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56 Cards in this Set

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How does HIV enter the cell?
By attaching to Gp120 and anchors to GP41
What do antiretroviral meds do?
control viral replication and slow HIV disease progression
What is HAART?
a highly active combination of 3 or more ARTs
What is a side effect of the NRTIs?
Upset stomach-DDI
Pancreatitis-DDI, d4T
Peripheral neuropathy-DDI
Define adherance
The willingness and ability to start and take medications as prescribed
What do protease inhibitors do?
prevent HIV from being assembled and released from infected CD4 cells
What do fusion inhibitors do?
prevent GP120 from binding to CD4 cells
what was the first antiretroviral?
Zidovudine (AZT,Retrovir)1987
What is the dose for Fuzeon (T-20)?
90mg SC BID

Local site Rxn: induration, nodules, cysts, redness, pain
Which NRTI is NOT renally excreted?
Abacavir, so you don't have to dose adjust
What is the MOA of NRTIs?
incorporates into DNA and causes chain termination
What is the dose for retrovir(AZT)?
300 mg/BID
Which drug should you NOT combine with retrovir?
Stavudine-(d4T)Zerit
What is the dose of Zerit (d4T)
40mg BID if >60kg
30mg BID if <60kg
What is the dosing for Abacavir (ABC)
600mg/day
What is the MOA of NNRTIs?
inhibit RT by noncompetitively attaching to and inhibiting RT
Which drug causes a hypersensitivity reaction?(skin rash)
Abacavir

The rash has to be reported
Which NRTI causes > cholesterol and > triglycerides?
Stavudine (d4T)
Which NRTI causes anemia, neutropenia, and muscle weakness?
Zidovudine (Retrovir, AZT)
Which statin causes lactic acidosis?
Metformin

So don't give this in combination with NRTIs
Name the NNRTIs
Efavirenz (EFV)
Nevirapine (NVP)
Delavirdine (DLV)
What is the dose for Nevirapine(NVP)?
200 mg/daily x 14 days
then
400 mg/daily
Is Nevirapine and inhibitor or inducer?
Inducer
What is the dose of Efavirenz?
600 mg/daily in the morning(to prevent nightmares)

Do NOT take with food
Is Efavirenz an inducer or inhibitor?
Both
What are the side effects of NNRTIs?
Rash
CNS toxicity-Efavirenz (confusion, nightmares, dizziness)
Liver toxicity
What is the MOA of Protease Inhibitors?
prevent HIV from being successfully assembled and released from infected CD4 cells
What is the dose of Saquinavir(SQV)?
Only boosted w/ RTV:

2000/100 mg/daily

Taken within 2hrs of meals
What is the dose of Ritonavir?
600 mg
twice daily
as sole PI
As booster:
100-200 mg
once-twice daily
A VERY powerful inhibitor
Ritonavir
What is the biggest side effect of Indinavir?
Kidney stones, so take this pill with 48oz of water
Do not take this PI w/ food except when taken w/ RTV;
Do not combine w/ ATV, and take it with lots of water
Indinavir
Which drug do you NOT combine
w/ IDV?
Atazanivir (ATV)
What is the dose of Fosampremavir (f-APV)?

(Very popular drug)
1400/200 mg/daily boosted with RTV

Do not combine with APV
What is the dose of Tipranavir (Aptivus)
ONLY boosted:
500/200 mg/BID
What are the side effects of Protease inhibitors?
>Glucose-Indinavir
>Cholesterol-Ritonavir
Diarrhea-Nefinavir
Lipodystrophy-buffalo hump, >breast size
Which PI > cholesterol?
Ritonavir
Your pt has >cholesterol, which PI would you prescribe?
atazanavir (cholesterol friendly)
What are the side effects of Protease Inhibitors?
> Glucose (Indinavir)
> Cholesterol (Retonavir)
Rash-(don't give to sulfa allergic) APV, f-APV, Tipranavir
> Bilirubin- IDV, ATV
Kidney stones- IDV
Which drug increases the levels of Didanosine causing toxicity?
Tenofovir
Which drug should you avoid taking with Lamivudine?
Emtricitabine
Which drugs decrease Atazanavir levels?
Efavirenz
Tenofovir
how should you take Didanosine?
Take at least 30 minutes before or 2 hrs after a meal, except when taken with tenofovir
How much does food decrease the levels of Didanosine?
It decreases levels by 55%
How does food effect Efavirenz?
Cmax increases 39-79% w/ high-fat/caloric meals
T/F Efavirenz should be taken on an empty stomach
TRUE
How does food effect unboosted Indinavir and how should it be taken?
decreases levels by 77%

Take 1 hour before or 2 hrs after a meal, except when taken with ritonavir
When would you start ART?
All patients with AIDS
CD4 count <200

Offer Tx:
CD4 >200 - <350
Which combo would you give a naive ART pt?
Efavirenz + Lamivudine + Tenofovir
what are the side effects of Indinavir?
Kidney stones
>Glucose
>Bilirubin
Describe the PIs
PIs- Prevents assembly and release of HIV

Fosamprenavir- Do NOT combine with APV(prodrug)
Dose: 1400/200 with RTV

Ritonavir- > Triglycerides; Inhibitor
Dose: 600mg/BID as sole PI or 100-200 as booster (take with food)

Indinavir- S.E:Kidney stones, >glucose, >Bili;
Food > by 77%-take 1hr B4 or 2hr after meals

Saquinavir- Only boosted 2000/100mg/daily; take w/in 2hrs of meal

Amprenavir- Do NOT combine with f-APV

Atazanavir- Cholesterol friendly; >Bilirubin

Nelfinavir- Diarrhea

Tipramavir- Only boosted 500/200 BID
Describe the NRTIs
NRTI- Incorporates into DNA causing chain termination

Abacavir- H.S.Rxns; needs no renal adjst
Dose: 600mg/daily

Zidovudine- Anemia, neutropenia; do NOT combine with d4T; prevents perinatal transmission
Dose: 300mg/BID

Tenofovir- NucleoTIDE; >DDI levels; used for HBV
Dose: 300mg/daily

Didanosine- Food < 55%, take 30min B4 of 2hrs after meals; many side effects

Lamivudine(3TC)- do NOT combine with FTC

Stavudine- >cholesterol, >triglycerides; do NOT combine with AZT
Dose: 40mg/BID >60kg, 30mg/BID <60kg
Describe the NNRTIs
NNRTI- Inhitbit RT by attaching to enzyme

Efavirenz- Both Inhibitor/Inducer; CNS symptoms, nightmares
Dose: 600mg/daily in AM; do NOT take with food

Nevirapine- Inducer

Delavirdine
What are the side effects of PIs?
>cholesterol- Ritonavir
>Glucose- Indinavir
Diarrhea- Nelfinavir
Lipodystrophies- Fat accumulation
What are the side effects of NRTIs?
Stomach upset- DDI
Head ache
Pancreatitis- DDI + d4T
Peripheral neuropathy- DDI
Lactic Acidosis- DDI, d4T
Lipoatrophy- d4T + DDI
What are the side effects of NNRTIs?
CNS- Efavirenz
Liver Toxicity- Nevirapine
Rash- Nevirapine