Unit 3

reverse transcriptase inhibitors (NRTIs)

always combined w/ other antiretroviral drugs

MOA: inhibits HIV replication by suppressing DNA synthesis

AEs: hematologic toxicity, anemia, neutropenia, lactic acidosis w/ hepatomegaly, GI effects

uses: prevent mother → child transmission (pregnancy - delivery)

• zidovudine (AZT)

non-nucleoside reverse transcriptase inhibitors (NNRTIs)

interacts with St. John’s wort

AEs: transient adverse CNS effects, rash, teratogenicity

take on empty stomach at night (high fat meals → increased toxicity)

uses: 1st line agent for HIV

• nevirapine

protease inhibitors

avoid high fat & high protein foods

MOA: increases CD4 cell counts & reduces viral load to undetectable level (used w/ RTIs)

AEs: nephrolithiasis (encourage hydration)

• indinavir

3

treatment of HIV should include a minimum of how many drugs?

ACE inhibitors

MOA: blocks ACE, prevents angiotensin I → II

AEs: hyperkalemia, dry cough, decreased renal function, angioedema (rare)

TEs: increase vasodilation, decrease preload/afterload/BP

1st line tx for HF and HTN

• lisinopril (Prinivil, Zestril)

angiotensin renin blockers (ARBs)

MOA: prevents angiotensin II from binding to its receptors

AEs: BLACK BOX for pregnancy

TEs: increase vasodilation, decrease preload/afterload/BP

• valsartan

beta blockers

MOA: block SNS + to heart & its conduction system

AEs: hypoglycemia

cardioprotective!

• metoprolol (cardio selective)

• carvedilol (non-cardio selective)

furosemide or spiranolactone

what are 2 diuretics that are used for heart failure?

iontropy

increases or decreases the force of myocardial contraction

chronotropy

increases or decreases heart rate

dromotropy

accelerates or decelerates cardiac conduction

B-type natriuretic peptides

MOA: synthetic BNP → vasodilation of arteries & veins

AEs: hypotension, dysrhythmias, headache, abd pain, insomnia

TEs: diuresis, natriuresis, vasodilation, indirect increase in CO & RAAS suppression

used as last resort in ICU for seve

• nesiritide

cardiac glycosides

MOA: increases contractility, changes electrical conduction

AEs: narrow therapeutic window, toxicity (increased w/ low K+), brady/tachycardia, colored or halo vision, N/V/D

TEs: + ionotropic effect (increase force & velocity), - chronotropic effect (decrease HR), - dromotropic effect

used in HF & A fib

• digoxin

organic nitrates

TEs: vasodilation

AEs: headache, orthostatic hypotension, reflex tachycardia

contras: closed-angle glaucoma, severe head injury, severe anemia

• nitroglycerin (rapid & long acting)

• isosorbide dinitrate (rapid & long acting)

• isosorbide mononitrate (long acting

P wave

component of ECG: depolarization in the atria

QRS complex

component of ECG: depolarization of the ventricles

T wave

component of ECG: repolarization of the ventricles

zidovudine

drug of choice for preventing mother to child transmission during pregnancy, labor, delivery 

nevirapine

1^st line agent for treating HIV that should be taken on an empty stomach

methotrexate

folate antagonist that is also used for RA and psoriasis

leucovorin

what is the rescue drug for methotrexate?

floxuridine fluorouracil (5-FU)

pyrimidine antagonist that is only available in IV form and is used to treat solid tumors

mercaptopurine

purine antagonist that is also used for UC and Crohn’s

vincristine

vinca alkaloid that is toxic to peripheral nerves but does not cause myelosuppression

vinblastine

vinca alkaloid that causes significant myelosuppression but has no effect on peripheral nerves

asparagine, pegaspargase

list 2 antineoplastic enzymes which are used in the treatment of acute lymphocytic leukemia (ALL)

doxorubicin

antitumor antibiotic (anthracycline) that causes damage to the heart

dactinomycin

antitumor antibiotic (non-anthracycline) that does not cause damage to the heart

tamoxifen

antiestrogen drug that increases the risk of endometrial cancer

vancomycin, gentamycin

with which 2 antibiotics is it important to monitor peak & trough levels?

vancomycin, piperacillin-tazobactum

list 2 antibiotics that affect the bacterial cell wall

clindamycin, azithromycin, linezolid

list 3 antibiotics that affect bacterial protein synthesis

nephrotoxicity

what toxicity do all of these drugs have in common?

gentamycin, tobramycin, vancomycin, amphotericin B 

vancomycin

glycopeptide that can cause “red man” syndrome

clindamycin

lincosamide that increases the risk of developing C. difficile

azithromycin

macrolide that causes prolonged QT intervals

30 minutes after IM or immediately after IV 

when should peak levels be taken?

right before next dose (divided dose) or 1 hour before next dose (once daily dose) 

when should trough levels be taken?

acyclovir

1^st choice drug for HSV or VZV 

oseltamivir

drug used for influenza A & B in high-risk patients

paxlovid

oral drug used for COVID-19

remdesivir

IV drug used for COVID-19