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Chapter 67

Chapter 67. The Immune System and Antiretroviral Medications. Drug Overview. Antiretrovirals Nucleoside reverse transcriptase inhibitors (NRTIs) Non-nucleoside reverse transcriptase inhibitors (NNRTIs) Protease inhibitors (PIs) Second-generation PI fusion inhibitor 

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Chapter 67

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  1. Chapter 67 The Immune System and Antiretroviral Medications

  2. Drug Overview • Antiretrovirals • Nucleoside reverse transcriptase inhibitors (NRTIs) • Non-nucleoside reverse transcriptase inhibitors (NNRTIs) • Protease inhibitors (PIs) • Second-generation PI fusion inhibitor  • HIV integrase inhibitors

  3. Drug Overview • Indications • Nucleoside reverse transcriptase inhibitors (NRTIs) • Non-nucleoside reverse transcriptase inhibitors (NNRTIs) • Protease inhibitors (PIs) • Second-generation PI fusion inhibitor  • HIV integrase inhibitors

  4. Mechanism of Action • Highly Active Antiretroviral Treatment (HAART) • Reverse Transcriptase Inhibitors • Protease Inhibitors • Fusion Inhibitors • HIV Integrase Inhibitors

  5. Treatment Principles • Standardized Guidelines • Guidelines from the International AIDS Society–USA • Hammer SM et al: International AIDS Society–USA Panel: Treatment for adult HIV infection: 2006 recommendations of the International AIDS Society–USA Panel, JAMA 296:827-843, 2006

  6. Treatment Principles • Evidence-Based Recommendations • Beneficial • Unknown effectiveness • Cardinal Points of Treatment • Initiation of therapy in symptomatic persons • Initiation of therapy in asymptomatic persons • Antiretroviral choice • Special populations • Adherence

  7. Treatment Principles • Cardinal Points of Treatment (cont’d) • Prophylaxis and prevention • How to Monitor • Patient Variables • Special populations • Geriatrics • Pediatrics • Pregnancy and lactation

  8. Treatment Principles • Patient Education

  9. Reverse Transcriptase Inhibitors • zidovudine (ZDV, AZT) (Retrovir) • Contraindications • Warnings • Precautions • Adverse effects • Drug interactions • Dosage and administration

  10. Reverse Transcriptase Inhibitors • Other Drugs in Class • lamivudine (3TC) (Epivir) • Contraindications • Warnings • Important differences among lamivudine-containing products • Precautions • Adverse effects • Drug interactions • Dosage and administration

  11. Reverse Transcriptase Inhibitors • Other Drugs in Class (cont’d) • abacavir (Ziagen) • Adverse effects • Dosage and administration

  12. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) • delavirdine mesylate (DLV) (Rescriptor) • Contraindications • Precautions • Drug interactions • Other Drugs in Class • Similar to the prototype except: • efavirenz (Sustiva) • Precautions • Drug interactions • Adverse effects • nevirapine (Viramune) • Adverse effects

  13. Protease Inhibitors • ritonavir (Norvir) • Contraindications • Warnings • Precautions • Drug interactions • Dosage and administration

  14. Fusion Inhibitor • enfuvirtide (Fuzeon, T-20) • Contraindications • Warnings

  15. HIV Integrase Inhibitors • raltegravir (Isentress) • Indications • Adverse effects • Dosage and administration

  16. Combination Drug Therapies • See Table 67-4

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