Pharm Winter quarter - antimicrobials

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Pharm Winter quarter - antimicrobials
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  1. First line TB agents
    • Isonaizid
    • Rifampin
    • Pyrazinamide
    • Ethambuine
    • Rifabutin
    • Rifapentine
  2. Second Line TB Agents
    • Cycloserine
    • p-Aminosalicylic acid
    • Eethionamide
    • Amikacin
    • Kanamycin
    • Capreomycin
    • Levofloxacin
    • Moxifloxacin
    • Streptomycin
    • Linezolid
  3. MDR-TB
    Multi-drug resistant TB

    Resistant to isoniazid and rifampin
  4. XDR-TB
    Extensively drug-resistant M. tuberculosis

    Resistant to isoniazid, rifampin, fluoroquinolones, and aminoglycosides and/or capreomycin
  5. Isoniazid
    TB - #1 for latent

    • bactericidal against actively growing
    • bacteriostatic against nonreplicating organisms
    • inhibits mycolic acid synthesis
    • hepatic metabolism

    TOX: hepatotox, neurotox (tx: pyridoxine), also fever, rash, drug-induced lupus
  6. Rifampin
    TB

    • lots of drug interactions (induces p450)
    • bactericidal against actively replicating M. tb
    • inh RNA pol

    TOX: Hepatitis, flushing, fever, pruritis, flu-like, red body fluids
  7. Rifabutin
    TB

    =Rifampin with less p450 activation - used with protease inhibitors in AIDS pts

    Tox: polymyalgia, pseudojaundice, uveitis
  8. Rifapentene
    TB

    Rifampin with longer half life
  9. Pyrazinamide
    Short course anti-TB

    bactericidal

    Tox: n/v, hepatotox, polyarthralgia
  10. Ethanmbutol
    TB

    bacteriostatic - inh arabinosyl transferase (cell wall)

    Tox: optic neuritis (can be irrev), hyperuricemia
  11. Capreomycin
    2nd line TB

    polypeptide antibiotic. inh protein syn

    Tox: hearing loss, tinnitus, dec renal f
  12. Para-aminosalycylic acid
  13. Para-aminosalycylic acid
    2nd line TB

    Blocks folate syn

    Tox: crystalluria, GI intol, lupus-like
  14. Cycloserine
    2nd line TB

    Inh cell wall syn. Crosses BBB.

    Tox: periph neuropathy, CNS dysf
  15. Ethionamide
    2nd line TB

    Bacteriostatic

    Tox: GI, psych
  16. Aminoglycoside examples
    • Streptomycin
    • Gentamicin
    • Amikacin
    • Neomycin
    • Kanamycin
  17. Aminoglycoside properties
    • Water soluble (don't cross BBB well)
    • Active against aerobic and faculative gram negative incl enterobacteria, pseudomonas, haemophilus
    • Synergistic
    • Cross placenta
    • Tox: neuromuscular blockage, ototox!! nephrotox
  18. Streptomycin
    Aminoglycoside

    TB, Yersinia
  19. Spectinomycin
    Aminocyclitol (no glycosidic bonds)

    Gonorrhea
  20. Neomycin
    Aminoglycoside

    Part of bowel prep before GI surgery
  21. Protein Synthesis Inhibitors
    • Tetracyclines
    • Macrolides
    • Clindamycin
    • Chloramphenicol
    • Streptogram
    • Oxazolidinones
  22. Tetracycline
    Protein synthesis inhibitors

    • bacteriostatic, 30s
    • acne, rickettsial, chlamydia, mycoplasma, cholera, lyme, mycobacterium marinum
    • renal excretion
    • tox: tooth hypoplasia, GI, hepatotox, renal, vertigo, photosen
    • don't take with milk, dilantin, barbiturates
  23. Doxycline
    Tetracycline protein syn inh

    no renal excretion, good for kidney failure
  24. Macrolide examples
    • Erythromycin
    • Clarithromycin
    • Azithromycin
  25. Macrolide properties
    • Binds 50s
    • Gram positive, good for penallergic pts
    • Tox: GI common, phlebitis, cholestatic hepatitis, transient hearing loss
  26. Erythromycin
    • Macrolide protein syn inh
    • destroyed by gastric acid
  27. Clarithromycin
    • Macrolide protein syn inh
    • Better against strep and staph than erythromycin
    • Less toxic, take less often
  28. Azithromycin
    • Macrolide protein syn inh
    • Less active than erythromycin against strep and staph
    • Better at H. flu, Salmonella/campylobacter, chlamydia STDs
    • Least often dosing
  29. Clindamycin
    • Prot syn inh
    • Binds 50s
    • Very active against anaerobic bacteria and gram positive cocci, toxoplasmosis
    • Tox: diarrhea, pseudomembranous colitis
  30. Chloramphenicol
    • Prot syn inh
    • Binds 50s
    • Gram positive and negative, anaerobes, rickettsia (not staph, pseudomonas)
    • Tox!! Bone marrow suppression (reversible), aplastic anemia (irrev on first dose)
  31. Linezolid
    • Prot syn inh
    • Binds 50s
    • Gram pos/neg, (includes staph, strep, enterococci, corynebacteriu, listeria)
  32. Nucleic Acid Inhibitors
    • Sulfonamides
    • DHFR inh (Trimethoprim, Pyrimethamine)
    • Quinolones (--floxacins)
  33. Sulfonamide properties
    • Nucleic acid inh
    • PABA analog; can't make folate and need to
    • Gram neg, gram pos, actinomyces, chlamydia, plasmodia, toxoplasma, nocardia, PCP, malaria, listeria
    • Tox: crystalluria, hemolytic anemia, pg-kernicterus, rash, diarrhea, nv
  34. Sulfonamide examples
    • Sulfamethoxazole
    • Sulfadoxine
    • Sulfisoxazole
    • Sulfadiazine
    • Salicylazosulfapyridine (Azulfidine)
  35. Quinolone examples
    • Nalidixic acid
    • Ciprofloxacin
    • Levofloxacin = levoquin
  36. Ciprofloxacin
    • Quinolone nucleic acid inhibitor
    • Inh DNA gyrase
    • gram neg incl pseudomonas, some mycobacteria, many gram positive (not for anaerobes)
  37. Levofloxacin
    • Quinolone nucleic acid inh
    • Inh DNA gyrase
    • Better than cipro against strep
    • Used for legionella, mycoplasma, strep pneumo, diarrhea
  38. Cell wall inh
    • Penicillin
    • Cephalosporins
    • Monobactam
    • Carbapenems
    • Glycopeptide - Vancomycin
    • Lipopeptide - Daptomycin
  39. Penicillins
    • Penicillin G
    • Penicillinase resistant - oxacillin, methicillin, nafcillin, dicloxacillin
    • Ampicillin/Amoxicillin
    • Piperacillin
  40. Ampicillin/Amoxicillin
    Active against gram-neg (H. flu, E.coli, Proteus)
  41. Piperacillin
    • Penicillin deriv
    • Activity against gram neg
  42. Penicillin hypersensitivity
    • 5% pts
    • skin rashes (not IgE), anaphylaxis
  43. Beta-Lactamase inhibitors
    • Use with penicillins to enhance activity
    • Ciavulanic acid, sulbactam, tazobactam
  44. Cephalosporins
    • Transpeptidase inhibitor
    • 1st gen: strep and staph, some gram neg (E coli, klebsiella)
    • 2nd gen: more gram neg
    • 3rd gen: most gram neg (incl pseudomonas)
    • 4th gen: gram neg and pos
  45. 1st gen cephalosporin ex
    • Cephalexin
    • Cefazolin
  46. 2nd gen cephalosporin ex
    • Cefuroxime
    • Cefaclor
    • Ceftoxitin
    • Cefotetan
  47. 3rd gen cephalosporin ex
    • Cefotaxime
    • Ceftriaxone
    • Ceftazidime
  48. 4th gen cephalosporin ex
    Cefepime
  49. Monobactam
    • Aztreonam
    • Aerobic gram-neg
  50. Carbapenems
    • Imipenem (with cilastin)
    • Meropenem
    • Ertapenem
  51. Vancomycin
    • Glycopeptide - not a beta-lactam
    • Inhibits transglycosylation
    • Active against all gram positives
    • Bad oral abs, so works to swallow for c. difficile
    • Tox: ototox, nephrotox
  52. Polymixins
    • Polymyxin B and Colistin
    • cell membrane disruption
    • MDR gram neg bacilli (actinobacter)
    • Tox: nephrotox, neurotox
  53. Daptomycin
    • Lipopeptide (not beta lactam)
    • Cell membrane disruption, changes memb V
    • Tox: myositis
  54. Bacitracin
    • Topical only antibiotic
    • rarely causes hypersensitivity
  55. Killing P. falciparum
    • Artemisinin derivative+other active agent
    • Quinine+doxycycline/clinamycin, mefloquine
    • Atovaquone-proguanil
  56. Malarone
    • Atovaquone-proguanil
    • For P. falciparum
  57. Killing P. vivax/ovale
    Chloroquine+primaquine (for hypnozoites)
  58. Killing P. malariae
    Chloroquine
  59. Quinoline derivative
    • Malaria - inhibits parasitic heme polymerase that protects parasite from toxic metabolite
    • Quinine
    • Quinidine
    • Chloroquine
    • Mefloquine
    • Amodiaquine
    • Primaquine
  60. Quinine
    Malaria

    • For severe malaria, eg chloroquine-resistant P falciparum. Fo babesiosis
    • Tox: GI, cinchonism (tinnitus, HA, nausea, blurry vision), hypotension
  61. Chloroquine
    Malaria

    • For all kinds, falciparum forms resistance
    • Tox: well tol, HA, dizziness, blurry vision, GI
  62. Mefloquine
    Malaria

    • For all kinds, prophylactic
    • Tox: GI, neuropsych (avoid w quinine, beta blockers, seizures, psych disorders)
  63. Primaquine
    Malaria (toxoplasmosis)

    • Exoerythrocytic/hepatic forms of parasite
    • Tox: well tol (ex pts w G6PD or methemoglobinemia)
  64. Artemisinin deriviatives
    • Malaria
    • Most potent, saving for emergencies
    • Tox: minimal, GI, inc LFT
  65. Dihydrofolate Reductase Inhibitors - antimalarial
    • Proguanil
    • Pyrimethamine
  66. Proguanil
    • Malaria
    • Inhibits plasmodial DHFR
    • Kills erythrocytic forms
  67. Pyrimethamine
    • Malaria (PCP, toxoplasmosis)
    • Inhibits plasmodial DHFR
    • Tox: BMS
  68. Atovaquone
    • Malaria (babesiosis, PCP, toxoplasmosis)
    • (usually with proguanil in malarone)
    • Tox: GI, fever, rash, HA, insomnia
  69. Malaria prevention
    • Chloroquine (28d)
    • Malarone (7d)
    • Mefloquine (28d)
    • Doxycycline (28d)
    • Primaquine (not used much)
  70. Pneumocystis jiroveci treatment
    • Trimethoprim/sulfamethoxazole (Bactrim)
    • Atovaquone
    • Clindamycin+primaquine
    • Pentamidine
    • Dapsone
  71. Pentamidine
    • PCP (Trypanosomiasis, leishmaniasis)
    • IV
    • Inh nucleic acid, protein, phospholipid syn
    • Tox: 50% have rxn: hypotension, tachycardia, nv, flushing
  72. Dapsone
    • PCP
    • Sulfone - inh dihydropteroate synthase
    • Tox: fever, hemolytic anemia, methemoglobinemia, BMS
  73. Babesiosis
    • Clindamycin+quinine
    • Atovaquone+azithromycin
  74. Toxoplasmosis
    • Pyrimethamine+sulfonamide
    • Trimethoprim-sulfamethoxazole for prophylaxis
    • Or Dapsone+pyrimethamine
    • Or Atovaquone
  75. Leishmaniasis
    Stibogluconate Na, miltefosine, amphotericin B, pentamidine
  76. Trypanosomiasis
    Nifurtimox, Benznidazole, Pentamidine, Suramin
  77. Stibogluconate Sodium
    • Leishmaniasis
    • Tox: myalgia, nv, diarrhea, arrhythmias
  78. Trichomoniasis
    • Metronidazole
    • Tinidazole
  79. Amebiasis
    • Asx: Iodoquinol, paromomycin
    • Invasive: Metronidazole+iodoquinol/paromomycin
  80. Giardia
    Tinidazole, nitazoxanide
  81. Isosporiasis
    Trimethoprim-sulfamethoxazole
  82. Cyclosporiasis
    Trimethoprim-sulfamethoxazole
  83. Microsporidiosis
    Albendazole, fumagillin
  84. Cryptosporidiosis
    Nitazoxanide
  85. Nitroimidazole
    • Anti-parasitic
    • Ex: metronidazole, tinidazole
    • Mech- free radicals
    • Tox: HA, n, dry mouth, metallic taste, peripheral neuropathy, neutropenia
  86. Metronidazole
    Anaerobic/microaerophilic bacteria, entamoeba histolytica, giardia, trichomonas vaginalis, dracunculus medinensis
  87. Tinidazole
    Giardia - single dose, trichomonas vaginalis, entamoeba
  88. Dracunculiasis
    Metronidazole
  89. Ascariasis/enterobiasis
    Mebendazole
  90. Hookworm
    Albendazole
  91. Trichuriasis
    Mebendazole
  92. Filariasis
    • Diethylcarbamazine (DEC)
    • Ivermectin
  93. Strongyloidiasis
    Ivermectin
  94. Enterobius vermicularis = pinworm
    Albendazole/Mebendazole - single does, repeat in 2 weeks
  95. Benzimidazoles
    • Albendazole or mebendazole
    • Inh microtubule polymerizations
  96. Albendazole
    • Nematodes: capillaria, necator americanus, toxocara, ancylostoma, trichinella, taenia solium
    • Well tol
  97. Ivermectin
    • Opens glutamate gated cl channels
    • well tolerated
    • Onchocerca volvulus, strongyloides stercoral
  98. Taeniasis
    Praziquantel, Albendazole
  99. Echinococcosis
    Albendazole
  100. Praziquantel
    Schistosomiasis, intestinal flukes, paragonomiasis
  101. Liver flukes
    Triclabendazole, bithionol, praziquantel
  102. Ectoparasiticides
    • Permethrin (lice, crabs, scabies)
    • Malathion=Nix (lice)
    • Crotamiton (scabies)
    • Lindane (scabies)
  103. Polyenes
    • Anti-fungal
    • Amphotericin B
    • Nystatin
  104. Amphotericin B
    • Anti-fungal
    • Amphoterrible
    • Binds ergosterol, makes holes
    • Tox: renal, intra renal vasospasms(reversible, dose dep), anemia (low epo)
  105. Nystatin
    • Anti-fungal
    • binds ergosterol
    • poor absorpsion
    • Tox: major-so only topical
  106. Flucytosin (5FC)
    • Antifungal - antimetabolite
    • De-am to 5UTP, blocks fungal DNA/RNA syn
    • Oral only
    • Use for Cryptococcal meningitis (w AmB)
    • Tox: myelosuppression, hepatitis
  107. Azole properties and ex
    • Antifungal
    • Inh lanosterol demethylase
    • p450
    • Imidazoles: ketoconazole, clotrimazole, miconazole
    • Triazoles: fluconazole, itraconazole, voriconazole, posaconazole
  108. Ketoconazole
    • Antifungal - imidazole
    • Requires low gastric pH
    • Oral and topical
    • Use: tinea, prostate ca
    • Tox: gynecomastia, oligospermia, mpotence, menstrual irreg, alopecia
  109. Clotrimazole
    • Antifungal - imidazole
    • Topical only
    • Use: tinea, candida vaginitis, thrush
  110. Miconazole
    • Antifungal - imidazole
    • topical only
    • use: candida vaginitis, tinea skin inf
  111. Fluconazole
    • Antifungal - triazole
    • Oral
    • Leasat c450 inh of azoles
    • Uses: skin, mucosal, systemic candida; cryptococcal meningitis; coccidioidomycosis; NOT aspergillus/zygomycetes
    • Tox: Hepatitis, rash, alopecia
  112. Itraconazole
    • Antifungal - triazole
    • Oral, requires low gastric pH
    • Uses: Candida, aspergillus, histoplasma, blastomycis, sporothrix, tinea, onychomycosis, madiera foot
    • Tox: n, diarrhea, hepatitis, HTN, hypokalemia, edema
  113. Voriconazole
    • Antifungal - triazole
    • IV/oral
    • Uses: candida, cryptococcus, dimorphs, ASPERGILLUS not zygomyces)
    • Tox: Skin photosensitivity, visual disturbances, hepatitis
  114. Posaconazole
    • Antifungal - triazole
    • Oral (w food)
    • Uses: broadest spectrum; aspergillus, zygomycetes, cadida, cryptococcus, dimorphs
  115. Echiocandins properties and ex
    • Antifungal
    • Inhibit glucan synthesis (fungal cell wall)
    • Less toxic than ergosterol meds
    • Caspofungin, micafungin, anidulafungin
  116. Caspofungin
    • Antifungal - echinocandin
    • Inh cell wall (glycan)
    • Use: candida, some aspergillus activity
    • Tox: allergic rxn, rash
  117. Antiviral categories
    • Adamantanes
    • Neuraminidase inhibitors
    • Nucleoside analouges
    • Nucleotide analogues
    • Pyrophosphate analoug
    • Interferons
  118. Adamantane properties and ex
    • blocks M2 protein H+ ion channel; no RNP entry into cell nucleus
    • Take within 24-48h of sx
    • Tox: CNS, resistance, don't give if seizures/need to concentrate at job
    • Ex: Amantadine, rimantadine
  119. Neuramindase Inh properties and ex
    • Blocks active site of influenza neuraminidase, can't spread in resp system
    • Treat influenza A/B within 48h of sx or for prophylaxis
    • don't give if known hypersensitivity
    • Ex: zanamivir, oseltamivir
  120. Nucleoside analogue ex
    • Ribavirin
    • Acyclovir/valacyclovir
    • Famciclovir
    • Ganciclovir/Valganciclovir
    • Entecavir
    • Telbivudine
  121. Ribavirin
    • Antiviral
    • Nucleoside analog like guanosine/inoside
    • Inhibits inosine monophosphate dehydrogenase
    • Uses: HCV with interferon, severe resp syncytial virus
    • Tox: hemolytic anemia, nausea, lethargy, HA
  122. Acyclovir/Valacyclovir
    • Antiviral
    • Triphosphorylated intracellularly by thymidine kinase to activate
    • Valacyclovir is oral pro-drug
    • ACV-PPP potent inhibits viral DNA pol
    • Uses: HSV/VZV tx, prophylaxis against HSV/CMV
    • Tox: phlebitis, reversible nephrotox (crystallizes in tubules), nv, light-headedness, diaphoresis, rash
  123. Famciclovir
    • Antiviral
    • Prodrug of penciclovir
    • Uses: HSV, herpes zoster
    • Tox: HA, n, fatigue. don't use if documented hypersensitivity
  124. Ganciclovir/Valganciclovir
    • Antiviral
    • Acyclic analog of guanosine; valgaciclovir is prodrug
    • Uses: severe CMV
    • Tox: seizures if with imipenem, bone marrow suppression, don't give with documented hypersensitivity
  125. Entecavir
    • Antiviral
    • nucleoside analogue of guanosine
    • Inhibits HBV DNA pol
    • Uses: chronic active HBV infection
    • Tox: mild
  126. Telbivudine
    • Antiviral
    • Nucleoside analog of thymidine
    • Uses: HBV infection
    • Tox: myopathy, lactic acidosis
  127. Nucleotide analogue properties and ex
    Ex: Cidofovir, adefovir dipivoxil
  128. Cidofovir
    • Antiviral
    • IV
    • p450
    • Tox: nephrotox, neutropenia, uveitis, alopecia, ocular hypotony
  129. Adefovir Dipivoxil
    • Antiviral
    • Nt reverse transcriptase inhibitor
    • Oral prodrug of adefovir
    • Uses: chronic active HBV
    • Tox: mild nephro, HIV spikes, hypersensitivity
  130. Pyrophosphate analogue
    • Foscarnet
    • Inhibits viral DNA Polymerase adn reverse transcriptase
    • IV only
    • Kidney excretion
    • Uses: CMV, HSV, VZV, HIV, HBV
    • Tox: nephrotoxicity, hypo/hypercalcemia, hypo/hyperphosphatemia, n/v, seizures, anemia, mucosal ulcerations
  131. Interferon
    • Antiviral
    • Small MW glycoproteins
    • Broad spectrum against RNA/DNA viruses
    • Inh viral penetration and uncoating, mRNA syn, viral protein translation
    • Recombinant alpha 2a/2b for HPV, Hep B, Hep C
    • Tox: flu-like sx, CNS, BMS
  132. Influenza treatment
    • Amantadine/rimantadine
    • Zanamivir/Oseltamivir
  133. Herpes simplex/varicella zoster tx
    • Acyclovir
    • Valacyclovir
    • Famciclorvir
    • Cidofovir
    • Foscarnet
  134. CMV tx
    • Ganciclovir
    • Valganciclovir
    • Foscarnet
    • cidofovir
  135. Hep B tx
    • Entecavir
    • Telbivudine
    • Tenofovir/Lamivudine/Emtricitabine
    • Adefovir dipivoxil
    • Interferon
  136. Hep C tx
    • Ribavirin
    • Interferon
  137. HPV tx
    Interferon
  138. Antiretroviral drug categories
    • CCR5 inhibitors (Maraviroc)
    • Fusion inhibitors (Enfuviritide)
    • NRTIs (abacavir, lamivudine, tenofovir, emtricitabine)
    • NNRTIs (efavirenz)
    • Integrase inhibitors (raltegravir)
    • PIs (atazanavir, darunavir)
  139. Typical anti-retroviral regimen
    • Tenofovir + emtricitabine
    • Plus efavirenz or atazanavir/ritonavir or darunavir/ritonavir or raltegravir
  140. Maraviroc
    • Anti retroviral - CCR5 inhibitor
    • blocks interactio nbtw HIV-1 gp120 and CCR5
    • Useless if HIV strain uses CCR5 and CXCR4
    • Tox: abdominal pain, cough, URI, allergic rxn, hepatotox, ortostatic hypotension
  141. Enfuviritide
    • Anti retroviral - fusion inhibitor
    • SubQ injection
    • Interferes with HIV-1 entry into cells
    • Tox: local injection site rxn, more bacterial pneumonia, hypersensitivity
  142. NRTI properties
    • Antiretroviral nucleoside reverse transcriptase inhibitors
    • triphosphorylated intracellularly to active form
    • Incorporated into growing viral nucleic acid - chain termination
    • Tox: lactic acidosis, hepatic steatosis
  143. NRTI ex
    • Antriretroviral
    • Zidovudine (ZDV)
    • Didanosine (ddl)
    • Stavudine (D4T)
    • Lamivudine (3TC)
    • Abacavir (ABC)
    • Tenofovir (TDF)
    • Emtricitabine (FTC)
  144. Combivir
    • Antiretroviral
    • Zidovudine and lamivudine
  145. Trizivir
    • Antiretroviral
    • Zidovudine and lamivudine and abacavir
  146. Truvada
    Tenofovir and emtricitabine
  147. Epzicom
    Abacavir and lamivudine
  148. Zidovudine (ZDV)
    • Antiretroviral
    • Liver metab then kidney excrete
    • Tox: Mito tox with lactic acidosis and hepatic steatosis , anemia, granulocytopenia, GI, HA, insomnia, asthenia
  149. Lamivudine (3TC)
    • Antiretroviral
    • Minimal tox
  150. Tenofovir (TDF)
    • Antiretroviral
    • Tox: asthenia, HA, diarrhea, n/v, flatulence, RENAL, bone loss
  151. Emtricitabine (FTC)
    • Antiretroviral
    • Tox: minimal, hyperpigmentation
  152. Resistance mutations against antiretroviral drugs
    • Q151M (can only then use Tenofovir)
    • 69 insertion complex of T69S (no drugs work)
    • K65R (can only then use Zidovudine)
  153. NNRTIs
    • Antiretroviral - non-nucleoside reverse transcriptase inhibitors
    • Reversible non-comp inh of HIV reverse transcriptase
    • Nel and Efavirenz induce P450
    • Do not use with: rifampin, sedatives, PPIs
    • Mutations lead to loss of utitility of multiple drugs eg K103N
    • ex: EFAVIRENZ, nevirapine, delavirdine, etravirine, rilpivirine
    • Tox: skin rash, stevens-johnson syndrome, hepatotox, EFV has CNS sxs
  154. Raltegravir
    • Antiretroviral - integrase inhibitor
    • Inh catalytic activity of HIV-1 integrase
    • few drug interactionsTox: muscle inflam, nv, HA, fever
  155. Protease inhibitor ex
    • Antiretroviral
    • Atazanavir*
    • Darunavir*
    • Saquinavir, ritonavir, indinavir, nelfinavir, fosamprenavir, lopinavir, tipranavir
  156. Protease Inhibitor properties
    • Antiretroviral
    • Blocks protease cleavage of viral gag and gag-pol polyproteins making noninfectious viral particles
    • Inhibits p450
    • Tox: bleeding in hemophiliacs, CV effects, Fat malabsorption (buffalo hump and protease paunch), hyperlipidemia, osteonecrosis, inc DM

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