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Anti-viral drug (ANTI HIV DRUGS (Protease Inhibitors (Boosters (Cobicistat…

- - - - Tenofovir alafenamide
        
        Careful of Hep B
        
        Renal insufficiency
        
        Osteomalignancy
        
        Category B
    - - Must test for HLA-B5701 negative
        Else will have fatal hypersensitivity syndrome
    - - For young children use
      - Cross placenta
    - - Careful of Hep B
      - Renal insufficiency
      - For young children use
      - Cross placenta
    - - Renal insufficiency
      - Category B
      - Careful of Hep B
  - - - Eliminated by hepatic glucorination UGT1A1
      - Taken: 2 hours before OR 6 hours after
        Any cation-containing antacid or laxative or oral supplements with iron/calcium
      - Reduce by Efavirenz
      - Reduced by Rifampicin
      - Increases Metformin formation
      - Cat B
    - - Eliminated by hepatic glucorination UGT1A1
      - Rash, Steven John syndrome, diarrhoea, depression
      - Major resistance from Q184R/H/K or N155H in integrate gene
  - - - Cobicistat
        
        Potent inhibitor of CYP450 enzyme (CYP3A4)
      - Ritonavir
        
        Potent inhibitor of CYP450 enzyme (CYP3A4)
    - - DDI
        
        Contrainidicated with drugs that are also CYP450 substrate
        
        Simvastatin
        
        Lovastatin
        
        Wafarin
        
        Decreased by CYP450 inducers
        
        Rifampin
        
        Phenytin
        
        Efavirenz
      - Adverse side effects:
        
        GIT
        
        Hyperglycemia, Hyperlipidemia
        
        Fat maldistribution
        
        Rash
        
        Hepatic injury
  - - - DDI
        
        Inducers of CYP450
      - Eaten with high fat food
      - Effects: Rash, CNS problem
      - Category D
        
        Patients that got pregnant after using this drug should not stop because removing it has higher risk, increase resistance
  - - - Mechanism
        
        However virus may avoid by targeting CXCR3
        
        Chemokine receptor antagonist bind to the host cell CCR5 block gp120
      - Food decreases bioavailability
      - Metabolized by CYP450 Reduce dose when given with ritonavir
    - - Inhibit fusion of viral and cell membrane mediated by CD4 and gp41 interactions
- - - - For all herpes virus
      - Especially for CMV
    - - Myelosuppression
  - - - Used for genital herpes infection
      - Used for HSV encephalitis
    - - Inactivate viral DNA polymerase
      - Competitive inhibit viral DNA polymerase
      - Incorporate into growing viral DNA