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IPT: ID > Block 4 - HIV/OI > Flashcards

Block 4 - HIV/OI Flashcards

1
Q

What is AIDS?

A

Caused by HIV

CD4 count <200

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2
Q

What kind of virus is HIV and what receptors do they have?

A

Enveloped single-stranded RNA retrovirus that has its own reverse transcriptase and integrase

gp41 glycoprotein with a gp120 docking glycoprotein

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3
Q

CD4 count and viral load + HIV

A

Within 2-8 wks, viral load spikes up and CD4 goes down.

Then in 1-3 months, CD4 goes back up, but not to normal limit and viral load dramatically goes down

Then after 2 years, viral load steadily goes up and CD4 goes down

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4
Q

When diagnosing for HIV, what kind of test should you get?

A

4th gen

Tests for IgG, IgM, and p24 antigen

**takes 2-3wks

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5
Q

What is considered the “backbone regimen” of HIV Tx?

A

Always 3 drugs

2 of them are NRTI

Third drug is an INSTI or NNRTI, sometimes PI

Start ASAP and use a back up for first 6 months and until viral load is under 200

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6
Q

What are the NRTIs?

A

Lamivudine
Emtricitabine
Abacavir
Tenofovir disoproxil or ala.

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7
Q

What are the NNRTIs?

A

Ends with “virine” or is efavirenz

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8
Q

What are the integrase inhibitors?

A

Ends with “gravir”

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9
Q

What are the protease inhibitors?

A

Ends with “navir”

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10
Q

NRTI MOA?

A

DNA analogue that prohibits reverse transcriptase of viral RNA to viral DNA

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11
Q

When prescribing your two NRTIs, how should you do it?

A

Either Tenofovir or Abacavir

with either emtricitabine or lamivudine

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12
Q

Abacavir info?

A

Avoid w/ heart issues

Must have HLA 5701*B testing prior to initiation

Metabolized by liver only (no kidney adjustments)

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13
Q

Tenofovir DF info?

A

Renal impairment

Bone demineralization

Decreases in lipids

Has generic drug

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14
Q

Tenofovir alafenamide info?

A

Wt gain with INSTI

Does NOT decrease lipids

Brand only

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15
Q

INSTI AE?

A

Wt gain

DDI w/ polyvalent cations (2hrs before or 6 hours after)

Dolutegravir and Bictegravir has neural tube defects

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16
Q

DDI of Dolutegravir?

A

RIF

17
Q

Which INSTI is an injectable?

A

Cabotegravir awaiting FDA approval

18
Q

Efavirenz counseling?

A

Bedtime on empty stomach

Has CNS effects (nightmares, psychosis, depression, etc)

Dont use if HIV load >100k

19
Q

Rilpivirine counseling?

A

Take w/ water AND high calorie meal to increase absorption

Dont take w/ PPIs, caution with H2RAs or antacids, DDI with warfarin or decadron

QTc prolongation

Dont use if viral load >100k or CD4 <200

20
Q

Protease Inhibitors class AE?

A

Hyperlipidemia, lipodystrophy/fat redistribution, insulin resistance

21
Q

Darunavir counseling?

A

Take w/ food

Must be boosted w/ PK enhancer

22
Q

What are the PK enhancers that are used?

A

Ritonavir and Cobicistat

23
Q

What drug regimen must be used in PrEP?

A

Tenofovir DF + emtricitabine

Must have a negative HIV test too

24
Q

What drug regimen must be used in PEP?

A

Tenofovir DF + Emtricitabine + dolutegravir or raltegravir for 28 days within 72 hrs of exposure

25
Q

What additional immunizations are needed for peeps with HIV?

A

Pneumococcal, meningitis, HPV, HAV, HBV

26
Q

Pros and Cons of PrEP?

A

Pro: Prevents HIV

Cons: Takes 21 days to be effective, doesnt protect from other STDs, and labs q3months

27
Q

What is used prophylactically and used as Tx for PJP Pneumonia?

A

CD4 <200

Bactrim

**requires G6PD testing prior to initiation

28
Q

What is used prophylactically and used as Tx for Toxoplasmosis?

A

Undercooked meat, cat feces, raw shellfish

CD4 <100 if IgG+

Bactrim for prophylaxis

Pyrimethamine (available thru special pharmacy programs), Sulfadiazine, Leucovorin for Tx

29
Q

What is used prophylactically and used as Tx for Mycobacterium avium Complex (MAC)?

A

Acid fast bacilli + Greatest risk if CD4<50 and not suppressed on ART

Azithromycin 1200mg weekly for prophylaxis

Clarithromycin 500mg BID + ethambutol daily for treatment for 12 months

30
Q

Info of immune reconstitution inflammatory syndrome?

A

Risk factors = TB and cryptococcal meningitis

Prevent = delay ART until OI induction completion

IPT: ID (11 decks)

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