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NAPLEX REVIEW

HIV

QuestionAnswer
HIV threshold for therapy: under 200cells/mm^3 OR if viral load above 100,000 copies/mL OR symptomatic
HIV HAART therapy, what it stands for: highly active antiretroviral therapy:
HIV HAART therapy, what it is: 2 Nukes and PI : : or 2 NUKES and non-Nuke
HIV resistance risk increased with: nonadherence and mono or dual therapy
nuke metabolism (1 exception) renal, abacavir hepatic: few drug interactions
nucleoside reverse transcriptase inhibitors MOA: causes chain termination, inhibiting HIV viral replication
nuke most common adverse side effect: gastrointestinal: n/v/d
nrti BBW: lactic acidosis and hepatic steatosis
abacavir: NUKE: nucleoside reverse transcriptase inhibitor:
didanosine NUKE: nucleoside reverse transcriptase inhibitor:
emtricitabine NUKE: nucleoside reverse transcriptase inhibitor: do not combine with lamivudine
lamivudine NUKE: nucleoside reverse transcriptase inhibitor: do not combine with emtricitabine
stavudine NUKE: nucleoside reverse transcriptase inhibitor: do not use with zidovudine
tenofovir NUKE: nucleoside reverse transcriptase inhibitor: nucleotide reverse transcriptase inhibitor
zalcitabine NUKE: nucleoside reverse transcriptase inhibitor:
zidovudine NUKE: nucleoside reverse transcriptase inhibitor: do not use with stavudine
Trizivir: abacavir, lamivudine, zodovudine
Combivir: lamivudine, zodovudine
Truvada: tenofovir, emtricitabine
Epzicom: abacavir, lamivudine
Atriplia: efavirenz, emtricitabine, tenofovir
NON-Nukes: (3) nevirapine, delavirdine, efavirenz is preferred
NNRTI MOA: bind directly to reverse transcriptase
NNRTI metabolism: hepatic
nevirapine: MOA and metabolism non-nuke inhibitor
efavirenz: MOA and metabolism non-nuke induce/inhibit
delavirdine: MOA and metabolism non-nuke inducer
non-NRTI class SE: liver enzymes, rash, HA
efavirenz SE: CNS symptoms and teratongenicity
protease inhibitor MOA: inhibit viral protease, necessary to cleave newly produced viral parts into functional virions
PI metabolism liver, 3A4
PI drug interactions: rifampin (3A4 inducer), simvastatin (3A4 substrate), lovastatin (3A4 substrate, oral contraceptives (3A4 substrate)
PI dose adjustments with: NNRTI (3A4 inducer), atorvastatin (3A4 substrate), methadone (3A4 substrate), sildenafil (3A4 substrate), rifabutin (3A4 inducer), azole antifungals (3A4 inhibitor), phenytoin (3A4 inducer), clarithromycin (3A4 substrate)
ritonavir boosting: 3A4 inhibitor: low doses used to enhance the concentrations of PIs: give at same time
PI class SE: n/v/d, hyperglycemia, dyslipidemia, fat re
amprenavir PI
atazanavir PI
tripanavir PI
fosamprenavir PI
indinavir PI
lopinavir/ritonavir PI
nelfinavir PI
ritonavir PI
saquinavir hard PI
saquinavir soft PI
dorunavir PI
fusion inhibitor: enfuvirtide
fusion inhibitor MOA: inhibits attachment to CD4 cells
fusion inhibitor dosage form: dry powder for reconstitution SQ
fusion inhibitor adverse reactions: enfuvirtide: local injection site reactions, pain, erythema, pneumonia, and hardening of tissue (induration)
pneumocystis carinii pneumonia treatment: PCP: trimethoprim-sulfamethoxazole
CMV retinitis treatment (4) ganciclovir, valganciclovir, foscarnet (for resistant), cidofovir
mycobacterium avium complex treatment: ethambutol AND (clarithromycin or azithromycin) +- FQ for serious disease
cryptococcus neoformans meningitis treatment: amphotericin B +- flucytosine with fluconazole for maintenance therapy
Created by: vitasoy
 

 



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