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HIV Exam 1

Which NRTIs are NOT once daily dosing? stavudine and zidovudine
Which NRTI should be taken on an empty stomach? didanoside (Videx)
Who is at increased risk of NRTI-related lactic acidosis? Obese females
Which NRTI does not require renal adjustment? abacavir (Ziagen)
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
What is didanosine's black box warning? Pancreatitis, dose-related
What drugs should not be used concurrently with didanosine (contraindicated)? ribavirin and allopurinol
Which NRTI combination offer the greatest risk for lactic acidosis? didanosine (Videx) and stavudine (Zerit)
Which NRTIs are weight-adjusted? didanosine (Videx) and stavudine (Zerit)
Major side effect of emtricitabine Hyperpigmentation, usually of the palms or soles
Which NRTIs treat HepB? emtricitabine (Emtriva), lamivudine (Epivir), and tenofovir (Viread)
What is stavudine's black box warning? Pancreatitis
Which NRTI has the best CNS penetration? zidovudine (Retrovir)
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)
Major side effect of tenofovir Nephrotoxicity: Fanconi syndrome, ARF
Which NRTI has lipodystrophy as a side effect? stavudine (Zerit)
NRTI class side effects lactic acidosis and GI (N/V, diarrhea)
Which NRTIs have peripheral neuropathy as a side effect? stavudine (Zerit) and didanosine (Videx)
NNRTI class side effects Rash (greatest with nevirapine)
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
What are the nevirapine CD4 cut offs? Use in women with <250 and in men with <400
Do you take efavirenz (Sustiva) with food? NO, on an empty stomach
Major side effect of efavirenz (Sustiva) CNS side effects
Dosing frequency: efavirenz (Sustiva) Once daily
Which NNRTI is not effective therapy for HIV-2? nevirapine (Viramune)
Do you take rilpivirine (Edurant) with food? YES, daily with meal
Dosing frequency: rilpivirine Once daily
Which NNRTI has high rate of failure if HIV-RNA level is >100,000? rilpivirine (Edurant)
Which medications should not be given and/or separated from rilpivirine (Edurant)? Do not use with PPIs; separate from H2RAs and antacids
Pregnancy category of rilpivirine B
In whom is nevirapine-related hepatoxicity risk greater? Females
Which NNRTI has a black box warning about severe skin reactions? nevirapine (Viramune)
Dosing frequency: atazanavir daily
Do you take atazanavir (Reyataz) with food? YES
Major side effects of atazanavir (Reyataz) 1) hyperbilirubinemmia 2) PR interval prolongation 3) nephrolithiasis
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.
Dosing frequency: darunavir (Prezista) DAILY in treatment-naive; TWICE DAILY in treatment-experienced
Do you take darunavir (Prezista) with food? YES
In which patients should you use darunavir (Prezista) with caution? Sulfa allergy
Dosing frequency: lopinavir/ritonavir (Kaletra) DAILY or BID in treatment-naive; TWICE DAILY in treatment-experienced
Dosing frequency: fosamprenavir (Lexiva) DAILY or BID in treatment-naive; TWICE DAILY in treatment-experienced
In which PI is lipid elevations, especially of TRIG, especially a concern? lopinavir/ritonavir (Kaletra)
In which PI is QTc prolongation especially a concnern? saquinavir (Invirase)
Do you take ritonavir (Norvir) with food? YES
In which PI are PPIs ok to use, but not H2RAs? fosamprenavir (Lexiva)
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
Which PI is considered to be lipid neutral? atazanavir (Reyataz)
Dosing frequency: raltegravir (Isentress) TWICE daily
Take raltegravir with food? It doesn't matter
What is an important monitoring aspect regarding raltegravir (Isentress)? Monitor lipid panel and CPK, as it may cause rhabdomyolysis
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.
Dosing frequency: enfuvirtide (Fuzeon) TWICE daily, SUBCUTANEOUS
Is enfuvirtide (Fuzeon) effective in HIV-2? No
How do you store reconstituted vials of enfuvirtide (Fuzeon)? In the fridge for 24 hours
Major side effect of enfuvirtide (Fuzeon) Local injection site reactions
Dosing frequency: maraviroc (Selzentry) TWICE daily
Take maraviroc (Selzentry) with food? It doesn't matter
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)
HIV-2 has de novo resistance to what? NNRTIs and Fuzeon
What is the type of resistance obtained without prior drug exposure? Primary
Which 'do not use' combination causes additive hyperbilirubinemia? atazanavir +indinavir
What are the NRTI combinations that are on the 'do not use' list? lamivudine + emtricitabine AND didanosine + tenofovir
Created by: 2029334