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adv and dis of HIV
adv and dis of ART initial therapy
| discription of drug adv & dis | drug |
|---|---|
| has less lipid effect than efavirenz | nevirapine |
| skin rash is a class effect | NNRTI |
| has highest hepatotoxicity of NNRTI's | nevirapine |
| can't be used with a good immune system >250 in women and 400 in men | nevirapine |
| must be titrated on for 2 weeks | nevirapine |
| contraindicated in first trimester | efavirenz |
| metabolic complications is a class effect | PI |
| GI is a class adverse effects | PI |
| which PI has the least amount of adverse effects on lipids | atazanavir |
| which PI has good GI tolerability (importatant to know because PI's have bad GI SE | atazanavir |
| which PI's (two) leads to hyperbilirubinemia | atazanavir and indinavir |
| which PI can prolong your PI interval | atazanavir |
| which drugs must have an acidic enviroment to be absorbed | fosamprenavir, atazanavir, indinavir, tipranavir, delavirdine(NON nuke) |
| which drugs have a food requirement | atazanavir (must), darunavir(should), nelfinavir( must), etravirine(must), zidovudine (decrease GI discomfort but not a must) saquinavir (should) ( don't get "D" drugs mixed up, one requires food and other is empty stomach) |
| which drugs requires an empty stomach | efavirenz (qhs to decrease CNS effects), didanosine, indinavir (if not used with ritonavir) ( don't get "D" drugs mixed up, one requires food while other is on empty stomach) |
| which drugs can cause nephrolithiasis | indinavir and atazanavir. drink 1.5 to 2 liters of water a day. Probably won't be good for someone on a fluid restricted diet or someone who aspirates or has a history of nephrolithiasis. (bevs need to be non caffeinated, counsel) |
| drug cause bad hyperlipidemia | all PI except (atazanavir less) plus stavudine(nuke), efavirenz (non-nuke), nevirapine(non-nuke) |
| which PI is recommended in pregnant women | lopinavir/ritoniavir only in twice daily formulation and the alternative PI reg is saquinavir and ritonavir. You might use the alternative when women has bad lipidemia because has less effect than lopinavir but has high pill burnden and must eat with it |
| which class has lactic acidosis and hepatic steatosis | NRTI's with stavudine, zidovudine and didanosine the worst |
| which combo may increase cardio effects in those with cardio risk factors | abacavir and lamivudine combo so brand epzicom |
| drug combo disadvantage of causing peripheral neuropathy, pancreatitis, and must be taken on empty stomach | didanosine and lamivudine or didanosine and emtricitabine |
| which drug combo increase toxicities when use with ribavirin | didanosine and lamivudine or didanosine and emtricitabine. zidovudine and ribavirin together will be a double wammy on the bone suppression |
| might think twice before using this class in hemophiliacs because cause an increase risk of bleeding | PI's |
| this combo may cause reanl impairment and may decrease bone mineral density (look in the case for osteoporosis or on a bisphosphate) | tenofovir or emtricitabine |
| what is the preferred NRTI based reg in pregnant women | zidovudine and lamivudine ( don't know why, high incidence of GI effects, a guy wrote these guidelines) |
| this combo causes bad mitrochondrial tox including lipoatrophy, lactic acidosis and hepatic steatosis | zidovudine lamivudine combo brand for this combivir and also in the trizivir combo |
| why is delavirdine no recommended as initial therapy | inferior virologic efficacy and inconvenient (TID) dosing. rash is worse than with nevirapine, contraindicated with PPI (many HIV patients need) |
| why is enfuvirtide not recommended as initial thearpy | requires twice daily sub Q injections that require daily reconstitutions |
| why is indinavir unboosted and indinavir boosted not recommended as initial therapy | (unboosted needs TID dosing and meal restriction) both are bad and nephrolithiasis and require large amounts of water |
| ritonavir as sole PI not recommened | high pill burden and GI effects that most can't handle |
| stavudine and lamivudine are not used together why also stavudine and didanosine | significant toxicities like lipoatrophy (- stav and did combo), peripheral neuropahty, hyperlactatemia, lactic acidosis, hepatic steatosis, and pancreatitis. (GEEESE i get it, SE suck) |
| why should atazanavir and indinavir never be used together | hyperbilirubinemia |
| stavudine and zidovudine are not used together why | antagonistic effects |
| class effects of NRTI's | lactic acidosis, hepatomegaly, and fat redistribution |
| which NRTI is not renal adjusted | abacavir |
| which NRTI's are also active against HEP B (although not approved by FDA) | lamivudine, emtricitabine, tenofovir ( if have both, put on emtricitabine since first line in HIV) |
| which drugs cause hyperpigmentation | emtricitabine( palms and soles) zidovudine ( skin and nails) |
| which drugs cause pancreatitis and peripheral neuropathy | didanosine and stavudine |
| of the NRTI's which cause the greatest risk of lipodystrophy | stavudine |
| which drugs really need lipid level monitoring | all PI's stavudine, and NNRTI's |
| can cause acute renal insufficiency, fanconi syndrome, or chronic renal insufficiency | tenofovir |
| which drug can make you test false positive for THC | efavirenz |
| which drugs are absolutely never used in PEP | abacavir (needs test), delavirdine(just plain sucks), nevirapin (immune system is usually good and might make them feel like they have HIV, rash, hepatotoxic), maraviroc (needs test), raltegravir (not studies and worried about compliance with injection) |
| which drugs are CI with amiodarone | indinavir and ritonavir itherefor all boosted things) |
| which drugs might you stear clear of in a patient with sulfanomide allergy | durinavir, tipranavir, fosamprenavir/(amprenavir) |
| which drug must be kept in fridge | ritonavir capsules (only stable at room temp for 30 days) so if hot, put in fridge) cofomulated keletra tablets don't need be frigerated |
| which drug is associated with intracranial hemorrhage | tipranavir |
| drug need to avoid alcohol with because increase concentration by 41% | abacavir |
| biggest offender of diarrhea | nelfinavir. use loperamide and diphenoxylate/atropine |
| greater than 1000 ? of vit C decrease the concentration of | indinivir |
| which drugs cause both hyperbilirubinemia and nephrolithias | atazanavir and indinavir |
| drug could increase CPK levels and could progress to rabdo | ralegravir |
| maraviroc's AE's are | increase LFT, cough, orthostatic hypotension, many DDI so adjust based on other drugs. other things to know is requires tropisim CCR5 assement and only for those resistant to other thigns |
| what are the preferred PI opition | remember they are all boosted ( atazanavir/r, darunavir/r, fosamprenavir/r, loprinavir/r (not for pregers) |
| what are alternative PI | unboosted atazanavir or fosamprenavir, fosamprenavir once daily vs twice daily preffered, saquinavir/r |
| preferred NRTI combo | emtricitabine/tenofovir (not in renal insufficiency (<50 once you add on the efavirenz) |
| alternative NRTI combo;s | abacavir/lamivudine(bad in cardio), abacavir/emtricitabine,didanosine/emtricitabine, didanosine/lamivudine, (bad combo in pancreatitis/ per neuropathy, or zidovudine/lamivudine(bad in pancreatitis/peripheral neuropath and anemic/neutropenic patients) |
Created by:
lainylaina