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33 Cards in this Set
- Front
- Back
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Nucleoside Reverse Transcriptase Inhibitors (NRTIs) - class side effects
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GI (nausea, vomiting, flatulence)
Lactic acidosis Liver steatosis |
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Zidovudine (Retrovir - AZT)
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(NucleoSIde RTI)
Active metabolite - myelosuppressive Comes in IV formulation for pregnant women Consider signs of anemia in pregnant women |
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Didanosine (Videx - ddI)
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(NucleoSIde RTI)
Take on empty stomach Acid-labile drug - watch for drug interactions Contraindicated in pregnancy Drug specific side effects - pancreatitis, peripheral neuropathy |
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Lamivudine (Epivir - 3TC)
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(NucleoSIde RTI)
Also has Hepatitis B activity |
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Abacavir (Ziagen - ABC)
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(NucleoSIde RTI)
Metabolized by alcohol dehydrogenase Rare HS reaction - requires HLA-B*5701 testing (if positive, pt cannot take the medicine) |
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Emtricitabine (Emtriva - FTC)
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(NucleoSIde RTI)
Very similar to 3TC; fluorinated 3TC Also has Hepatitis B activity Drug specific side effects - hyperpigmentation, discoloration of palms and soles |
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Tenofovir (Viread - TFV)
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(NucleoTide RTI)
Active against both HIV and HBV Drug specific side effects - osteomalacia, renal impairment and failure Watch out for HIV nephropathy |
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Dosing adjustments of Nukes in renal impairment
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With the exception of ABC, dosing needed for CrCl <50 ml/min (this includes combo drugs - Atripla, Combivir, Trizivir, Epzicom).
Truvada is not recommended for CrCl <30 ml/min |
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Dosing adjustments of Nukes in hepatic impairment
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No dosing adjustment is necessary.
Exception, ABC dose adjustment needed according to the Child-Pugh Score |
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Protease Inhibitors - class side effects
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Lipodystrophy
Hyperlipidemia Diabetes GI intolerance Hepatic effects Risk of spontaneous bleeding (esp in pts with hemophilia) |
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Indinavir (Crixivan -IDV)
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(Protease inhibitor)
Drug specific side effects - hyperbilirubinemia, nephrolithiasis (unique SE - kidney stones), alopecia |
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Lopinavir/r (Kaletra - LPV)
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(Protease inhibitor)
Has Ritonavir in the formulation Drug specific side effects - significant increase in lipids (esp in TGs), QT prolongation |
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Atazanavir (Reyataz - ATV)
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( Common protease inhibitor)
Blocks 3A4 and UGT 1A1 The only lipid neutral PI Specific drug side effects - nephrolithiasis (kidney stones), elevated indirect bilirubin, PR interval prolongation, primary AV block |
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Fosamprenavir (Lexiva - FPV)
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(Protease inhibitor)
Different dosing for naive and experienced pts Specific drug side effects - rash (due to sulfa moiety) and nephrolithiasis |
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Tipranavir (Aptivus -TPV)
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(Protease inhibitor)
Moderate-severe hepatic disease is contraindicated Has greater risk for hepatotoxicity than other PIs - watch liver enzymes |
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Darunavir (Prezista - DVR)
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(Protease inhibitor)
Different dosing for naive and experienced pts Has greater risk for rash than other drugs |
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Non-nukes (NNRTIs) - class side effects
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Rash
Liver transaminase elevation |
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Efavirenz (Sustiva - EFV)
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(Common NNRTI)
Avoid high fat meal Drug specific side effects : CNS symptoms - vivid abnormal dreams, increased lipids, false (+) cannabinoid test, teratogenic (neural tube defects during early weeks 5-6 of pregnancy only ) |
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Rilpivirine (Edurant - RPV)
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(NNRTI)
Need a baseline of viral load before starting the pt on this drug Take with fatty meals to help with absorption Not an option of NNRTI - resistance Drug specific side effects: depression, insomnia and headache |
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Efavirenz + emtricitabine + tenofovir (Atripla)
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Take on empty stomach QHS to avoid CNS side effects
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Emtricitabine + rilpivirine + tenofovir (Complera)
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Take with fatty meal once daily
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Maraviroc (Selzentry - MVC)
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(CCR5 Inhibitor)
Testing required prior to start (tropism testing) - very expensive - almost 2 G's |
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Raltegravir (Isentress - RAL)
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(Integrase inhibitor)
Also UGT 1A1 metabolism Well tolerated - diarrhea, nausea, headache |
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Elvitegravir (Stribild - EVG)
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(Integrase inhibitor)
Only available in combo (EVG + COBI + TFV + FTC) Well tolerated - D/N, renal impairment (TFV; COBI increases SrCr), osteomalacia (TFV) Only use pts with CrCl 70 or greater |
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Lipid abnormalities - statins
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Statins go through the 3A4 pathways - be cautious of drug interactions with PIs.
Watch dose - Rosuva, pravastatin and atorvastatin are okay to use ("RAPr") Avoid - Simvastatin, lovastatin, pitavastatin (high drug interactions) |
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Drug treatment for lipodystrophy
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1st FDA approved drug: Egrifta
Once daily injection A synthetic growth hormone releasing factor |
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Standard regimen for HIV pts
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2 nukes + PIs botted (Ritonavir, Reyataz or Prezista)
2 nukes + Integrase inhibitors (Isentress) 2 nukes + NNRTI (Sustiva or Atripla) *2 nukes ie Truvada |
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Definition of AIDS
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CD4 count < 200
Total lymphocytes <14% |
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Post Exposure Prophylaxis(PEP) - Occupational
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Initiate therapy promptly - 2 nukes + PI for 4 weeks.
Follow up with HIV lab testing 6 weeks, 12 weeks, and 6 months post-exposure. |
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Post Exposure Prophylaxis (PEP) - Mother-to-baby transmission
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AZT to decrease transmission
Start at least 28 weeks (or sooner) in the mother Preferred: Combivir (AZT/3TC) BID + PI (Kaletra or Reyataz) Continue AZT prophylaxis for 6 weeks in infants (+3 doses of Nevirapine in 1st week of life if mom did not receive antepartum ARV) |
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Pre-Exposure Prophylaxis (PrEP) - Partner prevention
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Agent: Tenofovir/emtricitabine (TFV/FTC)
Treatment of HIV (+) partner - Early ART Treatment of HIV (-) partner - dual ART 67-75% risk reduction |
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Vaccinations for HIV (+) Adults with CD4 <200
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dTap (tetanus, diphtheria, pertussis)
HPV Influenza (inactivated) Pneumococcal Hep B (If indicated, Hep A and meningococcal) |
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Vaccinations or HIV (+) Adults with CD4 >200
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All for <200, plus
MMR Varicella |
