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Pharm Exam 2
Terms in this set (65)
What nucleoside is Zidovudine an analogue for?
What are the adverse drug reactions of Zidovudine?
bone marrow supression
What two drugs should you never give with Zidovudine?
In what scenarios is Zidovudine particularly useful as an ARV?
use for children and in perinatal treatment
initial preferred HAART standard
What NRTIs are noted to have drug-drug interactions with Ribavarin?
What nucleoside is Didanosine an analogue for?
What are the adverse drug reactions of Didanosine?
What nucleoside is Stavudine an analogue for?
What are the adverse drug reactions of Stavudine?
Lamivudine is an analogue for
Lamivudine has minimal side effects. True or false?
True. It is a well-tolerated drug. GI upset is the usual complaint.
An HIV patient has been diagnosed with Hepatitis B. What NRTIs are you thinking of prescribing?
Lamivudine, Emtricitabine, or Tenofovir. All three also can be used for Hep B treatment.
What's the down side to Lamivudine?
It only causes a single-point mutation, so it can lead to resistance.
Abacavir is an analogue for...
What should you be wary of with Abacavir use?
A fatal hypersensitivity reaction that happens in 3-5% of patients. Results in fever, rash, GI and other systemic problems.
What can you do to prevent the aforementioned problem?
Order an HLAB5701 test, which checks to see if the patient is susceptible to this reaction.
What is one cause of DDI between NRTIs?
If they are analogues for the same nucleoside. Competitive antagonism will decrease effectivity of these drugs.
What are the adverse drug reactions of Emtricitabine?
Why is Emtricitabine included in Atripla?
It has such a long half-life that it only has to be administered once a day.
Tenofovir is an analogue for
Adenine <-- a nucleoTIDE!
Adverse drug reactions of Tenofovir
Two advantages to Tenofovir are that
It is less toxic.
It already has a phosphate group and only needs to be diphosphorylated to be activated.
What 4 NRTIs are part of the HAART initial preferred regimen list?
The adverse drug reactions common to all NRTIs
What is a major patient factor causing NRTI dosage be adjusted?
Renal problems; all NRTIs are renally eliminated.
How do Non-Nucleotide Reverse Transcriptase Inhibitors work?
The name says it all. They are still inhibitors of reverse transcriptase. But they don't do this by acting as nucleotide impostors. Rather, they deactivate reverse transcriptase by binding to it allosterically, changing the shape of the enzyme.
Can both NRTIs and NNRTIs be used against any strain of HIV?
No. NRTIs work against both strains. But NonNRTIs only work against HIV1.
The adverse drug reactions common to all NonNRTIs
What is Stevens-Johnson syndrome?
This is a hypersensitivity reaction in which the epidermis separates from the dermis. It also involves destruction of mucus membranes. It can be caused by Nevirapine. It is why patients on this drug should be monitored closely for up the first 12 weeks.
What's a down side to NonNRTIs?
They are hepatically metabolized - specifically by CYP450 - so that they interfere with a lot of drugs.
Your pt has HIV and high cholesterol. What's one drug that comes to mind?
Nevirapine - it is not just a NonNRTI, but it also has a side effect which lowers LDL.
Your patient has HIV, and is an avid user of birth control. You are about to write her a script that includes Nevirapine, but you hesitate. Are you sure you want to prescribe this drug?
Not if you can find an alternative; Nevirapine lowers the bioavailability of contraceptives because it induces CYP3A4.
Don't give Nevirapine with
Your patient has HIV. He uses migraine medications and takes often - probably too often - takes Tums for his indigestion. Why does any of this matter if you want to prescribe Delviradine?
Delviradine can't be given with ergot alkaloids (migraine treatment) or other alkaloids that increase pH, decreasing Delviradine absorption.
Why does the above restriction not bother you?
Delviradine is less potent and not used much anyway.
What is the NNRTI that is part of the initial preferred HAART regimen?
Your patient has HIV and has suddenly been experiencing AMS, nightmares and hallucinations. Syphilis screen was negative with original STD testing diagnostic for the patient's HIV. What else might be causing this change in mental status?
Efavirenz. It causes these specific CNS effects in 50% of patients.
What NonNRTI is good for a patient's lipid profile, and what one is bad for it?
Neviradine lowers LDL
Efavirenz increases cholesterol
What is one must and one must-not for Efavirenz administration?
Do take on an empty stomach.
Don't take while pregnant.
Your patient has developed a resistance to Nevirapine. What other NonNRTIs are you now considering?
Etravirine and Rilpivirine. Use these when a patient has developed resistance to other NonNRTIs.
What two NonNRTIs don't you want to use if patient already has liver problems?
Your patient has a hard time sleeping and is taking an SSRI for dysthymia. What NonNRTI should you avoid?
Rilpivirine - ADR include depression and insomnia
What is boosted therapy?
By adding Ritonavir to other PI, you increase bioavailability. This is because Ritonavir inhibits CYP3A4
ADI of PI treatment
Take all PI with food, except
Indin without boost
HAART preferred regimen is
other as base
You don't want to give these drugs together because they all cause bone marrow suppression
Don't combine these drugs because they both cause PNS problems
These drugs all cause pancreas and renal problems
These drugs have overlapping liver toxicity
These drugs have overlapping rash toxicities
Distinct ADR of Protease Inhibitors
buffalo hump (inc. glucose, fat, fat redist.)
hepatotoxicity found in all ARV classes except
rash and hepatotoxicity
injection site reaction
Patient has HIV1 and is showing resistance to multiple ARV. Give her
The aforementioned patient has cardiovascular and liver disease. Now what?
Malfoviroc can cause complications with these. Instead, try
Drugs that work well against resistance
NNRTIs are generally not good against resistance, but:
Ataxanavir PITipranavir PI
Maraviroc EI (HIV1)
The regimen you currently have your pt on is not working. How many medications should you change?
At least two.
Criteria for Initiating HAART
CDC less than 350
viral load more than 100,000
Two things to consider for the pregnant patient:
DON'T use Efavirenz
Zidovudine can be used to prevent transmission, but it cannot be used as a single therapy for the mother.
What does Atripla consist of?
What is the advantage to Atripla?
It consists of three medications in one, that all only have to be taken once a day. This means one pill a day, and is great for the treatment-naive patient.
What drugs have precautions for people with sulfa allergies?
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