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26 Cards in this Set

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When do you start treating asymptomatic HIV?
if CD4 count is less than 350
How does miraviroc work
it is an R5 antagonist
it will not work on X4
test tropism before starting therapy
How does Enfuvirtide work
it is an HIV drug fusion inhibitor given by injection
binds gp41 to prevent fusion of viral surface
Non-NRTI HIV drugs work by
noncompetitively binding and inhibiting reverse transcriptase
Abacavir, Didanosine, Emtricitabine, Lamivudine, Stavudine, Tenofovir and Zidovudine are all
Nucleoside analogs for HIV therapy
How many nukes are usually combined in HIV therapy
2 nucs + 1 nonnuke
Atripla and Complera are examples
Interestingly which nucleoside analogs for HIV therapy do not have adverse side effects
the cytosine analogs
emtricitabin and lamivudine
What type of drug is Abacavir
what are common side effects
Guanosine analog
see hypersensitivity reactions
general flu-like symptoms
In HIV therapy lactic acidosis is a common side effect with what drug class
which is most common?
nucleoside RT inhibitors bc they induce mitochondrial dysfunction
worst w stavudine
What is a give away clinical feature of lactic acidosis during HIV therapy
low bicarbonate
Mechanism of Nevirapine and adverse effects
its a non nuke
hepatotoxic risk
greater risk w higher CD4 count
most commonly used non-nuke
efavirenz
In general the non nukes cause
rash and hepatotoxicity

efavirenz also has some CNS effects dizziness and vivid dreams
How does raltegravir work
it is an integrase inhibitor
has a really fast rate of virologic suppression
Atazanavir, Duranavir, Nelfinavir, and Ritonavir are all in what drug class
protease inhibitors
Protease Inhibitors as a class have these side effects
Gastrointestinal,hyperlipidemia, lipodystrophy
Side effect of atazanavir
eliminates clearance of bilirubin, get non pathological jaundice
Explain Ritonavir boosting
Ritonavir inhibits cytochrome p450 enzymes that metabolize other protease inhibitors

can increase concentration of other PIs
Treatment of HIV tries to achieve a viral load of
less than 50
Standard Treatments include
1 PI + 2nucs OR

One non-nuc + 2 nucs OR

Raltegravir +2 Nucs
Acyclovir and Gancyclovir work by what mechanism and for what kind of infections
Herpes
acyclic Guanasine gets Phosphorylated by Thymidine kinase
Inhibits DNA polymerase
Infections Acyclovir works against
how do they become resistant?
HSV-1, HSV-2, VZV
virus loses viralThymidine Kinase (uses host's), acyclovir doesn't get converted, no longer works
Acyclovir is particularly used for
Genital infections
Whitlow (HSV2 in weird places)
meningitis
Describe famicyclovir and valicyclovir
more bioavailable
prodrug esters of Acyclovir gets picked up in gut
acts just like acyclovir
Famicyclovir and Valicyclovir are used for what type of infections
recurrent genital herpes, varicella zoster, prevention of HSV2
What form does acyclovir work best?
given orally, the topical ones aren't great