HIV Exam 1
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| Which NRTIs are NOT once daily dosing? | stavudine and zidovudine
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| Which NRTI should be taken on an empty stomach? | didanoside (Videx)
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| Who is at increased risk of NRTI-related lactic acidosis? | Obese females
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| Which NRTI does not require renal adjustment? | abacavir (Ziagen)
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| What is abacavir's black box warning? | Hypersensitivity reaction; symptoms are fever, rash, respiratory symptoms, and/or GI symptoms; usually starts within 4-6 weeks
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| What is didanosine's black box warning? | Pancreatitis, dose-related
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| What drugs should not be used concurrently with didanosine (contraindicated)? | ribavirin and allopurinol
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| Which NRTI combination offer the greatest risk for lactic acidosis? | didanosine (Videx) and stavudine (Zerit)
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| Which NRTIs are weight-adjusted? | didanosine (Videx) and stavudine (Zerit)
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| Major side effect of emtricitabine | Hyperpigmentation, usually of the palms or soles
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| Which NRTIs treat HepB? | emtricitabine (Emtriva), lamivudine (Epivir), and tenofovir (Viread)
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| What is stavudine's black box warning? | Pancreatitis
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| Which NRTI has the best CNS penetration? | zidovudine (Retrovir)
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| What is zidovudine's black box warning? | Associated with bone marrow suppression and/or pancytopenia; for monitoring, assess MCV after 4 weeks (it should be >100)
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| Major side effect of tenofovir | Nephrotoxicity: Fanconi syndrome, ARF
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| Which NRTI has lipodystrophy as a side effect? | stavudine (Zerit)
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| NRTI class side effects | lactic acidosis and GI (N/V, diarrhea)
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| Which NRTIs have peripheral neuropathy as a side effect? | stavudine (Zerit) and didanosine (Videx)
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| NNRTI class side effects | Rash (greatest with nevirapine)
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| Which NNRTI requires "lead in" dosing? | nevirapine (Viramune); after that, it is BID; must also re-start lead-in dose if it's been >7 days without the medication
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| What are the nevirapine CD4 cut offs? | Use in women with <250 and in men with <400
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| Do you take efavirenz (Sustiva) with food? | NO, on an empty stomach
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| Major side effect of efavirenz (Sustiva) | CNS side effects
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| Dosing frequency: efavirenz (Sustiva) | Once daily
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| Which NNRTI is not effective therapy for HIV-2? | nevirapine (Viramune)
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| Do you take rilpivirine (Edurant) with food? | YES, daily with meal
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| Dosing frequency: rilpivirine | Once daily
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| Which NNRTI has high rate of failure if HIV-RNA level is >100,000? | rilpivirine (Edurant)
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| Which medications should not be given and/or separated from rilpivirine (Edurant)? | Do not use with PPIs; separate from H2RAs and antacids
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| Pregnancy category of rilpivirine | B
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| In whom is nevirapine-related hepatoxicity risk greater? | Females
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| Which NNRTI has a black box warning about severe skin reactions? | nevirapine (Viramune)
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| Dosing frequency: atazanavir | daily
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| Do you take atazanavir (Reyataz) with food? | YES
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| Major side effects of atazanavir (Reyataz) | 1) hyperbilirubinemmia 2) PR interval prolongation 3) nephrolithiasis
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| What is the major drug interaction concern with atazanavir (Reyataz)? | The drug requires an acidic environment, so do not give simultaneously with PPIs or H2RAs. Omeprazole max dose is 20mg/day in treatment-naive patients; CI in treatment-experienced patients.
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| Dosing frequency: darunavir (Prezista) | DAILY in treatment-naive; TWICE DAILY in treatment-experienced
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| Do you take darunavir (Prezista) with food? | YES
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| In which patients should you use darunavir (Prezista) with caution? | Sulfa allergy
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| Dosing frequency: lopinavir/ritonavir (Kaletra) | DAILY or BID in treatment-naive; TWICE DAILY in treatment-experienced
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| Dosing frequency: fosamprenavir (Lexiva) | DAILY or BID in treatment-naive; TWICE DAILY in treatment-experienced
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| In which PI is lipid elevations, especially of TRIG, especially a concern? | lopinavir/ritonavir (Kaletra)
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| In which PI is QTc prolongation especially a concnern? | saquinavir (Invirase)
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| Do you take ritonavir (Norvir) with food? | YES
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| In which PI are PPIs ok to use, but not H2RAs? | fosamprenavir (Lexiva)
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| For lopinavir/ritonavir (Kaltera), when would you increase the number of pills taken? | Increase dose to 3 tablets BID with inducers such as efavirenz or nevirapine
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| Which PI is considered to be lipid neutral? | atazanavir (Reyataz)
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| Dosing frequency: raltegravir (Isentress) | TWICE daily
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| Take raltegravir with food? | It doesn't matter
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| What is an important monitoring aspect regarding raltegravir (Isentress)? | Monitor lipid panel and CPK, as it may cause rhabdomyolysis
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| What is unique about the metabolism of raltegravir (Isentress)? What is one drug that should be used with caution if given concurrently? | UGT1A1-mediated glucoronidation. Rifampin is a strong inducer of UGT1A1, so it will decrease levels of raltegravir.
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| Dosing frequency: enfuvirtide (Fuzeon) | TWICE daily, SUBCUTANEOUS
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| Is enfuvirtide (Fuzeon) effective in HIV-2? | No
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| How do you store reconstituted vials of enfuvirtide (Fuzeon)? | In the fridge for 24 hours
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| Major side effect of enfuvirtide (Fuzeon) | Local injection site reactions
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| Dosing frequency: maraviroc (Selzentry) | TWICE daily
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| Take maraviroc (Selzentry) with food? | It doesn't matter
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| Name three medications that will require maraviroc (Selzentry) to be dose-adjusted | Maraviroc is a 3A4 substrate so it requires dose adjustment with inhibitors and inducers; ritonavir (it is a strong 3A4 inhibitor); efavirenz and rifampin (they are 3A4 inducers)
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| HIV-2 has de novo resistance to what? | NNRTIs and Fuzeon
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| What is the type of resistance obtained without prior drug exposure? | Primary
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| Which 'do not use' combination causes additive hyperbilirubinemia? | atazanavir +indinavir
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| What are the NRTI combinations that are on the 'do not use' list? | lamivudine + emtricitabine AND didanosine + tenofovir
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