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37 Cards in this Set
- Front
- Back
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NUCLeoside reverse transcriptase inhibitors
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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) |
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non-NUCLeoside reverse transcriptase inhibitors
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directly inhibit reverse trancriptase
Efarienz Nevirapine |
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protease inhibitors
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prevent viral proteins from being cleaved from gag-pol-env
Ritonavir atazanavir Darunavir indinavir nelfinavir |
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fusion inhibitors
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prevent fusion of the HIV virus particle to host target cell by binding to gp41 on the virus
not part of initial ART regimen |
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integrase inhibitors
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inhibit HIV-1 integrase so prevent integration and insertion of HIV DNA into human DNA
Raltegravir |
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chemokine coreceptor anatagonists
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CCR5 anatagonists on WBC targeted by HIV
prevent viral entry into cell Hepatotoxic, increase risk of infx, cancer, systemic allergic rxn, MI Maraviroc |
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start HIV therapy
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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 |
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recommended HIV ART regimen
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2 NRTI + (1 boosted protease inhibitor or 1 integrase inhibitor or 1 CCR5 antagonist(least preferred))
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treatement Naive pts
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specific regimens
efavirenz +tenofovir+emtricitabine ritonavir-boosted atazanavir +tenofovir+emtricitabi ritonavir-boosted darunavir +tenofovir+emtricitabi ritonavir+tenofovir+emtricitabi |
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HIV+ pregnant women
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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 |
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acute retroviral syndrome
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mononucleosis like syndrome that occurs in the 1st week of HIV infx
represents acute stage of HIV maye be treated to reduce viral load |
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opportunistic infx and treatements/prphylaxis
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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 |
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opportunistic infx and treatements/prphylaxis
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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 |
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opportunistic infx and treatements/prphylaxis
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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 |
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antibiotics that act of 50S subunit
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chloramphenicol (bacteriostatic)
Erthyromycin (bacteriostatic, macrolide) clindamycin |
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antibiotics that act of 30S subuni
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tetracycline (bacteriostatic, demeclocycline, oxytetracycline, minocycline, tigecycline, doxycycline)
Aminoglycosides (BACTERIOCIDAL, gentamicin, streptomycin, tobramycin, amikacin) |
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aminoglycosides
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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 |
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tetracyclines
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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 |
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chloamphenicol
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very toxic,
effective against aerobes inhibits P450 bone marrow toxic-->aplastic anemia can casue GREY BABY SYNDROME |
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Erythromycin
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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 |
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clindamycin
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DOC: anaerobic infx above diaphragm
same MOA as chlromaphenicol |
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eukaryotes
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Diptheria toxin: protein syntheis in eukaryotes
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pyrimethamine
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inhibit folate use
treat: toxoplasmosis alt: pneumocystitis and toxopl. |
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trimethoprim
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inhibit folate use
DOC and prophy: pneumocyctis Prophy DOC: toxopl |
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sulfa antibiotics/sulfonamides
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inhibit folate synthesis in bacteria by inhibiting DIHYDROPTEROATE SYNTHETASE
sulfadiazine sulfisoxazole sulfamethoxazole casue MEGALOBLASTIC ANEMIA |
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dapsone
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inhibit folate synthesis in bacteria by inhibiting DIHYDROPTEROATE SYNTHETASE
casue MEGALOBLASTIC ANEMIA |
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6 Mercaptopurine
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form thi-IMP-->thio-GMP acts to inhibit purine synth then DNA and RNa syntheis
for acute lymphocytic leukemia (ALL) hepatotoxic, bone marrow suppresion |
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cytarabine
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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 |
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flourouracil (5FU)
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inhibits thymidine syntehiss
for slow growing solid tumors (breast, colorectal, gastric) BM suppression |
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Actinomycin D/Dactinomycin
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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 |
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doxorubicin/adriamycin
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creaset ROS-->DNA damage
interclates between base pairs binds plasma memb-->decrease IP3 coupled transport BM suppression CARDIOTOXIC-->casue CARDIOMYOPHATH-->hEART FAILURE |
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Bleomycin
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binds DNA adn creates ROS-->DNA breaks
neprotoxic, hepatotoxin, toxic to skin, FIBROSIS OF LUNGS |
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Flouroquinolones (ciprofloxacin, levo, moxi, gemi)
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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 |
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rifampin (affect prokaryotes)
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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: |
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Alpha-amanitin (affect eukaryotes)
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toxin in poison mushrooms-->inhibit RNA producion in eukaryotes
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Dactinomycin (affect eukaryotes)
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inhibit transcription and DNA replication
SE: BM suppression, alopecia, stomatitis, immunosuppression uses: breast cancer, lung cancer, ALL, lymphoma resistance can develop to the drug |
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Doxorubicin(affect eukaryotes)
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inhibit transcription and DNA replication
SE: BM suppression, alopecia, stomatitis, + RED URINE+ DILATED CARDIOMYOPATHY |
