Medical Pharmacology: Antiviral Drug Practice Questions
Lopinavir/Ritonavir
Coformulation (Kaletra)
Lopinavir
Ritonavir
Click on the correct answer.
Loprinavir:
Available either as loprinavir alone or in combination with low-dose ritonovir.
With respect to HIV-1 lopinavir is up to 10 fold more potent compared to ritonovir against HIV-1.
Both
Neither
Loprinavir:
Approved nearly 25 years ago (2000), loprinavir in the West is viewed as a second-line therapy for HIV.
At this time, 2024 is still being prescribed in developing countries, notably among children were living with HIV.
Both
Neither
Lopinavir:
Similar antiviral efficacy compared to other "potent" HIV protease inhibitors and exhibits more potency compared to nelfinavir.
Lopinavir exhibits often sustained antiretroviral efficacy in individuals for whom previous HIV protease inhibitor-containing protocols are no longer effective.
Both
Neither
The role of low-dose ritonovir in coformulation with lopinavir is to act as an inhibitor of the cytochrome
P450 drug metabolizing isoform CYP3A4. This inhibition leads to an
increase in lopinavir plasma levels.
True
False
In patients who have been on extended periods of antiretroviral therapy, and whose HIV strains exhibit four or more protease inhibitor resistance mutations are still likely to be able to suppress HIV following initiation of lopinavir treatment.
True
False
Lopinavir pharmacokinetics:
Highly protein bound
Half-life on the order of 5-6 hours
Both
Neither
During pregnancy, the lopinavir/ritonovir combination (Kaletra) would be an appropriate alternative
in antiretroviral treatment protocol during pregnancy.
True
False
Prominent and common lopinavir adverse effect/effects:
Gastrointestinal symptoms
Elevation of serum lipids
Elevation of serum aminotransferases, notably more likely in patients with coinfections of HBV or HCV (hepatitis B or hepatitis C)
A & B
B & C
A & C
A, B & C
Cardiovascular adverse effects associated with lopinavir administration:
Prolongation of P-R and/or Q-T interval is possible.
Although not confirmed by all-studies, combination agent loprinavir/ritonavir (Kaletra) administration may result in elevated risk of heart attack (myocardial infarction).
Both
Neither
Prolongation of both P-R and Q-T intervals with lopinavir/ritonavir (Kaletra) can increase the risk for second-or third-degree AV block.
True
False
Loprinavir/ritonovir (Kaletra) administration may lead to a variety of drug-drug interactions.
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Source Material:
Acosta EP Chapter 62 Antiviral Agents (Nonretroviral)
in Goodman & Gilman's: The Pharmcological
Basis of Therapeutics, 14e, (Brunton LL Knollmann BC eds) McGraw-Hill Education, 2023.
Safrin S Chapter 49 Antiviral Agents in
Basic & Clinical Pharmacology (Katzung BG, Editor;
Vanderah TW, Associate editor) 15e McGraw Hill 2021.
Li JZ Coen DM Chapter 38 Pharmacology of
Viral Infections in Principles of Pharmacology:
The Pathophysiologic Basis of Drug Therapy 4e (Golan DE
Armstong EJ Armstrong AW, eds) Wolters Kluwer 2017.
Waller DB Sampson AP Section 11
Chemotherapy in Medical Pharmacology & Therapeutics
Elsevier 2018.
Burchum JR Rosenthal LD Chapter 97
Antiviral Agents I: Drugs for Non-HIV Viral Infections
in Lehne's Pharmacology for Nursing Care Elsevier 2022.
Waller DB Sampson AP Section 11: Chapter
51
Chemotherapy of infections in Medical Pharmacology & Therapeutics
Elsevier 2018.
Benavides S Bahal O'Mara N Nahata MC
Chapter 79 Viral Infections in Applied Therapeutics:
The Clinical Use of Drugs (Zeind C, Carvalho MG Cheng JW
Zaiken K Lapointe T, eds) Wolters Kluwer, 2024.
Davanathan AS Symonds AE Adams JL
Cottrell ML Chapter 76 Pharmacotherapy of Human
Immunodeficiency Virus Infection
in Applied
Therapeutics: The Clinical Use of Drugs (Zeind C, Carvalho MG Cheng JW
Zaiken K Lapointe T, eds) Wolters Kluwer, 2024.
Flexner CW Chapter 64 Antiretroviral
Agents and Treatment of HIV Infection
in Goodman &
Gilman's: The Pharmcological
Basis of Therapeutics, 14e, (Brunton LL Knollmann BC eds) McGraw-Hill Education, 2023.
Burchum JR Rosenthal LD Chapter
98
Antiviral Agents II: Drugs for HIV Infection and Related
Opportunistic Infections
in Lehne's Pharmacology for Nursing Care Elsevier 2022.
Woster PM Chapter 30 Drugs Used to Treat
Viral Infections in Foye's Principles of Medicinal
Chemistry 8e (Roche VF Zito SW Lemke TL Williams DA, eds)
Wolters Kluwer 2020.
