Study Questions

1. The mechanism of action of lamivudine differs from that of efavirenz in that

(A) Lamivudine inhibits HIV protease; efavirenz inhibits reverse transcriptase.

(B) Lamivudine inhibits reverse transcriptase; efavirenz inhibits HIV protease.

(C) Lamivudine is a cytosine nucleoside analogue; efavirenz is an adenosine nucleotide analogue.

(D) Lamivudine binds to the active site of reverse transcriptase; efavirenz binds adjacent to it.

(E) Lamivudine and efavirenz exhibit the same mechanism of action; there is no difference.

2. Sharon M. is a 35-year-old woman who is approximately 60% above the normal body weight for her height. She has a history of alcohol abuse and has been taking zidovudine and abacavir for the past 3 years to treat HIV infection. These factors put her at high risk for drug-induced

(A) Lactic acidosis, hepatomegaly, and hepatic steatosis

(B) Peripheral neuropathy

(C) Stevens-Johnson syndrome

(D) Hyperuricemia

(E) Hypersensitivity reaction

3. Mark C. is taking a regimen consisting of zidovu-dine, lamivudine, and efavirenz for the treatment of HIV infection. To help him fall asleep at night, he took a normal dose of diazepam (10 mg before bed), which he got from a friend. He then had symptoms of diazepam overdose, including grogginess and difficulty waking and maintaining consciousness. The most likely reason for this is that

(A) Efavirenz inhibits the hepatic metabolism of diazepam

(B) Efavirenz competes with diazepam for renal elimination

(C) Lamivudine potentiates the depressant activity of diazepam

(D) Zidovudine induces the metabolism of di-azepam

(E) Lamivudine stimulates conversion of diazepam to its active form

4. Adverse effects commonly associated with NRTIs include

(A) Central fat accumulation and peripheral fat wasting

(B) Drug interactions involving cytochrome P450 enzymes

(C) Myelotoxicity and hemolytic anemia

(D) Hypercholesterolemia and hypertriglyc-eridemia

(E) Hyperglycemia and insulin resistance

5. A fixed-dose combination of lopinavir and ritonavir is used to treat HIV infection in the United States. This combination is particularly effective because

(A) Ritonavir and lopinavir inhibit HIV reverse transcriptase in different ways

(B) Ritonavir decreases the hepatic metabolism of lopinavir

(C) Ritonavir decreases the renal elimination of lopinavir

(D) Lopinavir inhibits the ability of HIV to mutate in response to ritonavir

(E) Lopinavir inhibits the mutant HIV structural protein that confers viral resistance on ritonavir

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