cations STORE: room temp FOOD: with food *do not start if CrCl <70; stop if CrCl < 50 |
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Dolutegravir (DTG) |
ADRs: hypersensitivity, increased LFTs in HepB & HepC, GI side effects, fatigue, myositis, renal impairment INRX: st johns wort, metformin, anticonvulsants STORE: room temp FOOD: with or without |
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Opportunistic Infections that require primary prophylaxis |
1) Pneymocystis Jiroveci pneumonia (PCP) 2) Mycobacterium avium Complex (MAC) |
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PCP - opportunistic infection |
INDICATION: CD4 cell count falls <200, unexplained fever >2 weeks Treatment of CHocie: Bactrim DS PO daily |
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MAC bacteremia - opportunistic infection |
Proph: Azithromycin Treat/Maint: Clarithromycin + ethambutol *Maintenance D/c'd after 1yr or CD4 >100 for 6mos |
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Candida - opportunistic infection |
TREAT: azole antifungal, nystatin suspension Thrush: treat 10-14 days Esophagitis: treat 2-3 weeks |
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Cryptococcal Meningitis - opportunistic infection |
Induction: amphotericin B + flucytosine Consolidation: fluconazole Maintenance: Fluconazole - lifelong or CD4 >200 for >6 mos *spread thru inhalation of soil contaminated with bird droppings |
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Toxoplasmosis |
TREAT (x6 weeks): pyrimethamine + leucovorin + sulfadiazine Chronic Maintenance: same -lifelong or CD4 >200 for >6 months *spread thru raw or undercooked meat; infected cat feces |
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Histoplasmosis |
Induction(x2wks): liposomal ampho b or itraconazole Main(x1yr): itraconazole - CD4 >150 for >6mos *spread thru inhalation of dust particles (soil heavily contaminated by avian or bat feces - Ohio/Miss River Valleys) |
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Cytomegalovirus Ritinitis |
Treat (x21d): Intraocular ganciclovir, valganciclovir, foscarnet Maint: valganciclovir *oral ganciclovir not used as sole induction therapy * maintenance therapy can be stopped with inactive disease, CD >100-150 for 3-6 months |
