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38 Cards in this Set
- Front
- Back
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HIV drug classes
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NRTIs
NNRTIs PIs FIs CCR5 antagonists Integrase inhibitors |
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Typical HIV regimen
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Two NRTIs and one of the following:
-One NNRTI -A "boosted" PI -Raltegravir (Integrase inhibitor) |
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NNRTIs
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One NNTRI + dual NRTI
Efavirenz Nevirapine Delavirdine Ertavirine |
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Efavirenz
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Well studied, good efficacy
Preferred NNRTI (except pregnancy 1st trimester) SEs: CNS/psychiatric sympt. (52%) teratogenic potential rash, SJS |
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Atripla
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Once daily:
Efavirez, tenofovir, emtricitabine |
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Nevirapine
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NNTRI
SEs: hepatotoxicity seen in pts with higher CD4 counts Skin rash (50%) |
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Advantages/Disadvantages NNRTI
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Adv: save PIs for further use, long 1/2 lives
Disadv: Low genetic barrier to resistance (compliance VERY IMP) |
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PIs: typical regimen, MOA
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One PI (boosted or unboosted)
NRTI backbone MOA: Binds HIV protease |
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Preferred PIs
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Atazaznavir + Ritonavir
Darunavir + ritonavir Foramprenavir + ritonavir Lopinavir/ritonavir |
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PI SEs & DDIs
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Dyslipidemia (except non-boosted atazanavir)
fat maldistribution insulin resistance DDI: CYP 3A4 (PI are inhibitors AND substrates) GI SEs skin rash |
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Ritonavir
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A PI, but more importantly a booster:
InHIBITOR CYP 3A4 |
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PI regimens advantages/dis
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Advantage: higher genetic barrier to resistance
Disadvant: Metabolic complications, GI SEs, CYP 3A4 issues |
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NTRIs: MOA & regimen
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MOA: implant into chain, terminate
Dual NTRI is the backbone of all HAART treatments Regimen: Tenofovir/emtricitabine |
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NTRI: SEs
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Lactic acidosis
Hepatic steatosis/lipoatrophy |
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Abacavir SE
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NRTI
Hypersensitivity (higher in whites), pretest for HLA-B*5701 allele Fever/rash/fatigue Abd pain |
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Stavudine SE
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NRTI:
pancreatitis peripheral neuopathy |
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Didanosine SE
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NTRI:
Pancreatitis Hepatotoxicity peripheral neuropathy |
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Laminvudine SE
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NTRI:
Safest and well tolerated |
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Tenofovir SE
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NTRI:
Renal insufficiency |
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Zidovudine SE
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NRTI
Bone marrow suppression |
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Truvada
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NRTI
Emtricitabine & tenofovir |
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Epzicom
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NRTI
abacavir & lamivudine |
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Combivir
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NRTI
lamivudine & zidovudine |
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Kaletra
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PI
Lopinavir & ritonavir |
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Fusion Inhibitors
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Binds gp41
Only sub Q SEs: Injection site RXNs, pneumonia, hypersensitivity |
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Maraviroc
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CCR5 antagonist
CYP3A4 substrate |
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Ralegravir
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Integrase inhibitor
Primary therapy SEs: well tolerated, CPK elevations? Substrate to secondary metabolism enzyme |
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Pneumocystis Pneum
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P. jirovecii
Very common early Tx: TMP/SMX: HIGH DOSE, 3 WEEKS -when <200 CD4c If pt gets PCP they are "vaccinated" for life |
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Pneumocystis Pneum
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P. jirovecii
Very common early Tx: TMP/SMX: HIGH DOSE, 3 WEEKS -when <200 CD4c If pt gets PCP they are "vaccinated" for life |
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Pentamidine
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Interferes w/ protozoal RNA/DNA protein synthesis
CYP2C19 SUBSTRATE |
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Pentamidine
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Interferes w/ protozoal RNA/DNA protein synthesis
CYP2C19 SUBSTRATE |
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Mycobacterium avium complex (MAC)
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CD4 <50
Proph: Azithro, Clarithro D/c when CD4 >100/3 mo Tx: 2 DRUGS |
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Mycobacterium avium complex (MAC)
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CD4 <50
Proph: Azithro, Clarithro D/c when CD4 >100/3 mo Tx: 2 DRUGS |
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Cryptosporidiosis
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CD4 < 100
Acute onset of watery diarrhea Tx: HAART therapy to restore CD4 count Nitazoxanide |
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Cryptosporidiosis
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CD4 < 100
Acute onset of watery diarrhea Tx: HAART therapy to restore CD4 count Nitazoxanide |
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Toxoplasmosis gondii
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Encephalitis
CD4 <100 Proph: TMX/SMX: already on (PCP) Tx: pyrimethamine (pen BBB) + leucovorin + one other Tx: |
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Toxoplasmosis gondii
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Encephalitis
CD4 <100 Proph: TMX/SMX: already on (PCP) Tx: pyrimethamine (pen BBB) + leucovorin + one other Tx: |
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Pyrimethamine
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Inhibits folate pathway
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