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NAPLEX - 2021 > HIV > Flashcards

HIV Flashcards

1
Q

Diagnosis of AIDS

A

1) CD4 < 200

2) AIDS-defining condition: opportunistic infections

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2
Q

Transmission of HIV

A

Blood, Semen, Vaginal, Rectal

BREASTMILK

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3
Q

Timing of Diagnosis Testing

A

1st) @ 2 weeks: HIV-1/HIV-2 Ag/Ab Immunoassay

2nd) @ 4-6 weeks: If (+), then Confirm with Antibody DIFFERENTIATION Immunoassay
- Determines if HIV-1 or HIV-2

3rd) @ 3 months: Ora-Quick Test

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4
Q

HIV Replication Steps & Rx Sites of Action: Step 1

A

Step 1) Binding /Attachment:

Maraviroc (Selzentry) = patient must have Trofile test for (+) CCR5 co-receptor to work

Ibalizumab-uiyk (Trogarzo)

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5
Q

HIV Replication Steps & Rx Sites of Action: Step 2

A

Step 2) Fusion

Enfuvirtide (Fuzeon)

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6
Q

HIV Replication Steps & Rx Sites of Action: Step 3

A

Step 3) Reverse Transcription

NRTI (Nucleoside Reverse Transcriptase Inhibitors)
NNRTI (Non-NRTI)

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7
Q

HIV Replication Steps & Rx Sites of Action: Step 4

A

Step 4) Integration

INSTI (Integrase Stand Transfer Inhibitors)

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8
Q

HIV Replication Steps & Rx Sites of Action: Step 5 / 6

A

Step 5) Transcription / Translation
Step 6) Assembly

NO DRUGS

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9
Q

HIV Replication Steps & Rx Sites of Action: Step 7

A

Step 7) Budding / Maturation

PI (Protease Inhibitors)

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10
Q

Initial Evalutation

A

1) CD4 count
2) HIV RNA Viral Load
3) Test HepB & Hep C
4) Pregnancy

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11
Q

Recommended Tx:

A

INSTI-based (1 INSTI + 1 or 2 NRTI)

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12
Q

One Pill, Once Daily

A

1) Biktarvy
2) Triumeq
3) Dovato

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13
Q

Biktarvy

A

Bictegravir (INSTI)

Emtricitiabine (NRTI)
TAF (NRTI)

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14
Q

Triumeq

A

Dolutegravir (INSTI)

Abacavir (NRTI)
Lamivudine (NRTI)

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15
Q

Dovato

A

Dolutegravir (INSTI)

Lamivudine (NRTI)

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16
Q

Two Pills

A

1) Tivicay + Truvada
2) Tivicay + Descovy
3) Isentress + Truvada
4) Isentress + Descovy

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17
Q

Tivicay

A

Dolutegravir

Preferred in Pregnancy

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18
Q

Isentress

A

Raltegravir

Myopathy / increase in CPK

19
Q

Truvada

A

Emtricitabine + TDF

20
Q

Descovy

A

Emtricitabine + TAF

21
Q

Abacavir Brand / pharmacogenetic testing:

A

Ziagen

HLA-B*5701

22
Q

Dovato Contraindications:

A

1) HIV RNA > 500k

2) Hep B co-infection

23
Q

TAF vs TDF

A

TAF has less:

1) Renal toxicity
2) Bone loss

24
Q

TDF by itself Brand Name

25
Q

NRTI BBW/Warning

A 
BBW: stavudine, zidovudine, didanosine
1) Lactic acidosis
2) Hepatomegaly with steatosis
ADR = lipodystrophy
stavudine / didanosine = pancreatitis
zidovudine = anemia

Warning: TDF/TAF, abacavir, lamivudine

26
Q

NRTI - HBV Treatments

A

Lamivudine (Epivir-HBV)

TDF (Vemlidy)

27
Q

INSTI consideration:

A

Separate Al/Mg +2hr or -6hr

Raltegravir OK with Calcium Carbonate
Bictegravir OK with Ca or Fe if taken WITH FOOD

28
Q

INSTI Side Effects

A

weight gain

insomnia

29
Q

NNRTI (non-NRTIs) Brands

A

Atripla (EFAVIRENZ / emtricitabine / TDF)

Efavirenz ADR: psych issues, depression

Nevirapine

Rilpivirine

30
Q

NNRTI - BBW

A

1) Hepatotoxicity
2) Severe Rash

*Worst with Nevirapine

31
Q

Rilpivirine

A

1) WITH FOOD > 500 Cal

2) Requires ACIDIC pH (CI @ PPIs)

32
Q

Protease Inhibitors - Side Effects

A

Metabolic ADRs:

1) Hyperglycemia
2) Hyperlipidemia
3) Lipodystrophy

  • Least with:
    1) atazanavir
    2) darunavir
33
Q

Protease Inhibitors - DDIs

A

CYP Inhibitors

34
Q

Atazanvir Brand / consideration

A

Reyataz

1) Do NOT use with acid-lowering medications
2) Hyperbilirubinemia

35
Q

Darunavir Brand

36
Q

Sulfa allergy Protease Inhibitors

A

Darunavir
Fosamprenavir
Tipranavir

37
Q

Boosters

A

CYP3A4 Inhibitors:

1) Ritonavir
2) Cobicistat

38
Q

CCR5 Antagonist / consideration

A

Miraviroc (Selzentry)

- requires CCR5-tropism assay

39
Q

Fusion Inhibitor

A

Enfuvirtide (Fuzeon)

- SQ injection

40
Q

Post-attachment Inhibitor

A

Ibalizumab-uiyk (Trogarzo)

- IV injection for MDR HIV only

41
Q

Opportunistic Infections

A 
OPPORTUNISTIC INFECTIONS:
M. Avium Complex (MAC)
Pneumocystis jiroveci pneumonia (PCP)
Cryptococcus neoformans
Histoplasmosis
Severe Candida albicans
Tuberculosis

Kaposi’s sarcoma (cancer)

HIV Wasting Syndrome (lipoatrophy, loss of muscle mass)

42
Q

PrEP (Pre-Exposure Prophylaxis)

A

1) Truvada (TDF / emtricitabine)
2) Descovy (TAF / emtricitabine)

Baseline HIV test & HBV

Testing q 3 months

43
Q

PEP (Post-Exposure Prophylaxis)

A

Truvada only (NOT Descovy) PLUS:

1) Dolutegravir (Tivicay)
2) Raltegravir (Isentress)

within 72 hrs for 28 days

NAPLEX - 2021 (18 decks)

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