University:
University of North Carolina at Chapel Hill
Course:
NURS 312 | Pharmacology
Academic year:

2020
Views:

361

Pages:

1
Author:

Nesbyenvkk

6.1 – “Le Morte d’HIV d’HIV”: ”: NRTIs (abacav (abacavir, ir, diadnosine, emtr emtricitabine, icitabine, lamivudine, stavudine, te tenofovir, nofovir, zidovudine) • 6 classes of ARTs are combined depending on the characteristics of the patients, adverse effects, and bug profile. Usually 2 NRTIs + at least one other agent from a different class form the backbone of multidrug therapy. • Nucleoside/Nucleotide reverse transcriptase inhibitors (NRTIs) (Knights of the Round Table). Act by competitive inhibition of HIV reverse transcriptase (reverse trasncriptum spell book has been stolen). Because NRTIs are nucleotides/sides, incorporate into DNA transcription but lack the 3’ hydroxyl, blocking 3’-5’ phosphodiester bond formation and causing premature chain termination (nucleoside mace with broken 3’ -OH group; page #s; broken helix bookmark) • “-dine” suffix attached to some of the NRTIS (meal) • Nucleosides must be phosphorylated & activated by cellular enzymes (activating Ⓟ scroll). • Shared adverse effects o All are associated with mitochondrial toxicity (table shape) o Lactic acidosis (sour milk) • Lamivudine (Sir Lancelot) o Used to treat Hep B (hippo, hippies, secret society banner). Especially helpful in HIV/Hep B coinfection. Note that in the latter case, discontinuation of the drug may lead to a hepatitis flair. o Adverse effects ▪ Peripheral neuropathy (Lancelot’s stockings and gloves) • Tenofovir (Sir Tristan) o Nucleotide not nucleoside (Tenofovir starts with a T) o As a nucleotide, does not need to be activated by cell enzymes (sailing on the tide while the others must wait inside, doesn’t need to wait for the Ⓟ signal) o Also has hep B activity • Zidovudine (Isolde with the dove crest) o Used during pregnancy and breastfeeding to reduce vertical transmission (pregnant woman) o Infants born to HIV+ mother usually receive several doses of zidovudine in the first weeks of life. o Adverse effects ▪ May cause myelosuppression (empty bone-shaped dish), causing anemia/neutropenia & agranulocytosis (white dress; sand timer) ▪ Lipodystrophy, with ↑central adiposity, ↓peripheral fat (silly looking horse) • Stavudine (Sir Steve) o Adverse effects ▪ Peripheral neuropathy (Lancelot’s stockings and gloves) ▪ Lipodystrophy • Didanosine (Sir Dan) o Major toxicity: dose dependent pancreatitis (pancreas shaped sponge) o ↑risk of peripheral neuropathy when coadministered with stavudine (Lancelot’s stockings and gloves) • Abacavir (abracadabra; merlin) o Hypersensitivity strongly associated with HLA-B 57:01 allele (Spell name). Presentation of cell peptides to immune system → delayed Type 4 HS reaction (he’s distracted and has a delayed reaction to spotted rash) • Emtricitabine (Excalibur) o Hyperpigmentation of palms and soles (badass gloves)