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Therapeutics V Spring 2019 (P3 Spring) > Exam 5 - HIV/AIDS > Flashcards

Exam 5 - HIV/AIDS Flashcards

1
Q

General Rule of treatment:

need at least __#__ active agents from at least __#___ classes

A

3 active agents;

from 2 classes

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2
Q

HIV expresses receptor proteins _____ which preferentially binds to ______ receptors T cells, macrophages, dendritic cells

A

gp120;

CD4 receptors

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3
Q

T or F: HIV is spread through breastmilk

A

true

hepatitis B NOT spread via breastmilk though

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4
Q

3 stages of HIV infection?

A
  1. Acute retroviral syndrome
  2. Chronic HIV infection (asymptomatic)
  3. AIDS (acquired immunodeficiency syndrome) symptomatic
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5
Q

3 main routes of transmission for HIV/AIDs

A
  • Exposure of mucous membrane/damaged tissue to infected body fluids
  • Blood stream exposure to infected body fluids
  • Mother to child
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6
Q

When CD4 cells are infected with HIV/AIDs the cell is not able to do ______ production or secrete _______

A

antibody;

secrete cytokines

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7
Q

At CD4 counts below ________ is kinda start of opportunistic infections

A

500 cells/mm3

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8
Q

Sequence of appearance of laboratory markers for HIV infection:
1st seen:
2nd seen:
3rd seen:

A

1st seen: HIV RNA
2nd seen: HIV p24 antigen
3rd seen: HIV antibody

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9
Q

HIV RNA is first lab marker detectable — approx how long after infection?

A

10 days

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10
Q

A diagnosis of HIV an be made from either of the following:
-Positive result from __________
Positive ______ test (ex: _________)

A
  • multitest algorithm (initial and supplemental tests MUST be differnet)
  • virologic (ex: viral load or qualitative HIV NAT)
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11
Q

OraQuick Test:
Used to detect ________
uses ________ to test

A

detect HIV

use ORAL FLUID (not saliva tho)

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12
Q

OraQuick Test:

results seen how?

A

like pregnancy test

2 lines = positive

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13
Q

what is a seroconversion window?

A

a time THAT VARIES BETWEEN DIAGNOSTIC TESTS;

at end of window it will show a positive test/when antibodies will be seen…

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14
Q

OraQuick Test:

how long is the seroconversion for this test?

A

3 months

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15
Q

two main surrogate markers for HIV?

A 
CD4 T lymphocyte cell count
HIV RNA (viral load)
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16
Q

CD4 count or HIV RNA?

which one is used to assess a patients overall immunocopetence

A

CD4 T lymphocyte cell count

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17
Q

CD4 count or HIV RNA?

used to assess the effectiveness of therapy

A

HIV RNA (Viral load)

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18
Q

CD4 count or HIV RNA?

more useful BEFORE initiation of therapy

A

CD4

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19
Q

CD4 count or HIV RNA?

more useful AFTER initiation of therapy

A

Viral RNA

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20
Q

CD4 count is a calculated value based on __________ and can fluctuate depending on _________

A

based on total WBC count

may fluctuate with bone marrow suppressing medication/acute infections

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21
Q

Staging of HIV infection is split into __#___ of classifications and is based primarily on _______

A

into 4 classifications

based on CD4 count

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22
Q

two ways you can be in stage 3/AIDS?

A

CD4 count < 200
OR
any AIDS defining opportunistic infection

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23
Q

what drugs are the backbone of initial antiretroviral therapy in treatment naive patients?

A

NRTIs “nukes”

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24
Q

what NRTIs are adenosine analogues

A

Tenofovir

Didanosine

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25
Q

what NRTIs are cytidine analogues

A

lamivudine and emtricitabine

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26
Q

what NRTIs are thymidine analogues

A

stavudine and zidovudine

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27
Q

what NRTIs are guanosine analogue

A

abacavir

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28
Q

Prior to initiation of _______ pts must undergo screening for HLA-B5701 genotype

A

Abacavir

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29
Q

Class effects/ADEs of NRTIs?

A 
mitochondrial toxicity
lactic acidosis (w/ or w/out hepatomegaly and hepatic steatosis)
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30
Q

what are examples of mitochondrial toxicity

A 
anemia
granulocytopenia
myopathy
peripheral neuropathy
pancreatitis
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31
Q

Some agents have low affinity for mitochondrial DNA polymerase gamma —- these agents are (1st or last line) and are what specific agents

A

they are 1st line! if low affinity for mitochondrial = better ADE profile
Specific agents are TEAL!!!
Tenofovir, Emtricitabine, Abacavir, Lamivudine

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32
Q

TDF (tenofovir disoproxil fumarate) has been assoc. with new onset/worsening _________ and decreases in ________

A

renal impairment

decrease in BMD (bone mineral density)

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33
Q

most NRTIs are eliminated via ________

A

renal excretion

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34
Q

the only NRTIs that are hepatic glucuronidated are _________ and __________\

A

zidovudine

abacavir

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35
Q

All NRTIs (except _______) need dose adjusted in renal insufficiency

A

abacavir

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36
Q

NRTIs:

few or lots of drug interactions?

A

few

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37
Q

Due to inhibition of intracellular phosphorylation and minimal additive antiviral activity _______ and _______ should not be used as NRTI backbone therapy

A

emtricitabine
+
lamivudine

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38
Q

class effect ADE with NNRTIs

A

rash (usually happens within the first 4 weeks of therapy)

SJS is a potential issue

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39
Q

NNRTIs:

few or a lot of drug interactions?

A

lots of drug interactions

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40
Q

NNRTIs:

eliminated renally or hepatically?

A

hepatically

use in caution with hepatic impairment

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41
Q

Class effects/ADEs of Protease Inhibitors:

A

GI intolerance-N/V/D
Insulin resistance
lipodystrophy

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42
Q

PIs:

few or a lot of drug interactions?

A

SO MANY — because they get metabolized by CYP3A4

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43
Q

what drug class can have “boosting”

A

protease inhibitors (bc of CYP3A4 metabolism)

also elvitegravir in INSTIs

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44
Q

INSTIs is what drug class?

A

integrase strand transfer inhibitors

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45
Q

class effect/ADE for INSTIs

A

weight gain

46
Q

INSTIs are mainly eliminated via __________

and also subject to _______

A

UGT1A1 glucuronidation;

cationic chelation

47
Q

which INSTI needs boosting to be allowed to dose once a day

A

elvitegravir

48
Q

what does bPI stand for

A

boosted PI

49
Q

what drug is a chemokine coreceptor antagonist

A

maraviroc

50
Q

what drug is a fusion inhibitor

A

enfuviritide

51
Q

HIV Goals of Therapy:

Suppress plasma HIV RNA to below detecable levels (aka < _______)

A

20 copies/mL

52
Q

Persistent viremia results in immune activation/inflammation:
will cause what issues?

A

CV and thromboembolic events
cancer
neurocognitive dysfunction and frailty

53
Q

do ART therapy for how long?

A

indefinitely (lifelong)

54
Q

you can or not eradicate HIV infections with current treatments

A

can not (duh we have not cured AIDS)

55
Q

ART is recommended for who?

A

ALL PTS!! regardless of CD4 count

56
Q

what trial showed that it is best to start ART ASAP rather than wait for CD4 count to get below a certain #

A

START trial…

57
Q

_____________ and ___________ are NOT recommended for 1st line therapy since they have not demonstrated potent/sustained antiviral activity

A

monotherapy and dual therapy ART

triple drug regimen is best

58
Q

in general antiretroviral regimens for a treatment naive pt consist of what drugs?

A

TWO NRTIs in combo with a 3rd active antitetroviral agent from one of the following 3 drug classes:
INSTI, NNRTI, or PI boosted

59
Q

______ is the “backbone” of therapy

A

2 NRTIs

60
Q

what are the two common drug combos for NRTI backbone in ARV(antiretroviral) therapy

A

abacavir(ABC) + lamivudine (3TC)
or
TDF/TAF + emtricitabine (FTC)

61
Q

4 main recommended initial regimens for people with HIV?

A
  • ABC + 3TC + DTG
  • DTG + TDF/FTC OR TAF/FTC
  • BIC + TAF + FTC
  • RAL + TDF/FTC OR TAF/FTC
62
Q

what is abacavir’s abbreviation

A

ABC

63
Q

what is lamivudine’s abbreviation

A

3TC

64
Q

what is emtricitabine’s abbreviation

A

FTC

65
Q

what is dolutegravir’s abbreviation

A

DTG

66
Q

what is bictegravir’s abbreviation

A

BIC

67
Q

what is Raltegravir’s abbreviation

A

RAL

68
Q

Clinical Scenarios + Considerations:

if HLA-B5701 is + or unknown

A

AVOID ABC regimens!

69
Q

Clinical Scenarios + Considerations:
if we must start antiretroviral therapy before we have the drug resistance results available – what drugs should we DEFINITELY AVOID

A

ABC regimens

and NNRTI based regimens

70
Q

Clinical Scenarios + Considerations:
if we must start antiretroviral therapy before we have the drug resistance results available – what drug regimens should we do and why??

A

Tenofovir/FTC +
DRV/r or DRV/c or DTG

DRV and DTG have slow resistance to develop— so safe bet about low resistance!!

71
Q

Clinical Scenarios + Considerations:

what regimen should be taken on an empty stomach?

A

Efavirenz based regimens

72
Q

what is ritonavir’s abbreviation?

A

RTV

73
Q

Clinical Scenarios + Considerations:

what regimens SHOULD be taken with food

A

ATV based
DRV based
EVG based
RPV based

74
Q

Clinical Scenarios + Considerations:
what drug should be avoided in CKD
and
which one should be considered as avoided

A

avoid TDF

consider avoiding atazanivir

75
Q

what is atazanavir’s abbreviation

A

ATV

76
Q

Clinical Scenarios + Considerations:
which drug should be avoided in osteoporosis?

and what 2 specific ones can be used

A

AVOID TDF!!

TAF and ABC are ok

77
Q

Clinical Scenarios + Considerations:

avoid what drug based regimens if psychiatric illnesses are present

A

EFV and RPV based

78
Q

what is ritonavir’s abbreviation

A

RTV

79
Q

avoid what antivirals if high cardiac risk

A

abacavir or lopinavir regimens

80
Q

which antiviral may cause opioid withdrawal if initiated in patients who are on a stable dose of methadone

A

EFV

81
Q

______ and ______ are not recommended with any rifamycin containing regimen

A

TAF and BIC

82
Q

Antiviral Drug Interactions:

Boosted-PIs are CYP3A4 ______

A

inhibitors

83
Q

Antiviral Drug Interactions:

NNRTIs are CYP3A4 ______

A

inducers

84
Q

Antiviral Drug Interactions:

_______ are UGT1A1 substrates

A

INSTIs

85
Q

Antiviral Drug Interactions:
Statins and __________ interact (will need to decrease dose)

Statins also interact with _______ (will need to increase dose maybe)

A

Protease inhibitors/cobicstat

NNRTIs

(CYP interactions)

86
Q

Antiviral Drug Interactions:

_________ will increase metformin

A

dolutegravir

87
Q

Antiviral Drug Interactions:

PDE5 inhibitors and ______ interact

A

protease inhibitors/cobcistat

88
Q

Antiviral Drug Interactions:

Corticosteroids and _________ interact

A

protease inhibitors/cobcistat

89
Q

Antiviral Drug Interactions:

BZDs and ________ interact

A

protease inhibitors/cobcistat

90
Q

Antiviral Drug Interactions:

________ is contraindicated with PPIs

A

Rilpivirine

91
Q

Antiviral Drug Interactions:

antacids should be separated from _______ by 6 hrs because of chelation

A

INSTIs

92
Q

Antiviral Drug Interactions:

Never give _______ with Al or Mg

A

Raltegravir

93
Q

what does RAM stand for

A

resistance associated mutation

94
Q

to do resistance testing:

need a viral load of at least _______ copies/mL

A

1000

95
Q

clinical scenarios where resistance testing is warranted?

A

at entry to care
and
if virologic failure

96
Q

if a pregnant woman with HIV is near delivery:

if viral load is > 1000 copies/mL or unknown — do what?

A

schedule caesarian section at 38 weeks!!

and give IV zidovudine to mother during labor

97
Q

when can pregnant lady do vaginal birth?

A

when viral load is less than 50 copies/mL

98
Q

Postpartum considerations with HIV:

all newborns should get ARVs within ______ of life

A

6 - 12 hours of life

99
Q

ARV prophylaxis for newborns born to HIV + moms?

A

4 weeks of PO zidovudine

100
Q

PrEP vs PEP?

A

pre-expsoure phophylaxis
or
post exposure prophylaxis

101
Q

what is currently only approved PrEP regimen

A

TDF/emtricitabine

102
Q

who gets PrEP?

A

HIV NEGATIVE pts at high risk for HIV acquisition aka

  • men who sex with men in not in monogamous with neg. partner
  • heterosexual men or women in not in monogamous with neg. partner
  • infrequent condom user w/ 1 or more high risk partner
  • any bacterial STI in past 6 mos
  • or if known HIV + partner
  • ppl who inject drugs (sharing within past 6 mos)
103
Q

Testing needed PRIOR to PrEP initiation

A
  • documented negative HIV antibody or antigen test within 7 days
  • any Sxs of acute HIV retroviral syndrome
  • Hep B or Hep C serology
  • CrCl gotta be above 60 mL/min
  • pregnancy test
104
Q

monitoring for PrEP?

do not have the prescription exceed _______ in length

A

90 days

105
Q

If pt is on PrEP and at a return visit becomes HIV infected: do what?

A

stop PrEP therapy because only 2 drugs – need to bump up to 3 drug therapy options!

106
Q

who is PEP recommended for

A

pts that have had an accidental exposure to HIV

healthcare needlesticks, sexual assualt victims, or accidental condom break

107
Q

for PEP therapy:

how long to do it?

A

x 28 days;
OR
if source patient is found to be NEGATIVE – can just stop PEP therapy

108
Q

for PEP therapy:

Should start ASAP and needs to be started within _______ or little benefit will be obtained

A

within 72 hours

109
Q

PEP therapy option?

A

Emtrictabine/TDF +

(RAL or DTG) x 28 days

110
Q

for PEP therapy: if pt is women of childbearing potential/are pregnant — avoid what drug in the PEP therapy?

A

avoid DTG!

111
Q

Monitoring with PEP:
Rapid testing at baseline — if positive do not do PEP;
Repeat testing at ______ and ______

A

4 - 6 weeks;

and 3 months

112
Q

PEP Counseling:

Patient should use precaution to prevent __________

A 
secondary transmission (esp first 6 - 12 weeks)
(use barrier to contraception/avoid blood/tissue donation, avoid pregnancy or breastfeeding)

Therapeutics V Spring 2019 (P3 Spring) (27 decks)

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