Antiretroviral Drug Classes
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Which mechanism do non-nucleoside reverse transcriptase inhibitors (NNRTIs) primarily employ to inhibit HIV replication?

  • They block the HIV protease enzyme from cleaving proteins.
  • They directly bind to and inhibit HIV integrase.
  • They bind to the reverse transcriptase enzyme causing conformational changes. (correct)
  • They prevent the fusion of HIV with host cells.

    • Which class of antiretroviral drugs does not require intracellular phosphorylation for its activity?

  • Entry/Fusion Inhibitors
  • Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) (correct)
  • Integrase Strand Transfer Inhibitors (INSTIs)
  • Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

    • Which of the following is NOT a common side effect associated with NNRTIs?

  • Nausea (correct)
  • Rash
  • Hepatotoxicity
  • Dizziness

    • What is the main function of protease inhibitors (PIs) in antiretroviral therapy?

    <p>Block the cleavage of polyprotein precursors into functional proteins.</p> Signup and view all the answers

    Which of the following best describes the role of Entry/Fusion Inhibitors?

    <p>They prevent HIV from entering cells by blocking attachment or fusion.</p> Signup and view all the answers

    What type of HIV do NNRTIs primarily treat?

    <p>HIV-1</p> Signup and view all the answers

    Which drug class includes tenofovir and lamivudine?

    <p>Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)</p> Signup and view all the answers

    What primary role does the integrase enzyme play in HIV replication?

    <p>Integrates viral genetic material into host cell DNA.</p> Signup and view all the answers

    What is the main purpose of administering antiviral medications for genital herpes?

    <p>To reduce viral shedding and outbreaks</p> Signup and view all the answers

    Which of the following is NOT considered a common infectious agent of nongonococcal urethritis (NGU)?

    <p>Neisseria gonorrhoeae</p> Signup and view all the answers

    When is it essential for patients to abstain from sexual activity after initiating treatment for nongonococcal urethritis?

    <p>For 7 days following treatment</p> Signup and view all the answers

    What is the recommended first-line antibiotic regimen for treating uncomplicated nongonococcal urethritis in adults?

    <p>Doxycycline 100 mg twice daily for 7 days</p> Signup and view all the answers

    For pelvic inflammatory disease (PID), which of the following is part of the standard outpatient treatment regimen?

    <p>Single dose of Ceftriaxone plus doxycycline for 14 days</p> Signup and view all the answers

    What is the role of prompt treatment in cases of pelvic inflammatory disease (PID)?

    <p>To prevent complications like infertility</p> Signup and view all the answers

    What additional treatment should be considered for sexually acquired proctitis if perianal ulcers are present?

    <p>Antiviral treatment for herpes simplex virus</p> Signup and view all the answers

    Which of the following antibiotics is recommended for treating acute sexually transmitted epididymitis in men under 35?

    <p>Ceftriaxone plus Doxycycline</p> Signup and view all the answers

    Sexual partners of patients treated for nongonococcal urethritis should be evaluated and treated primarily to:

    <p>Prevent reinfection</p> Signup and view all the answers

    What is the standard course of treatment for uncomplicated cases of nongonococcal urethritis in pregnant women who cannot take doxycycline?

    <p>Azithromycin 1 g orally once</p> Signup and view all the answers

    Which statement about the follow-up care for sexually transmitted infections is accurate?

    <p>Testing 3 months after treatment is advised for trichomoniasis and syphilis.</p> Signup and view all the answers

    What is the primary bacterial cause of syphilis?

    <p>Treponema pallidum</p> Signup and view all the answers

    Which treatment is preferred for early syphilis?

    <p>A single dose of penicillin G benzathine</p> Signup and view all the answers

    Which of the following is true about bacterial vaginosis?

    <p>Overgrowth of anaerobic bacteria is a common cause.</p> Signup and view all the answers

    What is the alternative treatment for a patient with penicillin allergy who has early syphilis?

    <p>Doxycycline for 14 days</p> Signup and view all the answers

    Which of the following is a characteristic symptom of genital herpes?

    <p>Painful blisters or ulcers</p> Signup and view all the answers

    Regarding trichomoniasis, what is the recommended dosage for men?

    <p>2 g of metronidazole in a single oral dose</p> Signup and view all the answers

    What is a common sign of secondary syphilis?

    <p>Skin rashes and lymphadenopathy</p> Signup and view all the answers

    Which of the following is true regarding metronidazole and alcohol?

    <p>Alcohol should be avoided during treatment and for 3 days after.</p> Signup and view all the answers

    What is recommended for the treatment of neurosyphilis?

    <p>Aqueous crystalline penicillin G intravenously</p> Signup and view all the answers

    Which medication is known for reducing both symptoms and outbreak frequency in genital herpes?

    <p>Acyclovir</p> Signup and view all the answers

    What is a key preventative measure during outbreaks of genital herpes?

    <p>Consistent condom use</p> Signup and view all the answers

    What is not a characteristic symptom of bacterial vaginosis?

    <p>Painless sore</p> Signup and view all the answers

    What is the primary mechanism by which protease inhibitors (PIs) prevent HIV replication?

    <p>They bind to the active site of HIV protease and prevent cleavage.</p> Signup and view all the answers

    Which of the following statements about enfuvirtide is incorrect?

    <p>Enfuvirtide needs to be administered orally.</p> Signup and view all the answers

    Before initiating maraviroc therapy, what test is essential?

    <p>A tropism test to confirm CCR5 co-receptor use.</p> Signup and view all the answers

    Which of the following is NOT a common side effect of protease inhibitors?

    <p>Rash</p> Signup and view all the answers

    What is the preferred treatment duration for nonoccupational postexposure prophylaxis (nPEP) after potential HIV exposure?

    <p>28 days</p> Signup and view all the answers

    What alternative treatment might be preferred for severely immunocompromised patients with Pneumocystis pneumonia?

    <p>Intravenous pentamidine</p> Signup and view all the answers

    Which of the following drugs is NOT commonly used for treating cytomegalovirus retinitis?

    <p>Acyclovir</p> Signup and view all the answers

    What is the primary reason for using combination therapy with amphotericin B and flucytosine in cryptococcal meningitis treatment?

    <p>To decrease treatment failure and relapse rates.</p> Signup and view all the answers

    What key strategy complements PrEP in preventing HIV transmission?

    <p>Risk reduction counseling and condom use.</p> Signup and view all the answers

    Which of the following is a crucial aspect of drug therapy for Mycobacterium infections such as tuberculosis?

    <p>Multi-drug regimen for extended duration.</p> Signup and view all the answers

    Which of the following is NOT a first-line drug in the treatment regimen for drug-susceptible tuberculosis?

    <p>Amikacin</p> Signup and view all the answers

    Which statement regarding treatment for varicella zoster virus infection is true?

    <p>Oral acyclovir is recommended for children if started within 24 hours.</p> Signup and view all the answers

    Which side effect is notably associated with enfuvirtide administration?

    <p>Injection site reactions</p> Signup and view all the answers

    How is the treatment for herpes simplex virus infections best characterized?

    <p>Medications can reduce symptoms but cannot cure the infection.</p> Signup and view all the answers

    How is maraviroc primarily metabolized in the body?

    <p>By the CYP450 enzyme system, specifically CYP3A4.</p> Signup and view all the answers

    What is the standard dosing frequency for enfuvirtide?

    <p>Twice daily</p> Signup and view all the answers

    What is a key consideration when treating candidiasis in immunocompromised patients?

    <p>Chronic suppressive therapy may be necessary for recurrent infections.</p> Signup and view all the answers

    Which of the following best describes chlamydial infections?

    <p>They can lead to serious complications if left untreated.</p> Signup and view all the answers

    Which treatment is typically employed for ganciclovir-resistant CMV retinitis?

    <p>Cidofovir</p> Signup and view all the answers

    Which HIV treatment strategy focuses on reducing risk before potential exposure?

    <p>PrEP (preexposure prophylaxis)</p> Signup and view all the answers

    What is the standard treatment for uncomplicated gonococcal infections?

    <p>A single intramuscular dose of ceftriaxone.</p> Signup and view all the answers

    Why is it crucial to monitor patients receiving amphotericin B for adverse effects?

    <p>It can cause serious renal damage.</p> Signup and view all the answers

    What is the recommended course of treatment for an initial episode of herpes simplex virus infection?

    <p>Oral or IV antivirals for 7-10 days.</p> Signup and view all the answers

    What factor is important for treating varicella zoster virus infections in older adults?

    <p>Higher doses of oral acyclovir or valacyclovir are recommended.</p> Signup and view all the answers

    What condition can cause newborns to develop conjunctivitis during birth due to maternal infection?

    <p>Chlamydia trachomatis.</p> Signup and view all the answers

    Which of the following statements regarding dual therapy for gonococcal infections is accurate?

    <p>Dual therapy is no longer preferred due to microbiome concerns.</p> Signup and view all the answers

    What is the appropriate course of action for treating vulvovaginal candidiasis?

    <p>Oral fluconazole or topical azoles can be effective.</p> Signup and view all the answers

    What is an important consideration for patients with both TB and HIV?

    <p>Drug interactions and immune responses must be monitored.</p> Signup and view all the answers

    Study Notes

    Antiretroviral Drug Classes

    • Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs): Inhibit HIV reverse transcriptase, crucial for viral replication. Examples include tenofovir, abacavir, and lamivudine.
    • Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): Bind to and inhibit HIV reverse transcriptase differently than NRTIs. Examples include efavirenz, rilpivirine, and doravirine. They act by causing conformational changes, inhibiting the enzyme's activity, and blocking viral replication. Generally, NNRTIs are only active against HIV-1, not HIV-2. Side effects include rash, hepatotoxicity, and CNS effects.
    • Protease Inhibitors (PIs): Block viral protease, preventing the production of mature, infectious viral particles. Examples include atazanavir, darunavir, and lopinavir. They are metabolized by the CYP450 enzyme system which leads to drug interactions. Ritonavir often used in low doses to boost other PIs. Side effects include GI intolerance, hyperlipidemia, insulin resistance, and body fat redistribution.
    • Integrase Strand Transfer Inhibitors (INSTIs): Inhibit HIV integrase, crucial for viral integration into host cells. Examples include dolutegravir, raltegravir, and bictegravir.
    • Entry/Fusion Inhibitors: Prevent HIV from entering cells. Examples include enfuvirtide and maraviroc. Enfuvirtide used subcutaneously twice daily, as a last resort, for multiple-drug-resistant HIV. Maraviroc uses CCR5 co-receptor to block CCR5-tropic HIV infection.

    NNRTI Pharmacology

    • NNRTIs directly bind to HIV-1 reverse transcriptase, causing changes that halt its activity.
    • Unlike NRTIs, NNRTIs don't need cellular phosphorylation for activity.
    • Used in combination therapy (HAART) against HIV-1.

    PI Pharmacology

    • PIs inhibit HIV protease, preventing viral polyprotein cleavage.
    • This leads to non-infectious viral particles.
    • PIs significantly improve HIV outcomes but require careful monitoring due to CYP450 interactions and metabolic side effects.

    Enfuvirtide Pharmacology

    • Enfuvirtide is a fusion inhibitor, preventing HIV envelope fusion with host cells.
    • Administered subcutaneously twice daily, reserved for treatment-experienced patients with multidrug-resistant HIV.
    • Often combined with other antiretrovirals to delay resistance.
    • Potential side effects include injection site reactions, hypersensitivity reactions, and rare immune-mediated conditions.

    Maraviroc Pharmacology

    • Maraviroc blocks CCR5 co-receptor on CD4 cells, preventing CCR5-tropic HIV entry.
    • Must be used in combination with other antiretrovirals.
    • A tropism test is required before starting maraviroc to confirm CCR5-tropism.
    • Metabolism by CYP3A4 can lead to drug interactions.

    HIV Prevention (PrEP and nPEP)

    • PrEP: Daily antiretroviral use to reduce HIV acquisition risk. Regimens include Truvada and Descovy. Cabotegravir (long-acting) is an emerging option. Recommended for high-risk individuals.
    • nPEP: 28-day course of antiretrovirals after potential exposure. Must be initiated within 72 hours of exposure and usually involves a three-drug combination, including an integrase inhibitor. Recommended for single high-risk exposures.

    Opportunistic Infections and Drug Therapy

    • Pneumocystis pneumonia (PCP): Trimethoprim/sulfamethoxazole (TMP/SMZ) is the primary treatment. Intravenous pentamidine can be used for severely immunocompromised individuals.
    • Cytomegalovirus (CMV) retinitis: Ganciclovir (or valganciclovir) or foscarnet or cidofovir are first-line treatments. Lifelong maintenance therapy may be needed.
    • Mycobacterium infections (e.g., tuberculosis): Multi-drug regimen required, including isoniazid, rifampin, ethambutol, and pyrazinamide for 2 months (initial), then isoniazid and rifampin for 4 months. MDR/XDR TB require second-line agents. Co-infection requires special consideration.
    • Cryptococcal meningitis: Amphotericin B plus flucytosine is the preferred treatment. Maintenance therapy with fluconazole is generally used after initial treatment.
    • Varicella-zoster virus: Acyclovir is the primary medication for chickenpox and shingles. Early intervention is best, with supportive care.
    • Herpes Simplex Virus (HSV): Acyclovir, valacyclovir, famciclovir are used for symptomatic relief. Suppressive therapy is possible. Topical available for oral herpes.
    • Candidiasis: Topical antifungals (nystatin, clotrimazole, miconazole) for mucosal candidiasis. Oral azoles (fluconazole) for systemic infections.

    Bacterial STIs and Drug Therapy

    • Chlamydia: Azithromycin or doxycycline. Early treatment and partner treatment vital.
    • Gonorrhea: Ceftriaxone. Avoiding dual-therapy, for now. Partner treatment essential.
    • Syphilis: Intramuscular penicillin G. Alternatives (doxycycline) for penicillin-allergic patients. Partner treatment and follow-up testing necessary.
    • Bacterial vaginosis (BV): Oral or vaginal metroinidazole or clindamycin. Can use tinidazole.
    • Trichomoniasis: Metronidazole (or tinidazole) for both partners. Alcohol avoidance necessary. Follow-up testing essential.
    • Nongonococcal urethritis (NGU): Doxycycline is first-line therapy. Partner treatment required.
    • Pelvic Inflammatory Disease (PID): Intramuscular cephalosporin (e.g., ceftriaxone) plus oral doxycycline/metronidazole.
    • Acute sexually transmitted epididymitis: Ceftriaxone plus doxycycline (or levofloxacin for anal insertive activity).

    Other Conditions and Treatment

    • Genital herpes: Antivirals (acyclovir, famciclovir, valacyclovir) can reduce symptoms and outbreaks, but no cure.
    • Proctitis: Combination of antibiotics to cover multiple organisms.

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    Description

    This quiz covers key classes of antiretroviral drugs, including NRTIs, NNRTIs, and PIs. Learn about their mechanisms, examples, and side effects. Test your knowledge of how these drugs combat HIV infection and their role in modern treatment regimens.

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