Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm > chapter 29 > Flashcards

chapter 29 Flashcards

1
Q

goal of HIV/AIDS drugs treatment

A

primary goal: reduce HIV-associated morbidity and mortality.

b. Prolong duration and quality of life
c. Restore and preserve immunologic function
d. Maximally suppress plasma HIV viral load
e. Prevent HIV transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how to suppress HIV

A

b. Requires at least two (preferably three) active drugs from two or more drug classes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

HIV med regime aka?

A

HAART (highly active antiretroviral therapy) in combination with ART (antiretroviral therapy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

benefit of patient following thru with care and treatment?

A

HIV will be considered more a disease of chronic illness verse a disease of death and dying in this case

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

main problem with hiv drug therapy?

A

resistance to current therapies as virus can mutate.

Patients are asked to have >95% drug adherence to minimize resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

HIV

A

RNA retrovirus.

Unable to survive and replicate unless inside host cell.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

HIV infection

A

After initial infection, a rapid viral replication occurs > high level of virus in peripheral blood (viral load) > Corresponding drop in CD4 cells (immune suppressed), triggers immune response > CD4 cell replacement and HIV antibody production > Viral load drops with establishment of immune response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

CD4+ t cells aka?

A

also called helper T cells or CD4 + T lymphocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

normal cd4+ count?

A

800 - 1200 cells/mm3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

HIV symptoms

A

Symptoms range from mild to severe > 2 to 12 weeks after HIV exposure

i. Often mistaken for transient flu-like symptoms
k. Time from infection to positive HIV test averages 10 to 14 days, but some do not convert for 3 to 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

AIDS

A

diagnosis indicating advanced HIV

- CD4 count <200 cells/mm3 or <14% of lymphocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

HIV life cycle

A
  1. Binding and fusion
  2. Reverse transcription
  3. Integration
  4. Transcription
  5. Assembly
  6. Budding
  7. Maturation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

HIV transmission

A

a. contact with blood, semen, vaginal fluids, and breast milk
b. Occurs primarily by:
i. Sexual contact (oral, vaginal, and anal sex)
ii. Direct blood contact (IV drug abuse, shared needles, shared personal care items, blood transfusions, and occupational needle stick)
iii. Mother to child by maternal-fetal blood circulation, and direct blood contact through delivery or in breast milk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

HIV labs

A

a. CD4 T-cell count: More stable reflection of immune system. Used in conjunction with absolute count to monitor health status, and response to medication
b. Plasma HIV RNA quantitative assay (viral load): Indicative of level of virus circulating in the blood, and determinant of treatment efficacy
c. HIV resistance testing: Leads to treatment failure, and risk of transmitting drug-resistant virus. Two types of testing available (genotypic, phenotypic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

two types of HIV resistance testing

A
  1. Genotypic resistance testing: Identifies mutations in the genetic code of HIV associated with drug resistance
  2. Phenotypic testing: Determines if patient’s HIV is able to replicate in the presence of specific ART
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

HIV classification

A

a. Staging and classification systems are important tools for tracking and monitoring HIV
b. Two major classification systems are:
i. CDC (Centers for Disease Control and Prevention)
ii. WHO (World Health Organization)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CDC HIV classification

A
  1. Assesses severity of HIV disease by CD4 cell counts, and presence of specific HIV-related conditions
  2. Based on lowest documented CD4 cell count, and previously diagnosed HIV-related conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

WHO HIV classification

A
  1. Useful in resource constrained settings without access to CD4 measurements
  2. Classifies HIV disease on basis of clinical manifestations
19
Q

indications for antiretroviral therapy

A

a. Initiation, and ongoing treatment change rapidly based on updated clinical data, and expert medical opinions

20
Q

classes of antiretroviral therapy

A

c. Antiretroviral Agents
d. Nucleoside/Nucleotide Revere Transcriptase Inhibitors
e. Non-nucleoside Reverse Transcriptase Inhibitors
f. Protease Inhibitors
g. Entry Inhibitors
h. CCR5 Co-Receptor Antagonists
i. Integrase Inhibitors

21
Q

considerations for a patient with CD4 count <200 pre- art ?

A

do not use: RPV based regimen, DRV/r plus RAL.

higher rate of virologic failure observed in those with low pretreatment cd4 cell count

22
Q

consierations for pt with HIV RNA >100,000 copies/mL pre ART?

A

do not use RPV based regimen, ABC/3TC with EFC or ATV/rDRV/r plus RAL.
higher rates of virologic failure observed in those with high pretreatment HIV RNA

23
Q

considerations for pt with HLA-B*5701 positive pre ART?

A

do not use ABC containing regimen.

abacavir hypersensitivity, a potentially fatal rxn, is highly associated

24
Q

considerations for pt that must be treated before HIV drug resistance results are available?

A

avoid NNRTI-based regimens.
recommended ARTs: DRV/r plus TAF/FTC or TDF/FTC, DTG plus TAF/FTC or TDF/FTC.
Transmitted mutations conferring NNRTI resistance are more likely than mutations associated with PI or INSTI resistance.
Resistance to DRV/r and DTG emerges slowly; transmitted resistance to DRV is rare and transmitted resistance to DTG has not been reported to date.

25
Q

classes of antiretroviral therapy

A

c. Antiretroviral Agents
d. Nucleoside/Nucleotide Revere Transcriptase Inhibitors
e. Non-nucleoside Reverse Transcriptase Inhibitors
f. Protease Inhibitors
g. Entry Inhibitors
h. CCR5 Co-Receptor Antagonists
i. Integrase Inhibitors

26
Q

zidovudine (ZDV, AZT, Retrovir) Type, pd

A

nucleoside reverse transcriptase inhibitor

-inhibits viral enzyme reverse transcriptase

27
Q

zidovudine CI, prec

A
  • CI hypersens, bone marrow supp, renal/hep

- PREC bone marrow dep, renal/hep

28
Q

zidovudine DFL, se/adv, NI, cost

A
  • DFL rifampin dec eff, drug inc LFT
  • se/adv: N/V, anemia, seizure, neutropenia, numb, tingly, burning pain in lower extremities
  • ni: drug of choice for PREGgers and take with food
  • cost 648-4331/yr
29
Q

efavirenz (sustiva) action, CI, prec

A

nonnucleoside reverse transcriptase inhibitor
-Binds to reverse transcriptase, blocking RNA-dependant DNA polymerase activity
-CI: Allergies, use of midazolam, and triazolam
-prec: History of mental illness, and drug use
Liver impairment
Seizure disorder

30
Q

efavirenz DFL, se/adv, NI, cost

A

dfl: alc
se/adv: Allergic reaction, convulsion, liver failure, neuropathy, abnormal vision, suicide
CNS effects: impaired concentration, amnesia, agitation, hallucination
ni: Pregnancy Cat D
Needs to be taken with at least 2 other ART
cost: 12,120/yr

31
Q

atazanavir (Reyataz) action, CI, prec

A

protease inhibitor

  • Inhibits HIV protease, rendering enzyme incapable of processing polyprotease precursors
  • ci: Hypersensitivity, concurrent use with midazolam, lovastatin, rifampin
  • prec:Pre-existing conduction abnormalities, hepatitis B or C, hepatic impairment
32
Q

atazanavir reyataz DFL, SE/adv, ni, cost

A

dfl: May increase liver function enzymes, cholesterol, triglycerides, and glucose
Multiple drug-drug interactions
-se/adv: Hyperglycemia, diabetes, jaundice, Rash, nausea, cough
-ni: preg cat b
cost: $19,680-$19,872

33
Q

ARV affordability

A

I. Recommended that healthcare providers work with patients, case managers and social workers to understand their patients’ particular pharmacy benefit plans, and potential financial barriers to filling their prescriptions.

a. ARV affordability resources (such as ADAP and pharmaceutical company patient assistance programs for patients who qualify)
i. http://adap.directory
ii. Income gap to receiving benefits for California residents: $59,400

34
Q

J. Immune Reconstitution Inflammatory Syndrome (IRIS)

A

b. Related to specific opportunistic pathogens
c. Experienced by low percentage of patients early in ART
iii. May occur in response to many pathogens
iv. Diagnosis can be challenging as there is no laboratory markers
v. Condition of exclusion

35
Q

two entities of IRIS

A

i. Paradoxical IRIS
1. Exacerbation of treated opportunistic infection
ii. Unmasking IRIS
1. Response to undiagnosed or subclinical opportunistic infection

36
Q

nurse role with ART therapy

A

a. assess physiologic and psychosocial health needs and literacy levels
b. Follow-up assessment after ART therapy begins including side effects, adherence to regimen, and issues affecting medication adherence (Possible patient’s could confuse side effects with new symptoms)
d. Ask patients for a 95% adherence as non-adherence can result in HIV viral replication and drug resistance

37
Q

strategies for med adherence for ART

A

i. Medication organizers
ii. Alarms on cell phone
iii. Medication diaries
iv. Support from family and friends

38
Q

if patient is missing meds

A

f. If patient is missing medications, it is imperative nurse follows up as to why possibilities include:
i. Cost
ii. Pill fatigue
iii. Loss of insurance
iv. Lack of transportation
v. Side effects from medications

39
Q

nurse should give what pt ed for art therapy

A

g. Education should include
i. Dosage
ii. Schedule
iii. Suggested routine
iv. Food interactions
v. Nutritional counseling
vi. Anticipated side effects
vii. Purpose for the medications

40
Q

opportunistic infections with ART

A

a. As disease progresses, patients are more vulnerable to infections, and malignancies
b. Since introduction of HAART, there has been a significant reduction in incidence of infections among HIV+ patients receiving these medications
c. Opportunistic infections remain a leading cause of morbidity and mortality in HIV-infected persons
d. Will see different infections dependent on CD4 count

41
Q

antiretroviral therapy in pregnancy

A

a. Optimal drug therapy should be used for women of reproductive age and those who are pregnant
b. Additional goal to prevent transmission from mother to fetus
c. If viral suppression is at 1000 copies/mL or less there is a reduced risk in transmission to fetus or neonate
d. Can be transmitted during pregnancy, labor, delivery, and breastfeeding
e. If no preventative medications and breastfeeding, the risk of the infant becoming infected is 25%
f. ART therapy reduces the risk to 2% when combined with other therapies

42
Q

occupational exposure

A

a. Treatment after occupational exposure is called post-exposure prophylaxis (PEP)
b. Should be initiated within hours of exposure and require up to 4 weeks of treatment
c. Healthcare workers taking PEP have reported adverse reactions (17%-47%)
d. Most common complaints are nausea, fatigue, and malaise

43
Q

HIV prevention breakthroughs

A

a. Earlier initiation of ART leads to 96% reduction in HIV transmission to uninfected partners
b. Increased HIV testing, and increased numbers of infected patients receiving ART help individual patients and the community by decreasing community viral load
c. Medical male circumcision reduces risk of female-to-male sexual transmission of HIV by approximately 60% (more important in developing countries with limited treatment/preventative care)

Pharm (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions