NBME 24 Nucleoside reverse transcriptase inhibitor (NBME Answers)

Retired NBME 24 Answers

nbme24/Block 3/Question#3 (reveal difficulty score)
A 37-year-old woman with HIV infection is ...
Nucleoside reverse transcriptase inhibitor 🔍 / 📺 / 🌳 / 📖
tags: pharm HIV antivirals

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submitted by ∗neonem(630)

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Just had to know that NRTIs (specifically the nucleosides) cause lactic acidosis

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brethren_md Also NRTIs are hepatotoxic, cause the increased liver enzymes seen in the patient. +5

sherry Actually, NNRTIs are more well-known for hepatotoxicity. But I guess NRTIs is the next best option for this one. +11

and bone marrow suppression, specifically Zidovudine.

+1/- lilyo(94)

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submitted by ∗krewfoo99(115)

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NRTI - Bone marrow supression, Lactic Acidosis, Anaemia NNRTI - Hepatotoxicity, rash Integrase inhibitor (tegras) - Myopathy (causing Increased Creatinine Kinase) Protease Inhibitors (navir) - Lipodystrophy, Hyperlycemia, GI intolerance (think of hormonal effecs)

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madojo building off on this... answer choice A would be something like Maraviroc, and B is basically the same thing as A because a fusion inhibitor would be something like Maraviroc where you don't have any interaction with CCR5 and gp120. +1

overa ^ With B, they are referring to Enfuvirtide, which blocks FUSION via gp41 blockade. Maraviroc blocks ATTACHMENT by preventing gp120 binding the chemokine receptor CCR5 on macrophages mainly. -lolnotacop +3

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submitted by ∗sunshinesweetheart(112)

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out of curiosity, why are AST and ALT high? is that saying the NRTI used was diadenosine which led to pancreatitis also?

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krewfoo99 AST and ALT will not be elevated in pancreatitis, they will only be increased during liver damage. NRTI causes hepatoxicity (although FA 2018 states NNRTI causes hepatotoxicity, NRTI could also be an option considering the two classes are similar. The hepatoxicity will cause an increase in ALT and AST +

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submitted by ∗abhishek021196(120)

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Bone marrow suppression (can be reversed with granulocyte colony-stimulating factor [G-CSF] and erythropoietin), peripheral neuropathy, lactic acidosis (nucleosides), anemia (ZDV), pancreatitis (didanosine).

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abhishek021196 Adverse effects of NRTIs +

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submitted by ∗beltorres23(10)

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Fanconi syndrome induced by NRTIs.. High concentrations of NRTIs in the proximal convoluted tubule interfere with mitochondrial DNA synthesis resulting in cellular damage.

"Nucleoside analogues are associated with mitochondrial toxicity, which may manifest as lactic acidosis" https://journals.lww.com/aidsonline/fulltext/2008/07110/fanconi_syndrome_and_lactic_acidosis_associated.17.aspx

Also Uworld 155113

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