Anesthesia and HIV Flashcards
HAART
- Highly activate anti-retroviral therapy
- Halts HIV replication and delays transition from HIV to AIDS
What are some respiratory effects of HIV and how might they affect your care/plan?
- many opportunistic infections: PCP, bacterial PNA, TB, Aspergillosis, CMV, oral candidiasis, Kaposi’s sarcoma, herpes
- direct HIV pulmonary destruction leading to respiratory failure, chronic lung disease
- Care/plan: You would be more inclined to order pulmonary function tests.
- dynamic airway collapse more likely if they have history of karposi’s sarcoma
Some side effects of protease inhibitors:
- Increased cortisol
- hyperglycemia
- hyperlipidemia–> athlerosclerosis
- redistribution of fat
- sunken face, humps on back
Kaposi’s Sarcoma
Type of cancer that can grow on skin or lymph nodes when pt is immunocompromised
*when lymph nodes are involved, pt is at higher risk of airway collapse
*higher risk of bleeding with airway instrumentation
What are some cardiac effects of HIV and how will they affect your plan of care?
- Pericarditis
- pericardial effusion
- myocarditis
- dilated cardiomyopathy
- endocarditis
- PHTN
- thromboembolus
- CAD/MI
- aortic aneurisms- from weakened vascular walls
- 50% of HIV pts will have an abnormal echo
What are some GI effects of HIV?
- opportunistic infections
- GI bleeding
- cholecystitis
- anorexia
- N/V
- dysphagia (dandida albicans
- esophagitis
What are some Renal effects of HIV and how may they effect your plan of care?
- Nephropathy
- meds can damage kidney
- lower threshold for BUN, CR
What are some Endocrine effects of HIV and how my they effect your plan of care?
- Adrenal insufficiency (in advanced AIDS)- may have to give high dose steroids
- Glucose intolerance (related to HAART)
What are some hematologic complications with HIV?
- Anemia
- Leukopenia
- lymphoma
- thrombocytopenia
What are some neurologic complications of HIV?
- CNS is a large reservoir for HIV
- sensory neuropathy- numbness, tingling,
- we want to know if they already have neuropathy so we know we didnt cause it by positioning
- Encephalopathy or dementia- cognitive, motor, and behavioral changes
- Opportunistic infections/ malignancies- brain tumors
- HAART related cerebral vascular disease
What anesthesia interactions can you expect with Nucleoside reverse transcriptase inhibitors?
Other Side effects?
- Can change drug clearance and effect of methadone
- Nausea, diarrhea, myalgia, increase LFTs, peripheral neuopathy, marrow suppression, inhibition of CYP450
What anesthesia interactions can you expect with Non-nucleoside reverse transcriptase inhibitors?
Other side effects?
- extends the half life and effects of:
- midazolam, diazepam, triazolam
- fentanyl, meperidine, methadone
- Nevirapine- induces CYP450
- Delavirdine- inhibition of CYP450- decreased fentanyl clearance by about 67%
What anesthesia interactions can you expect with Rotanavir (protease inhibitors)?
Other side effects?
- Prolongs the half life and effects of:
- amiodarone, digoxin
- diazepam, midazolam, triazolam
- fentanyl, meperidine, methandone
- inhibits CYP450
- hyperlipidemia, glucose intolerance, abnormal fat distribution
What anesthesia interactions can you expect with integrase strand transfer inhibitors?
none
What kind of anesthesia interactions can you expect with early inhibitors?
- changes clearance and effect of midazolam
