042715 weight loss Flashcards
temporal wasting
HIV
differential for weight loss
cardiac: heart failure, endocarditis
pulm: COPD, TB(homeless, prison, travel)
GI: esophageal disorders, malignancy, peptic ulcer, gastric outlet obstruction, IBD, mesenteric ischemic, celiac sprue, lactose intolerance, bac overgrowth, pancreatic disorders, infectious diarrhea
renal: uremia, hypercalcemia
endocrine: adrenal insuff, hyperthyroidism, DM
heme onc: malignancy
infectious: endocarditis, TB, HIV, EBV, infectious diarrhea, tapeworm
psych: depression, anxiety
rheum: SLE, polymyalgia rheumatica, temporal arteritis, RA
what tests would you order to further evaluate weight loss pt if suspecting cancer, HIV
CD4 count HIV Ig or if acute, viral load full body CT (lymphoma) CBC w diff metabolic panel
normal CD4 T cell count
above 450-500
HIV tx regimen consists of
3 or more drugs from 2 or more drug classes
what should you consider when selecting drug regimen for HIV pt
viral resistance profile
factors to enhance compliance (dosing freq, combination products, tolerable side effects, cost)
drug drug interactions
co morbid conditions (liver or renal dis)
integrase inhibitors end in
-tegravir
protease inhibitors end in
-navir
ritonavir’s MOA
it boosts other protease inhibitors by inhibiting CYP3A4
associated with potentially fatal hypersensitivity rxns
abacavir–need check HLA-B5701 status
what comorbid conditions do you need to consider for HIV drugs
for the protease inhibitors:
- diabetes (PIs block GLUT4 glucose uptake and can decrease glucose sensing by beta cells)
- hyperlipidemia, CV disease
what HIV drug is of concern in pts with psychiatric illness
efavirenz (NNRTI)-high incidence of CNS and psychiatric symptoms
-conazoles drug drug interactions?
inhibits CYP3A and CYP2C9
problem for those taking protease inhibitors bc protease inhibitors are metabolized by CYP3A (but if pt on ritonavir, which is already CYP3A inhibitor, ok)
migratory thrombophlebitis
pancreatic carcinoma
unilateral swelling
red flag–could be DVT
