Pharmacology of Antiretroviral Agents An Emphasis on Drug ...

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Patient Case• Identify patient-specific factors affecting treatment <strong>of</strong>older adults with HIV infection including:• Pharmacokinetic changes• CRI: Avoid use <strong>of</strong> combination when CrCl
Patient Case• Drug Interactions• Nifedipine & ATV/r• Previously possible induction and now inhibition• Consider alternative vs lower dose• Simvastatin & ATV/r• Avoid; consider alternative (pravastatin, low dose atorvastatin)• Omeprazole & ATV/r• NTE omeprazole 20mg/d (naïve); avoid other acid reducing agents• Combinations• Avoid combination FTC/TDF; provide individual pills• Adherence and pill burden due to renal dysfunction
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PHARMACOLOGY OFANTIRETROVIRAL AGENT
Page 3 and 4:
Introduction- Patient Case• SY is
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1. Centers for Disease Control and
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3. Luther VP, Wilken AL. HIV Infect
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Incident cases in 2009 approx 48,00
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ANTIRETROVIRALTHERAPYPharma
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7. Pomerantz RJ and Horn DL. 20 Yea
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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 and 60: HMG-CoA Reductase Inhibitors andPro
Page 61 and 62: Lipid-Lowering Agents</stro
Page 63 and 64: Neuropsychiatric• An</str
Page 65 and 66: Other P450 interactions•
Page 67 and 68: PREVENTING DRUGINTERACTIONS
Page 69: Back to our patient case…• SY i
Page 73 and 74: References1. Centers for Disease Co
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