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IOS 11 Exam 4
Drug Interactions
| Question | Answer |
|---|---|
| Nucleoside reverse trasncriptase inhibitors excretion | Renal excretion and do not participate in drug interactions involving the liver |
| Efuvirtide excretion | Cleared by peptide catabolism and amino-acid recycling, drug interactions are not expected |
| Non nucleoside reverse transcriptase metabolism | Extensive hepatic metabolism |
| Protease inhibitors metabolism | Extensive hepatic metabolism |
| 3A4 inhibition is caused by | Ritonavir>Delaviridine>Nelfivavir>Indinavir>amprenavir?saquinavir |
| 3A4 enzyme induction | Lopinavir/r > Tipranavir/r = Darunavir/r > Nelfinavir =Indinavir=Delaviridine=Atazanavir |
| Therapeutic failure is | Viral load increases and the CD4 count declines. Resistance can occur to drug and class |
| Pharmacodynamic activity maybe | Additive, Antagonastic,Synergistic |
| Ritonavir is a potent inhibitor of | 3A4 and P-gP in the intestanal tract and Liver |
| Boosting dose of Ritonavir is | 100-200mg |
| Benefit of Indinivar/Ritonavir | Indinivar no longer has to be given on empty stomach |
| Efavirenz is an inducer and Kaletra (lopinavir/ritonavir) an inhibitor what happens | Efavirenz induces the metabolism of lopinavir AUC 40%. If give this combination take 3 tablets BID of Kaletra rather than 2BID=PK interaction. This occurs with many protease inhibitors and Efavarinz in a lot of the cases boost with 100mg of ritonavir PK |
| Tenofovir and Atazanavir interaction MOA | Do not known but Boost with Ritononavir |
| Fos-Amprinavir and Lopinavir | Both induce the metabolism of the other and boosting does not help. Do not use together PK |
| Tipranavir and other Protease inhibitors | Saquanavir,Amprinavir,lopinavir should not be used Tipranavir induces PK |
| Zidovudine and Stavudine | Thymidine analogs should not be used together-antagonism PD |
| Didanosine and tenofovir | Should not be used together they are adenosine analogs antagonism=PD also a Didanosine AUC is increased 48-64% so there is also a PK interaction if patient is >60Kg 250mg and 200mg if <60kg |
| Atazanavir + Rifampin | Decreased concentration of Atazanavir boosting does not work- PK |
| Efavarinz +Rifampin | AUC of Efavarinz is decreased 25% so increase does to 800mg monitor level in 2-4 weeks PK |
| Rifabutin + Ritonavir boosted | Decrease Rifabutin to 150mg 2-3 times a week PK |
| Efavarinz +Rifabutin | Remember Efavarinz is an inducer so must increase Rifabutin 450-600mgday |
| Bactrium(cotrimoxazole) +zidovudine | Overlapping bone marrow suppression=PD Monitor WBC |
| Didanosine +Ribavarin | Coadministration is not recommended due to pancretitis and lactic acidosis-PD |
| Ribavarin increases levels of DDAPT so when there is an accumulation | This can increase pancrititis and lactic acidosis |
| Atazanavir +omeprazole | Atazanavir is acid dependant for absorption and cannot be taken with a PPI can use H2 blocker is space 10 hours then 2 or take boosted with ritonavir and H2- PK |
| Tipranavir and PPI or H2 | Not recommended PK |
| INdinavir and PPI | There is a decrease in AUC must take with booster of Ritonavir |
| Lopinavir/ritonavir + Simvastatin or Lovastatin | They are contraindicated since high AUC- Choose Pravstatin or FLuvastatin- PK |
| Ritonavir + Sidenafi | Decrease Sildenafil to 25mg q48 hr PK |
| Ritonavir +Vardinafil | Vardinafil must be decreased to 2.5mg q72 hrs-PK |
| Ritonavir + Tadalafil | Tadalafil must be decreased to 10 mg q 72 hr-PK |
| Atazanavir + oral contraceptives | Increases the oral contraceptions concentrationIndinavir + Oral Contraceptive NC |
| Lopinavir/ritonavir + Phenytoin | Both drugs induce each other monitor drug levels-PK |
| St. Johns Worts + Protease inhibitor | Do not use Higly decrease protease concentration- PK |
| Secondary Adrenal Suppression | Weight gain, fatigue- Cushings this occurs from steroids- Protease inhibitors increase concentration so must monitor when give even an inhaled steroid- PD |
| Protease Inhibitors have increased rates of | Glucose and lipid abnormalities |
| Efavirenz is contraindicated in | Pregnancy |
| Pregant women should avoid | Efavarinz, Zalcitabine, Delaviridine |
| Need dose adjustment for renal dysfunction | emtricitabine, lamivudine,zidovidine,didanosine,tenovir,stavudine,abacavir |
| Treat HIV and HBV | Lamivudine,Tenofovir,emtricitabine Travuda=emtricitabine+tenofovir |
| Cytosine analogs are | Zalcitibine,emtricitabine,lamivudine |
| Thymidine analogs are | Stavudine, zidovudine |
| Adenosine analogs are | Didanosine and Tenofovir |
| Guanosine analogs are | Abacavir |
Created by:
liza001
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