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ID Quiz 6 - Coggle Diagram
ID Quiz 6
efavirenz (Sustiva)
common ADRs: anxiety, insomnia, HA, rash, N/V/D, HLD, vivid dreams, nightmares
rare ADRs: psychosis, seizures, hepatic failure, hypersensitivity, pancreatitis, suicidal ideation, fat redistribution, immune reconstitution syndrome
interactions: boceprevir (decreased absorption and loss of boceprevir activity), CYP3A4/5/2B6 inducers/inhibitors/substrates, CYP2C9/19 substrates, cisapride (additive risk of arrhythmias), oral contraceptives (reduced efficacy of contraceptive, unknown mechanism), agents that increase QTc interval (increased risk of QTc prolongation
efficacy: HIV viral load, CD4 count, HIV resistance testing prior to starting therapy
indications: treatment of HIV-1 infection
toxicity: LFTs, bilirubin, CBCs, lipid panel
class: antiretroviral agent, reverse transcriptase inhibitor
counseling: multiple, potentially serious drug interactions; do not take new medications, OTCs, or herbals without consulting HCP; take on empty stomach at bedtime; do not open, chew, or crush capsule; does not prevent transmission of HIV, practice safe sex; may cause drowsiness; avoid driving and concurrent CNS depressants
emtricitabine/tenofovir disoproxil (Truvada)
efficacy: prior to therapy, HIV resistance testing, HBV testing as acute, and severe exacerbations of HBV have been reported following D/C of antiretroviral therapy; HIV viral load, CD4 count for assessment of efficacy; if using for PrEP, patients should be screened just prior to initiating therapy and regularly thereafter; patients receiving PrEP who acquire HIV may be drug resistant at diagnosis; also test for STD and treat as necessary
common ADRs: hyperpigmentation, rash, hypophosphatemia, N/D, dizziness, insomnia, fatigue
indications: atazanavir (decreased atazanavir, unknown mechanism), lopinavir/ritonavir/tipranavir (increased tenofovir bioavailability, unknown mechanism), P-gp substrates (induction of substrate transport decreases effectiveness of substrate)
rare ADRs: lactic acidosis, HBV exacerbations, renal failure
indications: treatment of HIV-1 infection in combo with other antiretroviral agents, PrEP for prevention of HIV-1 infection in adults who are at high risk for acquiring HIV
counseling: take with or without food
class: antiretroviral agent, reverse transcriptase inhibitor
toxicity: LFTs, bilirubin, CBC, glucose, renal function, urine glucose and protein, phosphorus, assessment of osteoporosis; lactic acidosis and severe haptomegaly and sometimes fatal steatosis have been reported with nucleoside and nucleotide analogues
maraviroc (Selzentry)
common ADRs: fever, URI, rash, cough, vomiting
rare ADRs: coronary artery disease, angina, jaundice, hepatic failure, seizures
interactions: CYP3A4/5 inhibitors/inducers
efficacy: HIV viral load, CD4 count, troponin assay, HIV resistance testing
toxicity: LFTs, bilirubin
counseling: take with our without food; do not chew or crush tablet; does not prevent transmission of HIV, practice safe sex, do not share needles, etc; may cause drowsines, avoid driving and concurrent CNS depressants
indications: treatment of CCR5-tropic HIV-1 infection, in combo with other antiretroviral agents
class: antiretroviral agent, CCR5 antagonist
atazanavir (Reyataz)
common ADRs: rash, HLD, elevated LFTs, abdominal pain, elevated bilirubin levels, cough, fever
rare ADRs: hypersensitivity, renal failure, PR and QT prolongation, torsades de pointes, cholelithiasis, left bundle branch block
interactions: antacids (decreased absorption of ataznavir), CYP3A4/5 inhibitors/inducers/substrates), drugs that prolong PR or QTc interval (additive PR or QTc prolongation and cardiotoxicity), oral contraceptives, PPIs/H2 antagonists (decreased absorption of atazanavir)
efficacy: HIV viral load, CD4 count, drug levels with some concomitant medications
indications: treatment of HIV-1 infection (antiretroviral naive, prior virology failure, pregnant patients)
toxicity: LFTs, bilirubin, ECG monitoring in patients with prolonged PR interval or with concurrent AV nodal blocking drugs, CBCs, lipid panel
class: antiretroviral agent, protease inhibitor
counseling: multiple, potentially serious drug interactions; do not take new medications without consulting HCP; take with food; do not open, chew, or crush capsule; does not prevent transmission of HIV, practice safe sex; do not skip doses; report cardiac symptoms to physical; do not take antacids within 2 hours of medication
raltegravir (Isentress)
common ADRs: none
rare ADRs: anemia, cerebellar ataxia, depression, hepatitis, hypersensitivity, myopathy, nephrolithiasis, psychomotor hyperactivity (children), renal failure, rhabdomyolysis, SJS, suicidal ideation/behavior, thrombocytopenia, TENs
interactions: Al/Mg salts (decreased absorption of raltegravir), fosamprenavir (decreased concentrations of both agents, unknown mechanism), PPIs/H2 blockers (increased absorption of raltegravir with increased pH), rifampin (decreased raltegravir via induction of UGT by rifampin)
efficacy: HIV viral load, CD4 count, HIV resistance testing
indications: treatment of HIV-1 infection in combo with other antiretroviral agents
toxicity: LFTs, bilirubin, CBC, glucose
class: antiretroviral agent, integrase inhibitior
counseling: take with or without food; may chew or crush chewable tablet; for the PO suspension, add contents of foil pack (100 mg) to 10 mL water and swirl for 45 s, do not shake; use syringe to obtain correct dose; administer within 30 mins; does not prevent transmission of HIV; practice safe sex