-
Abacavir class and brand name
NRTI (Ziagen)
-
Didanosine class and brand
NRTI (Videx EC)
-
Emtricitabine class and brand
NRTI (Emtriva)
-
Lamuvudine class and brand
NRTI (Epivir)
-
Stavudin class and brand
NRTI (Zerit)
-
Tenofovir class and brand
NRTI (Viread)
-
Zidovudine brand and class
NRTI (Retrovir)
-
Combivir
zidovudine/lamivudine
-
Epzicom
Abacavir/Lamivudine
-
Trizivir
Abacavir/Lamivudine/Zidovudine
-
Truvada
Emtricitabine/Tenofovir
-
NRTI elimination and exceptions
mostly renal
- abacavir: metabolized by alcohol dehydrogenase
- zidovudine: glucuronidation
-
how to take NRTIs
with food
except didanosine - empty stomach
-
NRTI BBW
- lactic acidosis
- hepatomegaly with steatosis (especially with stavudine, didanosine, and zidovudine)
-
AE specific to stavudine and didanosine
- peripheral neuropathy
- pancreatitis
-
AE specific to tenofovir
nephrotoxicity
-
AE specific to zidovudien
BMS
-
AE specific to abacavir
hypersensitivity rxn (do not rechallenge if this happens)
HLA-B*5701 screening before starting tx
-
NRTI drug interactions
no CYP-P450 interactions
- didanosine, stavudine: additive peripheral neuropathy (vincristing, cisplatin, isoniazide)
- abacair: alcohol dehyrogenase (alcohol inc AUC)
- zidovudine: additive BMS (ganciclovir)
-
NRTI MOA
inhibit reverse transcriptase by binding to viral RNA
-
NNRTI MOA
Non-nucloeotide Reverse Transciptase Inhibitor
inhibit reverse transcriptase by binding directly to it
-
Delavirdine class and brand
NNRTI (Rescriptor)
-
Efavirenz class and brand
NNRTI (Sustiva)
-
Nevirapine class and brand
NNRTI (Virammune)
-
Etravirine class and brand
NNRTI (Intelence
-
Rilpivirine class and brand
NNRTI (Edurant)
-
NNRTI metabolism
- no renal dose adjustments
- many CYP interactions
-
NNRTI resitance
very susceptible to resistance (single mutation gives resistance to whole class)
-
NNRTI side effects
- hepatotoxicity
- rash (SJS/TEN)
-
AE specific to efavirenz
- CNS AEs (vivid dreams, dizziness, confusion)
- -- use in caution with people with preexisting psych issues or previous substance abuse
more dyslipidemia than other NNRTIs
-
preferred NNRTI and how to take
-
atazanavir class and brand
PI (Reyataz)
-
darunavir class and brand
PI (Prezista)
-
Protease inhibitor MOA
inhibit HIV-1 protease, so that enzyme can't cleave the protein that produces mature viruses
-
PI side effects
- hyperglycemia/insulin resistance/DM
- lipoatrophy/fat maldistribution
- hyperlipidemia
- hepatitis
- immune reconstitution syndrome
- diarrhea
-
preferred NNRTI in pregnancy
Nevirapine
-
preferred PI in pregnancy
- atazanavir
- lopinavir + ritonavir
-
AE specific to atanavir
- hyperbilirubinemia and jaundice
- PR interval prolongation
-
Preferred NRTIs
- emtricitabine
- tenofovir
- abacavir
- lamivudine
-
preferred NNRTIs
efavirenz
-
preferred PIs
- atazanavir
- darunavir
- lopinavir/ritonavir
- ritonavir
-
preferred INSTI
raltegravir
-
preferred NNRTI-based regimen
efavirenz + tenofovir/emtricitabine
-
preffered PI-based regimen
- atazanavir/ritonavir + tenofovir/emtricitabine
- darunavir/ritonavie + tenofovir/emtricitabine
-
preferred INSTI-based regimen
- raltegravir + tenofoivir/emtricitabine
- elvitegravir/cobicistat/tenofovir/emtricitabine (Stribild)
- dolutegravir + abacavir/lamivudine or tenofovir/emtricitabine
-
preferred PI-based regimen in pregnancy
- lopinavir/ritonavir (BID dosing) + zidovudine/lamivudine
- atazanair/ritonavir + zidovudine/lamivudine
-
preferred NNRTI-based regimen in pregnancy
nevirapine + zidovudine/lamivudine
-
Kaletra
lopinavir + ritonavir
-
Atripla generic
efavirenz + emtircitabine/tenofovir
-
Complera generic
rilpivirine + emtircitabine/tenofovir
-
Stribild generic
elvitegravir/cobicistat + emtricitabine/tenofovir
-
NNRTI-based nonoccupational postexposure prophylaxis (nPEP) recommendation
- efavirenz +
- (lamivudine or emtricitabine) +
- (zidocudine or tenofovir)
x 28 days
-
PI-based nonoccupational postexposure prophylaxis (nPEP) recommendation
- lopinavir/ritonavir +
- (lamivudine or emtricitabine) +
- zidovdine
x 28 days
-
occupational postexposure prophylaxis (PEP)
- 3 drug regimen:
- raltegravir + tenofovir/emtricitibine (Truvada) x 4 weeks
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