1. General concepts regarding ARV treatment:
    • - monotherapy (with NRTI) is not recommended.
    • - HAART or combined therapy is standard.
    • - treatment is based on whether pt is treatment-naieve or not.
  2. When to treat with ARVs.
    • - all pts with an AIDs defining illness or CD4>350
    • - pregnant pts, pts with HIV-associated nephropathy, or HBV coinfection (regardless of CD4 count)
    • - CD4 between 350 and 500
  3. How good must adherance be with PIs to avoid resistance?
    >95% adherance (increase likelihood by decreasing pill burden)
  4. Common AE of PIs and efavirenz
    • metabolic and lipodystrophy complications
    • - hyperlipidemia
    • - abnormal fat distribution
    • - hyperglycemia
    • - cardivascular events
  5. Hypersensitivity and abacavir
    • onset: 9 days to 6 weeks
    • see: fever, rash, malaise
    • screen pts for HLA-B*5701 before starting abacavir (if present, don't use)
  6. Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
    • ex. AZT, ddI, stavudine, abacavir
    • NRTIs integrate into newly forming DNA and block propagation
    • all are renally cleared except abacavir
  7. AZT (zidovudine)
    • NRTI
    • toxicities: bone marrow suppression, anemia, neutropenia
    • do not give with ganciclovir
    • may increase pigmentation of nails
  8. ddi (didanosine)
    • NRTI
    • acid labile, give with antacid to prevent drug breakdown
  9. Stavudine
    • NRTI
    • toxicities: lactic acidosis, ketoacidosis
  10. Abacavir
    • NRTI
    • Toxicities: hypersensitivity rxn (serious and potentially lethal, d/c immediately and do not attempt to use again)
    • screen for HLA-B*5701
  11. Drug interactions and ARVs
    Many, many drugs interact with ARVs, must always look up interactions.
  12. Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI)
    ex. nevirapine, delavirdine
  13. Nevirapine
    • NNRTI
    • lead-in dosing (start slow) to minimize incidence of rash.
    • if rash develops do not increase dose until rash resolves
  14. Delavirdine
    • NNRTI
    • toxicities: rash - red with or w/o itching. will resolve. continue med through rash. d/c med if rash is accompanied by fever.
  15. Protease Inhibitors (PIs)
    ex. Ritonavir, saquinavir, kaletra (combo drug)
  16. Ritonavir (Norvir)
    • PI
    • poorly tolerated
    • used as a booster drug to increase levels and half-lives of other meds (p450 rxn)
  17. Kaletra (lopinavir/ritonavir)
    • PI
    • Ritonavir inhibits metabolism of lopinavir, resulting in higher levels of lopinavir
  18. Saquinavir
    • PI
    • not recommended to use w/o ritonavir to boost levels
  19. Entry Inhibitors
    • Interfere with the process of viral binding to a cell, preventing infection
    • only ARV given sub-Q
    • very expensive (as are integrase inhibitors)
  20. Genotyping and HIV
    • fairly common
    • reveals genetic potential of most prevalent viral isolates in a patient
    • predicts resistance, not sensitivity
    • inexpensive, fast
  21. Phenotyping and HIV
    • virus is cultured in various concentrations of ARVs
    • sensitivity of pt's HIV strain is determined
    • defines how a specific drug performs agains HIV strain
    • expensive and relatively slow
Card Set
Pharm Exam 4, pt 6: ARVs