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Transcript of © Paradigm Publishing, Inc.1 Chapter 5 Therapy for Fungal and Viral Infections.
© Paradigm Publishing, Inc. 1
Chapter 5
Therapy for Fungal and Viral Infections
2© Paradigm Publishing, Inc.
Chapter 5 Topics
• Fungi and Fungal Diseases
• Viruses and Viral Infections
• HIV-AIDS and Antiretroviral Agents
© Paradigm Publishing, Inc. 3
Learning Objectives
• Understand the differences between fungi and viruses and why the drugs to treat them must have very different mechanisms of action.
• Differentiate antifungals, antivirals, and antiretrovirals by their indications, therapeutic effects, side effects, dosages, and administration.
© Paradigm Publishing, Inc. 4
Learning Objectives
• Use antifungal, antiviral, and antiretroviral terminology correctly in written and oral communication.
• Identify drugs used for HIV and understand their synergism.
5© Paradigm Publishing, Inc.
Fungi and Fungal Diseases
Fungi • Single-cell
organisms
• Mushrooms, yeasts, and molds
6© Paradigm Publishing, Inc.
Characteristics of Fungi
• Eukaryotic (defined nucleus): fungus, animal cell, and green plant cell
• Prokaryotic (no defined nucleus): bacteria• Fungi differ from green plants
– Lack chlorophyll– Reproduce by spores
• Fungi differ from animal cells– Have rigid cell wall unlike that of bacteria
© Paradigm Publishing, Inc. 7
Discussion
In what ways are human cells similar to fungi cells? How are they different?
Human cell membranes contain cholesterol, and cell membranes of fungi contain ergosterol.
8© Paradigm Publishing, Inc.
Fungal Diseases
• Systemic fungal diseases most likely to occur in immunosuppressed by disease or drug therapy (corticosteroids or antineoplastics)
• Fungi can cause skin and nail infections
• Women on antibiotics often need antifungal for vaginal yeast infection
9© Paradigm Publishing, Inc.
Fungal Organisms and Resulting Infections
Organism Disease
Aspergillus Aspergillosis
Blastomyces Blastomycosis
*Candida (yeast) *Candidiasis
10© Paradigm Publishing, Inc.
Fungal Organisms and Resulting Infections
Organism Disease
Coccidioides Coccidioidomycosis
Cryptococcus Cryptococcosis
Histoplasma Histoplasmosis
© Paradigm Publishing, Inc. 11
Drug ListAntifungals
– *amphotericin B (Abelcet (ABLC), AmBisome, Amphocin, Amphotec, Fungizone) IV, topical
– *clotrimazole (Mycelex) lozenge (for oral infection) topical, vaginal
– flucytosine (Ancobon)
– *griseofulvin (Fulvicin P/G, Gris-PEG)
capsule, tablet, oral suspension
© Paradigm Publishing, Inc. 12
Drug ListAntifungals
– *ketoconazole (Nizoral) tablet, cream,shampoo
– *nystatin (Mycostatin) oral liq, tab, topical, vaginal
– *terbinafine (Lamisil) tablet, cream
– *terconazole (Terazol)
© Paradigm Publishing, Inc. 13
Drug ListAntifungalsEchinocandin (IV)
– anidulafungin (Eraxis)
– caspofungin (Cancidas)
– micafungin (Mycamine)
© Paradigm Publishing, Inc. 14
Drug ListAntifungalsTriazole
– *fluconazole (Diflucan) IV, oral liq, tab
– *itraconazole (Sporanox) caps, IV, oral liq
– posaconazole (Noxafil) oral liq
– voriconazole (VFEND) IV, oral liq, tab
15© Paradigm Publishing, Inc.
How Antifungals Work
• Prevent synthesis of ergosterol, building block for fungal cell membranes
• Human cell membranes– Use cholesterol– Affected minimally by antifungals
16© Paradigm Publishing, Inc.
How Antifungals Work
• Inhibit fungal cytochrome P-450– Different from human P-450– Have little effect on human cells
• Result: destroys fungi
17© Paradigm Publishing, Inc.
How Antifungals Are Dispensed
• Three forms – Topical agents
– IV agents
– Systemic agents
18© Paradigm Publishing, Inc.
Side Effects of Antifungals
• Reports of serious side effects, even for topical agents
• Pay close attention to dosing regimen to avoid overdosing
19© Paradigm Publishing, Inc.
amphotericin B (Fungizone)
• Used for blood-born, life-threatening fungal infections
• Blood levels of drug monitored and vitals checked during infusion
• Infused slowly. Not piggybacked, not mixed with normal saline
• Side effects: fever, chills, shaking, headache, anemia, renal toxicity
20© Paradigm Publishing, Inc.
Dispensing Issues of amphotericin B
• IV requires prophylaxis with aspirin, antihistamine, or acetaminophen
• **Technician—if no accompanying orders, contact pharmacist or prescriber
Warning!
21© Paradigm Publishing, Inc.
clotrimazole (Mycelex)
• Effective against oral candidiasis– Yeastlike fungi causing infection in the
mouth
• Troche (small lozenge)
Figure 3-16 Types of fungi and a fungal infection of the tongue. (Photo Source: Courtesy of Jason L. Smith, MD.)
23© Paradigm Publishing, Inc.
griseofulvin (Fulvicin P/G, Gris-PEG)
• Used for fungal infections of hair, skin, nails
• Take with fatty meals
• Avoid sun• Side effects: dizziness, drowsiness,
passing headache
24© Paradigm Publishing, Inc.
nystatin (Mycostatin)
• Used for oral candidiasis
• Often used in liquid form, swish and swallow
25© Paradigm Publishing, Inc.
terbinafine (Lamisil)
• Kills fungus instead of inhibiting growth
• Oral form taken once daily– 6 weeks for fingernails – 12 weeks for toenails
• Topical form for ringworm
26© Paradigm Publishing, Inc.
Dispensing Issues of (Lamisil)
• Look-alike– Lamisil– Lomotil,– Lamictal
• Use dosing and indications to keep them straight
Warning!
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*foscarnet (Foscavir)
• *Used for cytomegalovirus (CMV) infections in immunocompromised
• IV infusion. Not rapid or bolus injection
• *Patient must be hydrated
28© Paradigm Publishing, Inc.
*fluconazole (Diflucan)
• *Oral form used for vaginal or oral candidiasis
• IV if cannot tolerate oral therapy• Side effects: headache, rash, GI
upset
29© Paradigm Publishing, Inc.
*itraconazole (Sporanox)
• *Fungal infections of nails
• Capsule taken twice a day with– Fatty meal, and – Cola to increase stomach acidity and
increase absorption
• *Drug is especially toxic to liver– Monitor for liver damage, jaundice
30© Paradigm Publishing, Inc.
*posaconazole (Noxafil)
• Prevents Candida and Aspergillus infections for immunocompromised
• *Broader spectrum of activity than other triazoles
• Oral suspension, shake well before administration
31© Paradigm Publishing, Inc.
voriconazole (VFEND)
• Alternative to amphotericin B• Can be started IV and switched to
oral dose• Can cause liver toxicity and blurred
vision
32© Paradigm Publishing, Inc.
Caspofungin (Cancidas)
• Inhibit synthesis of D-glucan, important cell wall component of fungus
• Only available in IV form for invasive aspergillosis if unresponsive to other therapies
© Paradigm Publishing, Inc. 33
Terms to Remember
fungus
eukaryotic
prokaryotic
cholesterol
bacteria
aerobic
anaerobic
© Paradigm Publishing, Inc. 34
Terms to Remember
nosocomial infection
Gram staining
ergosterol
permeability
troche
immunocompromised
35© Paradigm Publishing, Inc.
Viruses and Viral Infections
• *Virus – Minute infectious agent– Does not have all components of a cell– Replicate *within cell by using metabolic
process of *host cell– Can only replicate within a *living host
cell: animal, plant, or bacteria
Viruses
• Infectious particles that have core containing genetic material surrounded by protective protein coat called a capsid
Cannot grow, eat, or reproduce by
themselves; must enter another cell and use that cell for energy to grow and reproduce
• Do not respond to antibiotics; can stay dormant in body and become active later in life
37© Paradigm Publishing, Inc.
Virus and Bacterium
• A virus is much smaller than a bacterium.
• Image shows a virus infecting a bacterium.
Figure 3-15 A virus.
39© Paradigm Publishing, Inc.
Virus Characteristics
• Most viruses spread by– Direct contact– Ingestion of contaminated food and
water– Inhalation of airborne particles– Exposure to contaminated body
fluids/equipment
40© Paradigm Publishing, Inc.
Virus Characteristics
• Virion– An individual virus particle capable of
infecting a living cell– Consists of nucleic acid, DNA or RNA– Capsid (protein shell) surrounds and
protects nucleic acid
41© Paradigm Publishing, Inc.
Virus Characteristics
• Depending on virus, capsid is– Covered with a membrane called an
envelope – Not covered with an envelope
• Naked virus: a virus without an envelope
42© Paradigm Publishing, Inc.
Five Stages of Viral Infection(how viruses affect the body)
1. Virus attaches to a cell receptor.
2. Virus penetrates cell as cell membrane indents and closes around the virus.
3. Virus escapes into the cytoplasm of the cell.
43© Paradigm Publishing, Inc.
Five Stages of Viral Infection
4. Virus uncoats.• Sheds its covering• Releases DNA or RNA into cell nucleus
5. Virus converts nuclear activity in the cell to viral activity and reproduces new viral particles.
• *Uses energy of host cell to infect the cell and make more virus
44© Paradigm Publishing, Inc.
Blocking Viral Division
• All viruses have some characteristics different from uninfected cells
• These differences offer ways to block viral division– Normal cells not affected
45© Paradigm Publishing, Inc.
Viral Infections and Illnesses
• Common and significant illnesses– Influenza– Hepatitis, inflammation of the liver– HIV (human immunodeficiency virus)
• Chronic disease to be managed• Pharmacy team stay alert for drug
interactions
© Paradigm Publishing, Inc. 46
Discussion
Provide an example of a common viral infection and the symptoms of this condition.
The flu (influenza) with symptoms of malaise, myalgia (muscle pain), headache, chills, and fever
47© Paradigm Publishing, Inc.
Classification of Viral Infections
Viral infections classified in two ways– Viral duration and severity– Viral infection
48© Paradigm Publishing, Inc.
Viral Duration and Severity
• Acute: quickly resolves, no latent infection. Common cold, flu
• Chronic: protracted course with long periods of remission interspersed with reappearance. Herpes virus infection
• Slow: progressive course, ends in death. HIV (AIDS)
49© Paradigm Publishing, Inc.
Viral Infection
• Local: affects tissues of a single system, such as the respiratory tract, eye, or skin
• Generalized: has spread or is spreading to other tissues by way of bloodstream or tissues of the CNS
50© Paradigm Publishing, Inc.
Viral Latency
• Virus lies dormant, then under certain conditions, reproduces and behaves like an infective agent (usually from a stress that taxes the immune system)
• *Latency problem with herpes virus and HIV
51© Paradigm Publishing, Inc.
Virus and Cell Interaction
• A virus can damage host cell by– Altering the cell– Incorporating into genetic material of
host cell– Dividing when host cell divides– Killing host cell
52© Paradigm Publishing, Inc.
Virus and Cell Interaction
• Most viruses have several antigens on their surface
• Antigens stimulate host to produce immunoglobulins– An antibody that may prevent an organism
from attaching to a cell receptor or may destroy organism
53© Paradigm Publishing, Inc.
Interferon
• Some virus-infected cells respond by producing interferon– Substance that protects neighboring
uninfected cells from viral infection– Inhibits viral RNA synthesis– Host specific
54© Paradigm Publishing, Inc.
Vaccination
• Introduces a vaccine into the body to produce immunity to actual agent
• Exposes patient to a virus component or a similar strain that does not produce infection
• When vaccinated patient encounters actual virus, infection cannot develop
© Paradigm Publishing, Inc. 55
Discussion
Who should receive an influenza vaccine?
High-risk patients such as healthcare workers, nursing home residents, public safety workers, individuals over 65 years old, and immunocompromised patients.
56© Paradigm Publishing, Inc.
Antivirals
• Body can produce interferons
• But, some viruses cause normal cells to transform into cancer cells
• Antivirals prevent virus cell replication without interfering with host cell’s normal function– Difficult to develop
© Paradigm Publishing, Inc. 57
Drug ListAntiviralsSystemic Agents
– acyclovir (Zovirax)
– amantadine (Symmetrel)
– cidofovir (Vistide)
– famciclovir (Famvir)
– foscarnet (Foscavir)
– ganciclovir (Cytovene)
© Paradigm Publishing, Inc. 58
Drug ListAntiviralsSystemic Agents
– oseltamivir (Tamiflu)
– ribavirin (Copegus, Rebetol, Virazole)
– rimantadine (Flumadine)
– valacyclovir (Valtrex)
– valganciclovir (Valcyte)
– zanamivir (Relenza)
© Paradigm Publishing, Inc. 59
Drug ListAntiviralsOcular Agent
– ganciclovir (Vitrasert)
60© Paradigm Publishing, Inc.
Therapeutic Uses of Antivirals
• Cytomegalovirus (CMV) retinitis• Herpes simplex• Herpes simplex keratitis• Herpes zoster (shingles)• Influenza prophylaxis• Varicella (chicken pox)• Hepatitis B
61© Paradigm Publishing, Inc.
Side Effects of Antivirals
• Range from mild to severe– Mild: headache– Severe: renal disorders
62© Paradigm Publishing, Inc.
amantadine (Symmetrel)
• Inhibits uncoating which prevents absorption of viral particles into host cell
• Used for influenza A prophylaxis or treatment
• Also used for Parkinson disease• Rare side effects
63© Paradigm Publishing, Inc.
Dispensing Issues of amantadine (Symmetrel)
• Amatadine, rimantadine, and ranitidine can be easily confused
• Use dosing and indications to keep them straight
Warning!
64© Paradigm Publishing, Inc.
acyclovir (Zovirax)
• Used for– Genital herpes– Acute herpes zoster (shingles)– Varicella (chicken pox) – Herpes encephalitis (in IV form)
• Range of short- and long-term side effects
65© Paradigm Publishing, Inc.
famciclovir (Famvir)
• Used for– Acute herpes zoster (shingles)– Herpes simplex in immunocompromised– Genital herpes
• Dosed less frequently than acyclovir
• Prodrug
66© Paradigm Publishing, Inc.
ganciclovir (Cytovene)
• Used for cytomegalovirus (CMV) in immunocompromised
• When mixing, technicians must use chemotherapy agent precautions and label correctly
67© Paradigm Publishing, Inc.
Dispensing Issues of Cytovene
• Can be confused– Cytovene with dosages of 250 mg and
500 mg– Cytosar (chemotherapy agent) with
dose of 10 mg
Warning!
68© Paradigm Publishing, Inc.
Dispensing Issues of ganciclovir and foscarnet
• Patients given ganciclovir (Cytovene) or foscarnet (Foscavir) IV must be well hydrated
• Usually “standing orders” for hydration when prescribed
• If not, contact pharmacist or prescriber
Warning!
69© Paradigm Publishing, Inc.
oseltamivir (Tamiflu)
• Prevents influenza A and B
• Initiate within 48 hours of symptom onset
• Food improves tolerance
70© Paradigm Publishing, Inc.
ribavirin (Virazole)
• Inhalant antiviral, maximum absorption with aerosol generator via an endotracheal tube
• For viral infections and children with RSV• Side effects: fatigue, headache, insomnia,
nausea, anorexia
71© Paradigm Publishing, Inc.
rimantadine (Flumadine)
• Used for influenza prophylaxis or treatment
• Fewer side effects than amantadine (Symmetrel)
72© Paradigm Publishing, Inc.
valacyclovir (Valtrex)
• For herpes zoster in immunocompetent adults and genital herpes
• Take within 48 hours of onset of zoster rash with water
• Shortens postherpetic neuralgia duration
• Side effects: nausea, vomiting, diarrhea, constipation
73© Paradigm Publishing, Inc.
zanamivir (Relenza)
• Used for influenza A and B
• Take within 48 hours of onset of symptoms
• 2 inhalations daily, 12 hour intervals, for 5 days
• If using bronchodilator, use immediately prior to administration of zanamivir
• Sometimes prophylactic
74© Paradigm Publishing, Inc.
ganciclovir (Vitrasert)
• Ophthalmic antiviral
• Available in oral and IV form
• Pregnant women should not handle this drug
© Paradigm Publishing, Inc. 75
Terms to Remember
virusvirioncapsidenvelopenaked virusfluhepatitishuman immunodeficiency virus (HIV)
© Paradigm Publishing, Inc. 76
Terms to Remember
acute viral infection
chronic viral infection
slow viral infection
local viral infection
generalized viral infection
latency
immunoglobulin
© Paradigm Publishing, Inc. 77
Terms to Remember
interferon
vaccination
antiviral
prodrug
78© Paradigm Publishing, Inc.
HIV-AIDS and Antiretrovirals
• HIV is a retrovirus– Copies its RNA genetic information into
the host’s DNA– Uses reverse transcriptase, a retroviral
enzyme
• Antiretroviral drugs limit progression of HIV retrovirus
79© Paradigm Publishing, Inc.
Seven Classes of Antiretroviral Drugs
• Nucleoside reverse transcriptase inhibitors (NRTIs)
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
• Nucleotide reverse transcriptase inhibitors (NtRTIs)
• Protease inhibitors (PIs)
• Fusion inhibitors
• Chemokine receptors
• Integrase inhibitors
80© Paradigm Publishing, Inc.
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
• Mimic a DNA building block to inhibit the actions of the enzyme nucleoside reverse transcriptase
• Prevents replication of HIV
© Paradigm Publishing, Inc. 81
Drug List
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
– abacavir (Ziagen)
– didanosine (Videx)
– emtricitabine (Emtriva)
© Paradigm Publishing, Inc. 82
Drug List
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
– lamivudine (Epivir)
– stavudine (Zerit)
– zidovudine, AZT (Retrovir)
83© Paradigm Publishing, Inc.
Side Effects of NRTIs
• GI distress is common– Nausea, diarrhea, abdominal pain– Usually improves within first 2 weeks of
therapy
• More permanent side effects include degeneration of the liver
84© Paradigm Publishing, Inc.
Dispensing of NRTIs
• Taken with or without food
• Generally do not interfere with other drugs
• Administered in two or three doses per day
85© Paradigm Publishing, Inc.
lamivudine (Epivir)
• Used for HIV and chronic hepatitis B
• Must be taken exactly as prescribed
• Fewest side effects of any of the NRTIs
86© Paradigm Publishing, Inc.
zidovudine, AZT (Retrovir)
• One of the first drugs for HIV treatment
• Can be combined with all NRTIs– Exception: stavudine
• Used in combination with lamivudine (with or without PI) for needlestick or sexual exposure
87© Paradigm Publishing, Inc.
Dispensing Issues of zidovudine, AZT (Retrovir)
• Do not use the abbreviation AZT for zidovudine
• Use of abbreviation can lead to medical errors
Warning!
88© Paradigm Publishing, Inc.
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
• Inhibit action of HIV reverse transcriptase
• Prevent formation of DNA copy of viral RNA
© Paradigm Publishing, Inc. 89
Drug List
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
– delavirdine (Rescriptor)– efavirenz (Sustiva)– nevirapine (Viramune)
90© Paradigm Publishing, Inc.
efavirenz (Sustiva)
• Dosed once a day, prefer bedtime• Avoid high-fat meals• Side effects
– Dizziness, headache– Vivid dreams, nightmares, hallucinations
• Typically 1 to 3 hours after administration• Usually subside after 2 to 4 weeks on drug
91© Paradigm Publishing, Inc.
nevirapine (Viramune)
• Lower dose first 2 weeks, then increased to therapeutic level to avoid rash
• Antibiotic rifampin interferes with this drug
• Decreases serum concentration of PIs
• Must monitor liver functions
92© Paradigm Publishing, Inc.
Nucleotide Reverse Transcriptase Inhibitor (NtRTIs)
• Mimic a DNA building block to stop formation of DNA copy
• Less toxicity than NRTIs
© Paradigm Publishing, Inc. 93
Drug List
Nucleotide Reverse Transcriptase Inhibitor (NtRTIs)
– tenofovir (Viread)
94© Paradigm Publishing, Inc.
Protease Inhibitors (PIs)
• Inhibit protease enzyme, which cleaves certain HIV protein precursors needed to replicate virus
• Result: production of immature, noninfectious virions
• Combined with other antiretroviral drugs
© Paradigm Publishing, Inc. 95
Drug List
Protease Inhibitors (PIs)– amprenavir (Agenerase)– atazanavir (Reyataz)– darunavir (Prezista)– fosamprenavir (Lexiva)
– indinavir (Crixivan)
© Paradigm Publishing, Inc. 96
Drug List
Protease Inhibitors (PIs)– nelfinavir (Viracept)
– ritonavir (Norvir)
– saquinavir (Fortovase, Invirase)
– tipranavir (Aptivus)
97© Paradigm Publishing, Inc.
indinavir (Crixivan)
• Do not take with– St. John’s wort– Grapefruit juice– With food, especially high-fat
• 48 ounces/day of water (kidney stones)• Package with a desiccant• Patient to store in original container
98© Paradigm Publishing, Inc.
nelfinavir (Viracept)
• Can cause diarrhea– Loperamide and calcium carbonate can
help control
• Take with food
99© Paradigm Publishing, Inc.
ritonavir (Norvir)
• Increases serum concentrations and decreases dosage frequency of other PIs
• Given at a low dose
• Take with food
• Many side effects
• Store in refrigerator
100© Paradigm Publishing, Inc.
tipranavir (Aptivus)
• May have some advantages over other PIs– More adaptable structure to protease binding
sites
– Delivery system improves dissolution and bioavailability of drug
• Given with ritonavir (Norvir) as boost
• Black Box warning
© Paradigm Publishing, Inc. 101
Discussion
How do fusion inhibitors represent an advance in the treatment of HIV?
Prevents AIDS virus from entering the cell
102© Paradigm Publishing, Inc.
Fusion Inhibitors and Chemokine Coreceptors
• Prevent HIV from entering immune cells
© Paradigm Publishing, Inc. 103
Drug List
Fusion Inhibitors– enfuvirtide (Fuzeon)
Chemokine Coreceptor– maraviroc (Selzentry)
104© Paradigm Publishing, Inc.
maraviroc (Selzentry)
• First drug approved for R5 Virus
• Given with other antiretrovirals
• Taken without regard to food
• Side effect: cough
• Patient must be monitored closely for infection
105© Paradigm Publishing, Inc.
Integrase Inhibitor
• Drug blocks enzyme integrase
• Integrase inserts DNA produced by reverse transcriptase into patient’s DNA
© Paradigm Publishing, Inc. 106
Drug List
Integrase Inhibitor– raltegravir (Isentress)
107© Paradigm Publishing, Inc.
raltegravir (Isentress)
• Blocks action of enzyme integrase
• Used only in combination with other HIV drugs
• Reduces amount of HIV in blood
• Increases white blood cell count which helps fight infection
108© Paradigm Publishing, Inc.
Responding to HIV Exposure
• Centers for Disease Control (CDC) guidelines for healthcare workers exposed to HIV– Post-exposure prophylaxis (PEP)– Begin within two hours– Can decrease risk of infection by 80%
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Combining Antiretrovirals
• Standard care for AIDS treatment is to combine three or more drugs
• Regimens complex and difficult to follow
• Problem with compliance
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Combining Antiretrovirals
Regimen Type Recommendation
standard therapy NNRTI: efavirenz + lamivudine + (zidovudine or tenofovir or stavudine)
PI: lopinavir-ritonavir + lamivudine + (zidovudine or stavudine)
111© Paradigm Publishing, Inc.
Combining Antiretrovirals
Regimen Type Recommendation
alternative therapy 3-NRTI: abacavir + lamivudine + (zidovudine or stavudine)
post-exposure prophylaxis (PEP)
zidovudine + lamivudine + (indinavir or nelfinavir)
112© Paradigm Publishing, Inc.
Dispensing Issues of Antiretrovirals
• Avoid these antiretroviral drug combinations– didanosine with stavudine and
zalcitabine– zidovudine with stavudine
Warning!
113© Paradigm Publishing, Inc.
Combining Antiretrovirals
• Increasing number of manufacturers combining antiretrovirals into 1 tablet
• Decreases pill load
• Improves compliance– Partial compliance can lead to drug
resistance
© Paradigm Publishing, Inc. 114
Discussion
What is one of the biggest problems when treating HIV?
Noncompliance with drug regimen due to problematic side effects and complex dosing.
© Paradigm Publishing, Inc. 115
Terms to Remember
*retrovirus
reverse transcriptase
*antiretroviral
nucleoside reverse transcriptase inhibitor (*NRTI)
non-nucleoside reverse transcriptase inhibitor (*NNRTI)
© Paradigm Publishing, Inc. 116
Terms to Remember
nucleotide reverse transcriptase inhibitor (*NtRTI)
*protease inhibitor (PI)
fusion inhibitor
chemokine coreceptor
integrase inhibitor
*post-exposure prophylaxis (PEP)