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NBME 24 Answers

nbme24/Block 3/Question#3 (reveal difficulty score)
A 37-year-old woman with HIV infection is ...
Nucleoside reverse transcriptase inhibitor ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: pharm HIV antivirals

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 +8  upvote downvote
submitted by โˆ—neonem(629)

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)

 +5  upvote downvote
submitted by โˆ—krewfoo99(115)

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

 +1  upvote downvote
submitted by โˆ—sunshinesweetheart(112)

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 +

 +0  upvote downvote
submitted by โˆ—abhishek021196(117)

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 +

 +0  upvote downvote
submitted by โˆ—beltorres23(10)

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"

Also Uworld 155113

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