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vandy AIDS
n/a
59
Pharmacology
Professional
02/11/2010

Additional Pharmacology Flashcards

 


 

Cards

Term
what is used to treat chickenpox or disseminated zoster in immunocompromised patients?
Definition
1)acyclovir
2)valacyclovir
Term
how is acyclovir administered in the case of a severe variceela (disseminated, pneumonia, meningitis) infection?
Definition
IV for 10-14 days, oral once stabilized
Term
how is valacyclovir administered?
Definition
oral ONLY
Term
what is used to treat Candidiasis?
Definition
fluconazole
Term
what can be given to refractory cases of candidiasis that don't respond to flucanazole?
Definition
1) try voriconazole or itraconazole
2)IV echinocandins -caspofungin, micafungin
3)IV amphotericin B – not as tolerated due to kidney toxicity
Term
what is the treatment for penumocystis penumonia in AIDS patients?
Definition
sulfamethoxazole/trimethoprim
Term
how is Toxoplasma treated in HIV patients?
Definition
sulfadiazine and pyrimethamine (add leucovorin to prevent marrow toxicity)
Term
when does the opportunistic infection prophylaxis start to be less affective in HIV patients?
Definition
when CD4 falls below 20
Term
what is the treatment for CMV retinitis?
Definition
gancyclovir and HAART
Term
what prophylactic treatments are given when CD4 counts fall below 100?
Definition
1)daily trimethoprim-sulfamethoxazole for pneumocystis penumonia and CNS toxoplamsosis
2) weekly flucanzole for cryptococcal meningitis
Term
what is used for prophylaxis of MAC when CD4 is below 50?
Definition
macrolides - azithromycin
Term
what can be used for prophylaxis of CMV retinits?
Definition
valancyclovir - controversial bc of bone marrow toxicity and very expensive
Term
what should be used in addition to pyrimethamine/sulfadiazine when treating Toxoplasmosis if you see a midline shift?
Definition
adjunct steroids should be given
Term
what is the treatment for cryptococcal meningitis in AIDS patients?
Definition
IV - amphotericin B + flucytosine
may need daily spinal taps to decrease ICP
may change to oral fluconazole AFTER IV therapy for 2-3 weeks
Term
what should be used to maintain suppression of cryptococcal meningitis until HIV therapy can bring immune system back up in HIV patients?
Definition
oral fluconazole
Term
what is the treatment for histoplasmosis that is disseminated or has caused meningitis in a HIV patient?
Definition
IV amphotericin B - 21 days
then switch to oral itraconazole or voriconazole
*Make sure to diff. b/t histo and cryptococcus b/c fluconazole is NOT effective against histoplamosis)
Term
what is the treatment for disseminated coccidiomycosis in HIV?
Definition
treat with flucanzole - can add amphotericin if get meningitis (treated like crypotcoccus)
Term
what is used to treat legionella in HIV?
Definition
macrolides or quinolones
Term
what is used to treat disseminated TB in HIV?
Definition
isoniazid, rifampin, ethambutol, pyrazinamide
Term
what is the drug of choice for an atypical pneumonia caused by strongyloides in HIV?
Definition
Ivermectin
Term
what is the treament for MAC in HIV?
Definition
3 antimycobacterial drugs + HAART
1)macrolide (azithromycin or clarithromycin)
2)rfiampin or *rifabutin
3)ethambutol
Term
what is the primary goal of treating CMV retinitis?
Definition
protect the good eye
Term
what is used for the treatment of CMV retinitis in HIV?
Definition
1)IV gancyclovir -induction dose for a few weeks then used for chronic suppression until immune system brought back up
2) oral alternative - valgancyclovir
Term
what is a problmeatic side effect of gancyclovir and valgancyvlovir?
Definition
bone marrow toxicity- can acuse anemia/ neutropenia
Term
what can be used for salvage or intolerance to valgancyclovir when treating CMV retinitis?
Definition
vitreal implants filled with CMV drugs
Term
maraviroc blocks what? and is part of what category of drugs?
Definition
CCR4 and CCR5 and is a fusion inhibitor drug
Term
side effects of AZT (zidovudine)?
Definition
anemia
Term
side effect of D4T (stavudine)?
Definition
neuropathy
Term
side effect of DDI (didanosine)?
Definition
pancreatitis
Term
side effect of abacavir?
Definition
hypersensitivity
Term
side effect of tenofovir?
Definition
nephrotoxicity
Term
side effect of all drugs in NRTI class?
Definition
lactic acidosis (rare, stop the drugs or pt WILL die)
Term
side effects of stavudine (D4T) + lamivudine?
Definition
1)peripheral neuropathy
2)lipotrophy (haggard face)
3)lactic acidosis
Term
side effects of didanosine (DDI, videx) + lamivudine?
Definition
1)peripheral neuropathy
2)pancreatitis
Term
3 NNRTIs vande discussed
Definition
1)nevirapine
2)efavirenz
3)etravirine
Term
side effects of nevirapine?
Definition
rash, hepatotoxicity, (Do not use in females with CD4 >250, males >400)
Term
side effects of efavirenz?
Definition
rash, dizziness, drowsiness, very vivid dreams, can have neuropsych effects, teratogenic
Term
ritonavir is not used very often now as a PI for AIDs b/c of what mechanism?
Definition
very profound P450 inhibition. so its used only in low doses now to boost other PIs
Term
Pro for NNRTIs versus NRTIs ?
Definition
There is less fat maldistribution
Term
class side effects of protease inhibitors?
Definition

1)lipodystrophy

2)glucose intolerance

3)drug interactions

Term
what are the 5 classes of antiretroviral therapy?
Definition
1)NRTIs (nucleoside analogue reverse transcriptase inhibitors)
2)NNRIs (non-nucleoside analogue reverse transcriptase inhbitors)
3)Pis ( protease inhibtors )
4)FI ( fusion inhibitors )
5)Int I (Integrase inhibitor )
Term
side effects of indinavir?
Definition
kidney stones = nephrolithiasis
Term
side effects of nelfinavir?
Definition
diarrhea
Term
side effects of lopinavir/norvir?
Definition
diarrhea, nausea and vomitting
Term
side effects of atazanavir?
Definition

bilirubinemia, headache, GI symptoms

but doesn't have the lipodystrophy like all the other protein inhibitors

Term
what do fusion inhibitors target?
Definition
chemokine receptors
Term
what classes of antiretroviral drugs target reverse transcriptase?
Definition
NRTI's and NNRI's
Term
cons for use of PIs?
Definition
fat maldistribution, dyslipidemia, insulin resistance, drug interactions
Term
cons for use of atazanavir (PI)?
Definition
bilirubinemia and proton pump inhibitors greatly reduce its absorption
Term
How do protease inhibits work as an antiretroviral?
Definition
they inhibit the maturation of the virus resulting in production of non viable virus
Term
what is the mechanism of NRTIs (nucleoside analogue reverse transcriptase inhibitors)?
Definition
they bind DNA chain, thus blocking transcription
Term
what is the machanism of NNRIs (non-nucleoside analogue reverse transcriptase inhbitors)?
Definition
they bind the enzyme, reverse transcriptase, and prevent transcription
Term
Cons for using enfuvirtide (fusion inhibitor)?
Definition
PAIN at daily injection sites
Term
what is the critical combination therapy for HAART composed of?
Definition
3 highly active antiretrovirals -
Always critical to have a working backbone of therapy with 2 NRTIs or 1 NRTI + 1 NNRTI plus a third highly active agent
Term
cons for using maravaroc (fusion inhibitor)?
Definition
targeting of CCR5 often mutates to targeting CCR4 and it no longer works
Term
pros for using raltegravir (integrase inhibitor)?
Definition
no cross resistance or drug interactions and well tolerated
Term
what is used for prophylaxis of Toxoplasmosis and Pneumocystis jiroveci?
Definition
trimethoprim/sulfamethoxazole
Term
what are the side effects of Combivir?
Definition
bone marrow suppression - esp anemia
Term
name the HAART drugs that shouldn't be used in pregnancy (4)
Definition
efavairenz
nelfinivir
didanosine
stavudine
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