Brainscape's Knowledge GenomeTM

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


See full index

PR3151_Pharmacotherapeutics > HIV > Flashcards

HIV Flashcards

1
Q

List the mode of transmission for HIV

A

Mother to child transmission through pregnancy

Transfusion with contaminated blood and blood products

Sharing infected syringes and needles

Unprotected sexual intercourse with infected person

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

What are some of the indications for testing?

A

IV drug user

Person who have unprotected sex with multiple partners

Men who have sex with men

Commercial sex workers

Person treated for STDs

Recipient of multiple blood transfusions

Persons sexually assaulted

Pregnant women: mandatory for all who are pregnant in SG

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

What are the two diagnostics criteria used to diagnose HIV?

A

Serum antibody detection through EIA and western blot

HIV RNA detection through PCR

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

What are the goals of antiretroviral therapy?

A

Reduce HIV associated mortality and morbidity

Prolong duration and QOL

Restore and preserve immunological function

Maximally and durably suppress HIV viral load

Prevent HIV transmission

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

What are the surrogate markers used for antiretroviral therapy?

A

CD4 and viral load

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

What are the indications to use CD4 as a surrogate marker?

A

Lab indicator of immune function in HIV infected patients

Helps predict subsequent disease progression and survival

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

Discuss how CD4 is used as a surrogate marker

A

Determines urgency for initating anti-retroviral therapy

Assess response to anti-retroviral by detecting baseline, every 3-6 months upon initiation, every 12 months after adequate response

Assess need for initiating / discontinuing prophylaxis for opportunistic infections

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

What is defined as an adequate response to antiretroviral therapy?

A

When increase in CD4 count is in rage of 50-150 cells / mm3 during first month of therapy

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

How is viral load used as a surrogate marker?

A

Indicates the response to antiretroviral therapy

Act in predicting clinical progression

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

How often should viral load monitoring be done?

A

Before initiation of therapy

Within 2-4 weeks after treatment initiation/ modification

Every 4-8 weeks until viral load is suppressed

Upon suppression, every 3-6 months

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

What are the indications to initiating ART therapy?

A

All HIV infected individuals regardless of CD4 cell count

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

List the benefits of early initiation of ART.

A

Help in maintaining a higher CD4 cell count

Prevent potential irreversible damage to immune system

Decrease risk of HIV associated complications (occurs when CD4 cells < 350)

Decrease risk of non-opportunistic infections

Decrease risk of HIV transmission to others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the risks of initiating an early ART therapy?

A

Potential side effect and toxicities

Development of drug resistance due to incomplete viral suppression and cause a potential loss in future treatment

Decrease time to prepare for adherence

Cost and treatment fatigue

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

List out the factors to consider before initiating ART

A

Patient’s understanding of HIV

Cost and availability

Adherence issue and convenience

VIrulogic efficacy

Potential adverse effects

Childbearing potential

Genotypic drug resistance testing

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

Name the types of antiretroviral targets

A

CCR5/CXCR4 inhibitors

Fusion inhibitors

Nucleoside and non-nucleoside reverse transcription inhibitors

Integrase inhibitors

Protease inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the possible ART combinations for use?

A

2NRTI and 1INSTI:
- Tenofovir + Emtricitabine + Bictegravir (TEB)
- Tenofovir + Emtricitabine + Dolutegravir (TED)
- Abacavir + Lamivudine + Dolutegravir (ALD)

1NRTI + 1INSTI:
- Emtricitabine + Dolutegravir (ED)

17
Q

What are the contraindications to using 1NRTI + 1INSTI regimens?

A

Individuals with HIV RNA > 500, 000 copies / mL (i.e. high viral load)

HBV coinfection

ART started before genotypic resistance or HBV testing results are available

18
Q

What are some of the NRTI?

A

Tenofovir, Emtricitabine, Abacavir, Lamivudine, Zidovudine

19
Q

What are the advantages and disadvantages of using NRTI?

A

Advantages: dual backbone for combination ART and is renally eliminated (decreasing risk of DDI)

Disadvantages: Adverse effects are related to mitochondrial toxicity (lipoatrophy, hepatic steatosis and lactic acidosis) and dose adjustment is needed for renally impaired patients

20
Q

What are the adverse effects of Tenofovir?

A

Nausea, vomiting and diarrhea
Renal impairment
Lower bone mineral density

21
Q

What are the two agents of NRTIs with minimal toxicity?

A

Emtricitabine
Lamivudine

22
Q

Which NRTI agent requires genotypic testing before initation? What are its other associated adverse effects?

A

Abacavir
- Genotyping testing needed for those with HLA-B5701

Other ADR: Myocardial infarction, N/V/D

23
Q

What is the main adverse effect of concern in NRTIs such as Zidovudine?

A

Bone marrow suppression

24
Q

List the drugs which are INSTI inhibitors

A

Bictegravir
Dolutegravir
Raltegravir
Elvitegravir

25
Q

What are the advantages and disadvantages of using INSTI inhibitors?

A

Advantages
- High genetic barrier to resistance
- Well tolerated
- Good virulogic effectiveness

Disadvantages
- Adverse drug reactions such as weight gain, N/V/D and headache
- Avoid in neuropsychiatric patients
- DDI with polyvalent cation and act as CYP3A4 substrates

26
Q

What are the adverse reactions of INSTI?

A

Bictegravir and dolutegravir
- Increased serum creatinine

Raltegravir: pyrexia and creatinine kinase elevation

27
Q

List the drugs that are NNRTIs

A

Efavirenz
Rilpivirine

28
Q

What are the advantages and disadvantages of using NNRTIs?

A

Advantages: Long half lives, decreased metabolic toxicity than PI

Disadvantages: Decreased genetic barrier to resistance, cross resistance among approved NNRTI, ADR such as skin rash, SJS and QTc prolongation and DDI due to CYP450 substrates

29
Q

What are the adverse drug reactions and DDI of NNRTIs Efavirenz?

A

Rash, hyperlipidemia, neuropsychiatric disorders, increase LDL and TG and hepatotoxicity

DDI: CYP3A4 substrate and CYP2B6 and 2C9 inducer

30
Q

What are the adverse drug reactions and DDI of NNRTIs Rilpivirine?

A

Depression and headache

DDI: CYP3A4 substrate and oral absorption decreases with increased gastric pH

31
Q

What are the drugs of protease inhibitors?

A

Ritonavir
Lopinavir
Atazanavir
Darunavir
Fosamprenavir

32
Q

What are the advantages and disadvantages associated with protease inhibitors?

A

Advantages: Increase genetic barrier to resistance, decrease PI drug resistance

Disadvantages: ADR and DDI

33
Q

What are the adverse drug reactions and DDI of PIs like Ritonavir?

A

ADR: Paresthesia and taste pervasion
DDI: Potent CYP2D6 and 3A4 inhibitor

34
Q

What are the adverse drug reactions and DDI of PIs like Darunavir?

A

ADR: Skin rash and SJS

35
Q

What are the adverse drug reactions and DDI of PIs like Atazanavir?

A

ADR: Hyperbilirubinemia, prolong QT interval, Skin rash

DDI: PPIs

36
Q

What are the drugs that are fusion inhibitors and what is its adverse effects?

A

Enfuvirtide

ADR: Injection site reaction, increased bacterial pneumonia and rare hypersensitivity reactions

37
Q

What are the drugs in CCR5 antagonist?

A

Maraviroc

38
Q

What are the indications of using CCR5 antagonist?

A

Strain of HIV uses CCR5 receptor to enter CD4 cells

Should be checked using a co-receptor triopism assay

39
Q

What are the DDI and ADR of CCR5 antagonist?

A

Abdominal pain, cough, dizziness, mucoskeletal symptoms, URTI, hepatotoxicity and orthostatic hypertension

DDI: CYP3A4 substrates

PR3151_Pharmacotherapeutics (9 decks)

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