Pharmacology of Antiretroviral Agents An Emphasis on Drug ...

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Choosing Lipid Lowering TherapyHMG CoA Reductase Inhibitors- “STATINS”• Avoid lovastatin and simvastatin with ALL proteaseinhibitors• Atorvastatin: OK with all except TPV (lowest dosepossible)• Pravastatin, pitavastatin, rosuvastatin and fluvastatin leastpotential for interaction (exceptions exist!)• Pravastatin + DRV/r 81% increase in pravastatin conc• Rosuvastatin (not CYP mediated), but significant ATVconcentrations (max 10mg/d)BILE ACID SEQUESTRANTS• Avoid use
Lipid-Lowering <strong>Agents</strong> and PIs:Drug-Drug InteractionsFibratesFluvastatinPravastatin*EzetimibeFish oilStatin + fibrateAtorvastatinRosuvastatinNiacinLow interactionpotentialUse cautiously*AUC ↑↑↑ with DRV.LovastatinSimvastatinContraindicatedAptivus [package insert]; 2005. Carr RA, et al. ICAAC 2000. Abstract 1644.Fitchenbaum CJ, et al. AIDS. 2002;16:569-577. Gerber JG, et al. CROI 2004. Abstract603. Gerber J, et al. IAS 2003. Abstract 870. Hsue PH, et al. <strong>An</strong>timicrob <strong>Agents</strong>Chemother. 2001;45:3445-3450. Lexiva [package insert]; 2007. Prezista [packageinsert]; 2006. Reyataz [package insert]; 2007.29. Expert Viewpoint. Aging in the HIV Infected Patient. Available from: http://www.clinicaloptions.com/HIV/Treatment%20Updates/Stay%20Tuned/Volume%201%20Edition%21/Reference%20Material/Expert%20Viewpoint%20Slides.aspx
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PHARMACOLOGY OFANTIRETROVIRAL AGENT
Page 3 and 4:
Introduction- Patient Case• SY is
Page 5 and 6:
1. Centers for Disease Control and
Page 7 and 8:
3. Luther VP, Wilken AL. HIV Infect
Page 9 and 10: Incident cases in 2009 approx 48,00
Page 11 and 12: ANTIRETROVIRALTHERAPYPharma
Page 13 and 14: 7. Pomerantz RJ and Horn DL. 20 Yea
Page 15 and 16: Step 1: Binding & Attachment9. AIDS
Page 17 and 18: Enfuvirtide- Mechanism of</
Page 19 and 20: NRTI Mechanism of
Page 21 and 22: Integration12. Pommier Y, Johnson A
Page 23 and 24: Protease Inhibitors11. Brunton, L.
Page 25 and 26: When to Start ART in Older Adults
Page 27 and 28: OLDER ADULTSPharmacokineticsAdverse
Page 29 and 30: Drug MetabolismCytochrome P450 Enzy
Page 31 and 32: P-glycoprotein• Efflux transporte
Page 33 and 34: Risk Factors for Drug Interactions
Page 39 and 40: 19. Marzolini C, Back D, Weber R, e
Page 45 and 46: 21. Rastegar DA, Knight AM, and Mon
Page 47 and 48: RECOGNIZINGPREVENTABLE ADVERSEEVENT
Page 49 and 50: Preventable Adverse Events:CCR5 Inh
Page 51 and 52: Preventable Adverse EventsNNRTIs•
Page 53 and 54: Pharmacoenhancers• Cobicistat•
Page 55 and 56: Drug Interactions Involving Proteas
Page 57 and 58: Pharmacokinetic Interactions withPr
Page 59: HMG-CoA Reductase Inhibitors andPro
Page 63 and 64: Neuropsychiatric• An</str
Page 65 and 66: Other P450 interactions•
Page 67 and 68: PREVENTING DRUGINTERACTIONS
Page 69 and 70: Back to our patient case…• SY i
Page 71 and 72: Patient Case• Drug Interactions
Page 73 and 74: References1. Centers for Disease Co
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