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NAPLEX > HIV > Flashcards

HIV Flashcards

1
Q

AIDS

A
  • CD4 < 200

- AIDS defining condition

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2
Q

AIDS-defining Condition

A

Opportunistic Infections:

  • MAC
  • PJP
  • Severe Candida albicans
  • Thrush
  • TB

Cancers:
-Kaposi’s sarcoma

Other: HIV Wasting Syndrome

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3
Q

Screening/Diagnosis

A
  • Everyone once between 19-64 yo
  • High-risk for infection annually
  • High-Risk: sexual behaviors, injecting drugs, STIs/TB hx
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4
Q

Acute HIV

A
  • Flu-like sxs (occurs in 50-70%)
  • About 2 weeks post-infection high enough viral load for HIV RNA/p24 antigen to be connected (use HIV1/2 antigen/antibody screening)
  • Positive screening + positive confirmatory = HIV diagnosis
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5
Q

OraQuick

A
  • At home HIV antibody test
  • Done 3+ months post-exposure
  • Earlier can give false negative
  • Requires positive confirmatory test for diagnosis
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6
Q

Stage 1

A
  • Binding/attachment

- Binds to CD4 receptor by CCR5 and/or CXCR4

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7
Q

Maraviroc

A
  • Works on stage 1
  • CCR5 antagonist
  • Only works if patient only has CCR5 receptors
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8
Q

Fostemsavir

A
  • Works on stage 1

- Attachment inhibitor

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9
Q

Ibalizumeb-uiyk

A
  • Works at stage 1
  • Post attachment inhibitor
  • Uncommonly used
  • IV injection
  • For MDR HIV
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10
Q

Stage 2

A
  • Fusion

- Virus fuses with cell membrane and release HIV RNA/enzymes/proteins

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11
Q

Fuzeon

A
  • Enfurvirtide
  • Fusion inhibitor
  • SQ injection
  • Works at stage 2
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12
Q

Stage 3

A
  • Reverse transcription

- RNA converted to DNA by reverse transcriptase and enters nucleus

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13
Q

NRTIs

A
  • Nucleoside/Nucleotide Reverse Transcriptase Inhibitors
  • Works at stage 3
  • Ex: Tenofovir, Emtricitabine
  • Only abacavir DOESN’T need renal adjustment
  • Drug Class Warning: lactic acidosis, hepatomegaly w/ steatosis
  • SE: nausea, diarrhea, HA, increased LFT
  • Some used to treat HBV too, DON’T D/C if HBV positive
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14
Q

NNRTIs

A
  • Non-nucleoside reverse transcriptase inhibitors
  • Works at stage 3
  • Drugs contain “-vir-“
  • Ex: Efavirenz, rilpivirine
  • Box Warning: rash/severe rash, hepatotoxicity
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15
Q

Stage 4

A
  • Integration

- Integrase (HIV enzyme) released and HIV DNA incorporated into host DNA

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16
Q

INSTIs

A
  • Integrase strand transfer inhibitors
  • Works at stage 4
  • Drugs end in “-gravir”
  • Preferred tx with NRTI backbone in patient naive
  • Separate Al/Mg antacids from INSTIs (2 before, 6 after)
  • SE: HA, insomnia, diarrhea. weight GAIN
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17
Q

Stages 5/6

A
  • Replication
  • Assembly
  • No drug associations
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18
Q

Stage 7

A
  • Budding/Maturation

- Protease breaks up long viral chains to make them mature, infectable HIV

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19
Q

PI

A
  • Protease inhibitors
  • Works at stage 7
  • Drugs end in “-navir”
  • SE: metabolic problems (sugars/chol.), lipodystrophy
  • Lowest risk: atazanavir and darunavir
20
Q

Initial Evaluation

A
  • CD4 count (goal: normal levels)
  • HIV viral load (goal: undetectable)
  • Hep B/C screening
  • Pregnancy test
  • HLA-B*5701 (abacavir req., CI if positive, severe allergic rxn risk)
  • Tropism assay (maraviroc req.)
21
Q

Preferred ART Therapy

A
  • 2 NRTIs and 1 INSTI
  • Descovy or Truvada are common for 2 NRTI backbone
  • NEVER use lamivudine and emtricitabine together (redundant)
  • If renally insufficient, harder to use combo products (use individuals)
22
Q

Dovato

A
  • Dolutegravir/Lamivudine
  • Don’t use in naïve pts with RNA >500K, known HBV coinfection, or no genotyping
  • One pill per day
  • Dolutegravir: Increases SCr w/o eGFR
23
Q

Triumeq

A
  • Dolutegravir/Abacavir/Lamivudine
  • Abacavir requires HLA-B*5701 testing, CI if positive, severe allergic rxn risk
  • One pill per day
  • Dolutegravir: Increases SCr w/o eGFR
24
Q

Biktarvy

A
  • Bictegravir/Emtricitabine/TAF
  • One pill per day
  • Emtricitabine: risk for hyperpigmentation in hands/feet
  • Can be given with iron/calcium IF taken with food
  • Bictegravir: Increases SCr w/o effect on GFR
25
Q

NRTI Backbone

A

-TAF OR TDF OR ABACAVIR
PLUS
-Emtricitabine OR Lamivudine
-Then combined with INSTI, NNRTI, or PI for regimen

26
Q

Z LATTE

A 
NRTI pneumonic:
Z - Zidovudine (only used L&D now if RNA > 1000, protect baby)
L - Lamivudine
A - Abacavir
T - TDF
T - TAF
E - Emtricitabine
27
Q

Descovy

A
  • Emtricitabine/TAF

- Emtricitabine: risk for hyperpigmentation in hands/feet

28
Q

Truvada

A
  • Emtricitabine/TDF
  • Emtricitabine: risk for hyperpigmentation in hands/feet
  • CrCl should be > 60
29
Q

Tivicay

A
  • Dolutegravir
  • INSTI
  • Dolutegravir: Increases SCr w/o eGFR
30
Q

Isentress

A
  • Raltegravir
  • INSTI
  • Can be used in HD patients
  • Used multiple times a day
  • SE: myopathy/increased CPK/rhabdo, rash risk
  • Can be taken with calcium carbonate
  • Used in PEP
31
Q

BRED

A 
INSTI Pneumonic:
B: Bictegravir
R: Raltegravir
E: Elvitagravir
D: Dolutegravir
32
Q

Tenofovir Formulations

A
  • Viread: TDF
  • Vemlidy: TAF (monotherapy not available)
  • NRTIs
  • NOF Risks: nephrotoxicity, osteoporosis, Fanconi syndrome
  • TAF has less toxicities compared to TDF
33
Q

Epivir

A
  • Lamivudine
  • NRTI
  • Used for HBV AND HIV (different brands, use right one for indication)
34
Q

Emtriva

A
  • Emtricitabine
  • NRTI
  • Risk for hyperpigmentation in hands/feet
35
Q

Ziagen

A
  • Abacavir
  • NRTI
  • Require HLA-B*5701
36
Q

Retrovir

A
  • Zidovudine
  • NRTI
  • Anema (treat with erythropoietin)
  • Give IV during L&D if RNA > 1000 to protect baby
37
Q

Atripla

A
  • Efavirenz/Emtricitabine/TDF
  • Efavirenz can cause depression/psych issues => take at bedtime on empty stomach to reduce these SE
  • Emtricitabine has risk for hyperpigrmentation in hands/feet
  • FIRST one pill QD, so some still on it
38
Q

Rilpivirine

A
  • NNRTIs
  • MUST be take with full meal > 500 kcal
  • CI with PPIs
  • Don’t use if viral load >100K or CD4 < 400
  • H2RAs/antacids need to be separated
39
Q

Reyataz

A
  • Atazanavir
  • PI
  • CI: acid lowering medications
  • SE: hyperbilirubinemia (“bananavir”)
40
Q

Prezista

A
  • Darunavir
  • PI
  • Caution with sulfa allergy
  • SJS/TEN Risk
41
Q

Norvir

A
  • Rilpivirine
  • ONLY used with PI
  • PK booster
  • Numerous DDI!
  • 43% alcohol: avoid with metronidazole, disulfiram, etc.
42
Q

Tybost

A
  • Cobicistat
  • PK booster
  • No ART activity
  • Can be used with other ART classes
  • Numerous DDI!
43
Q

Wasting Syndrome Tx

A
  • Characterized by loss muscle mass, loss of appetite, diarrhea
  • Cannabis related products like Syndros (dronabinal) or nabilone help improve appetite
  • Megace ES (megesterol) is a progestin that also stimulates appetite
44
Q

IRIS

A
  • Immune reconstitution inflammatory syndrome
  • Worsening of underlying condition after starting ART (unmasks condition)
  • Self-limited, DON’T start ART
  • More likely to occur as viral loads drop and CD4 rises
45
Q

Preggo Tx Options

A
  • Abacavir/Lamivudine OR TDF/Emtricitabine (or Lamivudine here) with a boosted PI OR INSTI
  • Boosted PI Options: Atazanavir or darunavir with ritonavir
  • INSTI Options: Raltegravir or dolutegravir
  • *NO TAF**
46
Q

PrEP

A
  • Confirm negative HIV test first
  • Screen recent sxs, CrCl >= 60, HepB/STI screening
  • Treat with Truvada or Descovy
  • Follow-up in 3 months to ensure HIV negative status and check kidneys/STIs
47
Q

PEP

A
  • Start ASAP (w/in 72 hours) no matter then circumstance
  • Baseline HIV test, follow-up in 4-6 weeks, 3 months, and 6 months
  • Treat with Truvada + Tivicay OR Raltegravir
  • Raltegravir preferred for preggo/childbearing age

NAPLEX (59 decks)

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