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37 Cards in this Set

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NUCLeoside reverse transcriptase inhibitors
become triphosphorylated and become involved with the process of DNA prodution.
indirectly inhibit reverse transcriptase by mimicing nucleosides in DNA

Didanosine(ddl)
Lamivudine (3tc)
tenofovir (TDF)
zidovudine (AZT)
Emtricitabine (FTC)
non-NUCLeoside reverse transcriptase inhibitors
directly inhibit reverse trancriptase

Efarienz
Nevirapine
protease inhibitors
prevent viral proteins from being cleaved from gag-pol-env
Ritonavir
atazanavir
Darunavir
indinavir
nelfinavir
fusion inhibitors
prevent fusion of the HIV virus particle to host target cell by binding to gp41 on the virus

not part of initial ART regimen
integrase inhibitors
inhibit HIV-1 integrase so prevent integration and insertion of HIV DNA into human DNA

Raltegravir
chemokine coreceptor anatagonists
CCR5 anatagonists on WBC targeted by HIV
prevent viral entry into cell
Hepatotoxic, increase risk of infx, cancer, systemic allergic rxn, MI

Maraviroc
start HIV therapy
1) HIV+ with AIDS defining illenss (opportunistic infx, cancer)
2) HIV+ with a CD4 count of <350 cells microlitter
3) HIV+ wiht HIV associated Nephropathy
4) HIV+ wiht current Hep B infx
5) HIV+ and pregnant

Not reqd but recommended to start therapy in HIV+ wiht CD4 count between 350-500 cells /microlitter
recommended HIV ART regimen
2 NRTI + (1 boosted protease inhibitor or 1 integrase inhibitor or 1 CCR5 antagonist(least preferred))
treatement Naive pts
specific regimens
efavirenz +tenofovir+emtricitabine
ritonavir-boosted atazanavir +tenofovir+emtricitabi
ritonavir-boosted darunavir +tenofovir+emtricitabi
ritonavir+tenofovir+emtricitabi
HIV+ pregnant women
should get ART therapy regardless whether they meet the criteria or not
2 NRTI + 1 PI = LOPINOVIR + ZIDOVUDINE + LAMIVUDINE

this regiment will reduce transmission to infant. cdc recommends C-section delivery
acute retroviral syndrome
mononucleosis like syndrome that occurs in the 1st week of HIV infx
represents acute stage of HIV
maye be treated to reduce viral load
opportunistic infx and treatements/prphylaxis
Gancylovir: CMV retinitis, implanted intra-occularly, valgancyclovir also given
Amphotericin B+flucytosine: crytpococcal meningitis-->fluconazole when pt's stable
prophylaxis: not recommende but can start when CD4 <50 with fluconazole
clarithromycin and ethambutol: myobacterium avium complex (MAC)-->add streptomycin adn rifabutin for optimal 4 drug treatment. propylaxis against MAC:azithromycin or clarithromycin adn started when Cd4 <50 or 100 (sometimes) and discontinue when CD4 >100 for 3 months
opportunistic infx and treatements/prphylaxis
Trimethoprim-sulfmethoxazole: tretment and prophylaxis (CD4<200 or recent occurrence or oropharyngeal candidiasis) for pneumocyctis
alt propylaxis is Dapsone or dapsone + pyrimethamine+leucovorin
alt treatemnt: dapsone+trimethoprm, or primaquine +clindamycine, or atovaquone alone

proppylaxi for toxoplasma gondii (CD4<100)
alt prophylax: atovaquone +/- pyrimethamine and leucovorin or dapsone + pyrimethamine +leucovorin
treatment for toxoplasma: TMP-SMX, pyrimathamine + sulfadiazine/clindamycin +leucovorin
opportunistic infx and treatements/prphylaxis
fluconazole or itraconazole: prophylax for coccidiodomycosis

itraconazole: propy for histoplasmosis (CD4<150)

polysaccharide pneumoccocal vaccine: all wiht CD4>200 who havent received vaccine wihtin the past 5 years or CD4 <200

inactivated influenza vaccine: annually to all HIV+

measles Mumps rubbella vaccine: all HIV+ pts wiht CD4 >500

HBV vaccine: all HIV pt who never had vaccine or never exposed to virus

VZV vaccine: HIV pt exposed to chicken pox or shingles in 96 hrs

interferon adn ribavarin: hIV + acute HCV infx to prevent chronic hCV
antibiotics that act of 50S subunit
chloramphenicol (bacteriostatic)
Erthyromycin (bacteriostatic, macrolide)
clindamycin
antibiotics that act of 30S subuni
tetracycline (bacteriostatic, demeclocycline, oxytetracycline, minocycline, tigecycline, doxycycline)
Aminoglycosides (BACTERIOCIDAL, gentamicin, streptomycin, tobramycin, amikacin)
aminoglycosides
bind to 30s subunit of ribosomes and inhibit intiatiation of protein synthesis.
only for aerobic pathogens because require o2 dependent membrane transfer
GRAM NEGATIVES ONLY
ototoxic, nephrotoxic, neurotoxic
don't cross BBB
tetracyclines
enter bacterium via cell membrane proteins
bind 30s subunit of ribosomes -->block acceptory site of incoming aminoacyl tRNA
can cause photsenstivity, pseudotumor cerebri (when used with isoretinoin, obese, fertile women)
contraindicated: childres less that 8 due staining of dentition, pregnant women
avoid antacids, iron, calcium, dairy within 2 hrs of dosage because Mg, Ca, Iron, Aluminum impair absorption
chloamphenicol
very toxic,
effective against aerobes
inhibits P450
bone marrow toxic-->aplastic anemia
can casue GREY BABY SYNDROME
Erythromycin
block translocation
DOC: penicillin allergic pts
macrolides are DOC: MYCOPLASMA PNEUMONIAE
increase risck of QT interval prolongation-->torsades
decrease risk by also taking P450 inhibitors
clindamycin
DOC: anaerobic infx above diaphragm
same MOA as chlromaphenicol
eukaryotes
Diptheria toxin: protein syntheis in eukaryotes
pyrimethamine
inhibit folate use
treat: toxoplasmosis
alt: pneumocystitis and toxopl.
trimethoprim
inhibit folate use
DOC and prophy: pneumocyctis
Prophy DOC: toxopl
sulfa antibiotics/sulfonamides
inhibit folate synthesis in bacteria by inhibiting DIHYDROPTEROATE SYNTHETASE
sulfadiazine
sulfisoxazole
sulfamethoxazole
casue MEGALOBLASTIC ANEMIA
dapsone
inhibit folate synthesis in bacteria by inhibiting DIHYDROPTEROATE SYNTHETASE

casue MEGALOBLASTIC ANEMIA
6 Mercaptopurine
form thi-IMP-->thio-GMP acts to inhibit purine synth then DNA and RNa syntheis

for acute lymphocytic leukemia (ALL)

hepatotoxic, bone marrow suppresion
cytarabine
phosphorylated to ara-CTP (nucleoside analog)-->acts as pyrimidine antagonis-->inibits reduction of CDP to dCDP and ara-CTP is incorporated in DNA-->premature termination

for: NON-LYMPHOCYCTIC LEUKEMA

Hepatotoxin, BM suppression, cytarabine syndrome
flourouracil (5FU)
inhibits thymidine syntehiss
for slow growing solid tumors (breast, colorectal, gastric)

BM suppression
Actinomycin D/Dactinomycin
interferes wiht DNA-dependent RNA polymerase (interferes wiht transcription)
highr dose also inhibit replication

SE: severe necrosis of tissues, cant be used in chicken pox
doxorubicin/adriamycin
creaset ROS-->DNA damage
interclates between base pairs
binds plasma memb-->decrease IP3 coupled transport

BM suppression
CARDIOTOXIC-->casue CARDIOMYOPHATH-->hEART FAILURE
Bleomycin
binds DNA adn creates ROS-->DNA breaks
neprotoxic, hepatotoxin, toxic to skin, FIBROSIS OF LUNGS
Flouroquinolones (ciprofloxacin, levo, moxi, gemi)
inhibit bacterial DNA gyrase (toposisomerase II)-->inhibit DNA replication
good for GRAM + and GRAM -
cant be used with drugs that increase QT lenght
not for use in kids <16 (joint cartilage injury) and people >60 (tendinopathy, achilles tendon rupture)
can cause false + urine assays for opiates
rifampin (affect prokaryotes)
transcription inhibitor, bactiriocidal for intra and extra cellular MYCOBACTERIUM (TB, leprosy, TB, atypical mycobaterial infx)
contact prophy: meningococcus (N. meningitidis) adn H. influenza meningitis.
contrain: hepatic dis because very heptotoxic
SE: BM suppression, THROMOBOCYTOPENIA
For:
Alpha-amanitin (affect eukaryotes)
toxin in poison mushrooms-->inhibit RNA producion in eukaryotes
Dactinomycin (affect eukaryotes)
inhibit transcription and DNA replication
SE: BM suppression, alopecia, stomatitis, immunosuppression
uses: breast cancer, lung cancer, ALL, lymphoma
resistance can develop to the drug
Doxorubicin(affect eukaryotes)
inhibit transcription and DNA replication
SE: BM suppression, alopecia, stomatitis, + RED URINE+ DILATED CARDIOMYOPATHY