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Pharm Spring 2023 > HIV > Flashcards

HIV Flashcards

1
Q

What is HIV/AIDS caused by?

A
  1. Human immunodeficiency Virus
    *member of the Lentivirus genus and Retroviride family
    *will destroy to CD4 cells
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2
Q

What is AIDS characterized?

A

Most advanced stage of HIV infection
1. CD4 cell count below 200
2. CD4 cell % of total lymphocytes less than 15%
3. Obtaining an opportunistic illness

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3
Q

What is the binding/attachment stage of HIV

A
  1. Binding of HIV to CD4 receptor
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4
Q

What is the fusion stage of HIV?

A
  1. HIV envelop fuses with CD4 membrane. Releasing HIV RNA and enzymes
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5
Q

What is the Reverse transcription stage of HIV?

A

Reverse transcriptase coverts HIV RNA into DNA that enters the CD4 nucleus

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6
Q

What is the integration stage of HIV?

A

The integrase protein integrate the HIV DNA into the host cells DNA

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7
Q

What is the replication stage of HIV?

A

Replication of host/HIV DNA occurs and translation of HIV proteins

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8
Q

What is the assembly stage of HIV?

A

New HIC RNA and protein move to CD4 surface and form immature HIV

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9
Q

What is the budding stage of HIV?

A

The new HIV pushes itself outside of the CD4 cell and releases protease to form infectious HIV

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10
Q

What is the most important part/goal for drug therapies?

A

Adherence at least 95% or greater
*Missing no more than 1dose/month of once-daily regimen

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11
Q

What is the 1 pill regimen for HIV (newly diagnosed)? (1 integrase strand transfer INSTI + 1-2 Nucleotide reverse transcriptase inhibitors NRTIs)

A
  1. Biktarvy = bictegravir/emtricitabine/tenofovir alafenamide (TAF)
  2. Triumeq = Dolutegravir/ abacavir/ lamivudine
  3. Dovato = Dolutegravir/lamivudine
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12
Q

What is the CI of Dovato?

A
  1. Hepatitis B infection
  2. HIV viral load >500,000 copies
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13
Q

What is the 2 pill regimen for HIV (newly acquired)?

A
  1. Trivicay (Dolutegravir) + Truvada (emtricitabine/tenofovir disoproxil fumarate) (TDF)
  2. Trivicay (Dolutegravir) + Descovy (emtricitabine/tenofovir alafenamide) (TAF)
  3. Isentress (raltegravir) + Truvada (emtricitabine/tenofovir disoproxil fumarate) (TDF)
  4. Isentress (raltegravir) + Descovy (emtricitabine/tenofovir alafenamide) (TAF)
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14
Q

What is PREP for (pre-exposure prophylaxis)

A

High risk sexual behavior

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15
Q

What needs to be completed before starting PREP?

A
  1. HIV -
  2. Screen for Hep B/STIs
  3. Confirm renal function
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16
Q

What are the options for PREP?

A
  1. Truvada (emtricitabine/tenofovir disoproxil fumarate) (TDF)
  2. Descovy (emtricitabine/tenofovir alafenamide) (TAF)
  3. Apretude (cabotegravir)
    *1&2 tablets
    *3 injection
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17
Q

What is the monitoring schedule for PREP?

A

Every 3 months

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18
Q

When should the PEP for HIV be taken?

A
  1. Within 72 hours and taken for 28 days
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19
Q

What are the options for HIV PEP?

A
  1. Truvada (emtricitabine/tenofovir disoproxil fumarate) (TDF)
    PLUS
  2. Tivicay (Dolutegravir)
    OR
  3. Isentress (raltegravir)
    *use once daily for 28 days

***Do NOT wait for HIV results to start PEP

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20
Q

What should be used during childbirth if the mom has HIV?

A
  1. Use Zidovudine IV if viral load is greater than 1000 copies/mL at delivery or unknown
21
Q

What are options of infant PEP?

A
  1. 3 dose of nevirapine during the first week of life and zidovudine
  2. 3 drug regimen of zidovudine, lamivudine,and nevirapine or raltegravir
22
Q

What drug is involved at the binding stage of HIV?

A

Maraviroc
*CCR5 anatagonist

23
Q

What drug is involved at the fusion stage of HIV?

A

Enfuvirtide
*Fusion inhibitor

24
Q

What drug is involved at the reverse transcription stage of HIV?

A

(Non) Nucleotide transcriptase inhibitors
*NNRTIs/NRT

25
Q

What drug is involved at the budding stage of HIV?

A

Protease inhibitors
*Saquinavir

26
Q

What drug is involved at the integration stage of HIV?

A

Integrase inhibitors

27
Q

What is the MOA of CCR5 anatagonist (Maraviroc)

A

Blocks HIV from binding to the CCR5 co-receptor preventing binding

28
Q

What is the special note about CCR5 antagonist? (Maraviroc)

A
  1. Works only with CCR5
    *not useful with CXCR4 or mixed CXCR4 and CCR5
29
Q

What is the MOA of fusion inhibitors (Enfuvirtide)

A

Prevents HIV from fusing to CD4

30
Q

What are the Nucleotide reverse transcriptase inhibitors? (NRTIs)

A
  1. Tenofovir disoproxil fumarate (TDF)
  2. Tenofovir alafenamide (TAF)
  3. Lamivudine
  4. Abacavir
  5. Zidovudine
31
Q

What is the BBW of NRTIs?

A
  1. Do not discontinue NRTIs if HBV + patients w/o adequate HBV treatment
    *Abacavir; must screen for HLA B 5701 before starting
32
Q

What are the AE of NRTIs?

A
  1. Tenofovir
    *renal toxicity (worse with TDF)
    *TDF will decreased bone mineral density
33
Q

What is the first line ART (anti-retroviral therapy) regimen?

A

NRTIs

34
Q

What are the NNRTIs?

A
  1. Efavirenz
  2. Rilpivirine
35
Q

What is the BBW of NNRTIs?

A
  1. Heptotoxicity
  2. Severe rash
36
Q

What is the CI about Rilpivirine?

A

DO NOT use with PPIs
*eat with food

37
Q

What is a special note about efavirenz?

A
  1. Take on an empty stomach at night
38
Q

What are the integrase inhibitors

A
  1. Bictegravir
  2. Dolutegravir
  3. Raltegravir
39
Q

What is the preferred treatment for HIV?

A

Integrase inhibitors

40
Q

What is the BBW about Dolutegravir and raltegravir?

A

D: neural tube defects (preferred drug in pregnancy), hypersensitivity rash, hepatoxicity
R: myopathy

41
Q

What are the special notes about integrase inhibitors?

A
  1. Do not give with cations (AI or Mg supplements)
42
Q

What are the protease inhibitors?

A
  1. Atazanavir
  2. Darunavir
43
Q

Why are protease inhibitor no longer 1st line treatment?

A

Bc of the DDI and AE, and increased resistance

44
Q

What are the special notes about protease inhibitors?

A
  1. ALL PI are substrates and strong inhibitors of CYP 3A4
    *creates DDI
    *3A4 inducers will decrease PI potency
    *DO NOT GIVE PI with a 3A4 inducer
45
Q

What is the CI about cyctochrome P450 inhibitors (boosting agents)?

A

Do not use with 3A4 inducers

46
Q

What are the special notes about CYP P450 inhibitors (boosting agents)?

A
  1. They inhibit CYP3A4, CYP2D6, and P-gp transporters
  2. Not interchangeable, have to be on the same one
47
Q

What is the strongest predictor for virologic failure?

A

Lack of adherence

48
Q

What are the Cytochrome P450 inhibitors (boosting agents)?

A
  1. Ritonavir
  2. Cobicistat
49
Q

What is the MOA of Cytochrome P450 inhibitors (boosting agents)?

A
  1. Inhibitor of CYP 3A4
  2. Will inhibit ART metabolism
  3. ART effect will be enhanced

Pharm Spring 2023 (27 decks)

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