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TOP 300 drugs - NAPLEX > HIV > Flashcards

HIV Flashcards

1
Q

Examples of immune-compromised states

A
  1. Diseases (e.g. HIV) with CD4 < 200
  2. Systemic steroids for 14 days + at prednisone equivalent dose of ≥ 20mg/day or 2mg/kg/day
  3. Asplenia
  4. Use of immunosuppressants
  5. Cancer chemotherapy (ANC < 500)
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2
Q

Common OIs requiring PPX

A
  1. PCP/PJP
  2. Toxoplasmosis gondii encephalitis
  3. Mycobacterium avium complex (MAC)
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3
Q

PCP: criteria for starting + preferred regimen (Prophylaxis)

A

CDC < 200 or AIDs defining illness
Bactrim SS or DS daily

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4
Q

PCP: Criteria for discontinuing ppx

A

CD4 count > 200 or > 3 months on ART Same for toxo

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5
Q

ALT agents when sulfa allergy is present for OI

A

Atovaquone
Dapsone
Pentamidine

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6
Q

ALT in setting of G6PD deficiency in OI

A

Atovaquone
Pentamidine

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7
Q

Toxoplasmosis: criteria for starting + preferred regimen (ppx)

A

IgG positive AND CD4 < 100
Bactrim DS daily

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8
Q

When is leucovorin added to OI regimens?

A

Whenever Pyrimethamine-containing regimens are used to reduce risk of pyrimethamine-induced myelosuppression

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9
Q

MAC: criteria for starting + preferred regimen (ppx)

A

If NOT taking ART & CD4 < 50
Azithromycin 1,200 mg weekly

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10
Q

MAC: when to d/c ppx

A

Taking fully suppressive ART

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11
Q

Candidiasis (thrush) preferred, + ALT treatment

A

Fluconazole
ALT = Itraconazole, Posaconazole
Oropharngeal: Topicals
Esophageal: Voriconazole

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12
Q

Cryptococcal meningitis preferred + ALT treatment

A

Amp B + Flucytosine
ALT = fluconazole + flucytosine OR Amp B. + fluconazole

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13
Q

Cytomegalovirus preferred + ALT treatment

A

Valganciclovir or ganciclovir
ALT = Foscarnet or cidofovir

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14
Q

PCP preferred + ALT treatment (active infection)

A

Bactrim high dose +/- prednisone or methylprednisone
ALT = atovaquone or pentamidine IV

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15
Q

MAC preferred + ALT treatment (active infection)

A

(Clarithromycin/azithromycin) + ethambutol
ALT = add 3rd or 4th agent using rifabutin, amikacin, or levofloxacin

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16
Q

Toxoplasmosis: risk factors

A

undercooked/raw meats, raw shellfish or contact with cat feces/litter

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17
Q

Toxoplasmosis preferred + ALT treatment (active infection)

A

Pyrimethamine + leucovorin + sulfadiazine
ALT = Bactrim

18
Q

HIV drugs that act on stage 1 (binding/attachment)

A

CCR5 antagonist: Maraviroc
Attachment inhibitor: Fostemsavir
Post-attachment inhibitor: Ibalizumab-uiyk

19
Q

HIV drugs that act on stage 2 (fusion)

A

Fusion inhibitor: Enfuvirtide

20
Q

HIV drugs that act on stage 3 (Reverse transcription)

A

NRTIs: emtricitabine, tenofovir
NNRTIs: efavirenz, rilpivirine

21
Q

HIV drugs that act on stage 4 (Integration)

A

INSTIs: Bictegravir, Dolutegravir, Raltegravir

22
Q

HIV drugs that act on stage 7 (Budding & maturation)

A

Protease inhibitors: Atazanavir, darunavir

23
Q

Initial evaluation + labs

A
  1. CD4 count
  2. Viral load
  3. Drug resistance genotyping
  4. CMP (including LFTs, CBC, lipids, BG, UA)
  5. Hep B & C screening
  6. Pregnancy test
  7. HLA-B*5701 (for abacavir) or tropism assay (for maraviroc)
24
Q

When NOT to use Dovato?

A

HIV RNA > 500,000 copies/mL
Known Hep B co-infection or unknown
HIV genotyping unavailable

25
Q

Zidovudine: use

A

IV during labor to protect the baby in pts with unknown HIV RNA or HIV RNA lvl > 1,000 copies/mL

26
Q

All NRTIs: warnings

A

Lactic acidosis + hepatomegaly

27
Q

Emtricitabine: warning

A

Hyperpigmentation of palms of hand or soles of feet

28
Q

INSTIs: drug interactions

A

Polyvalent cations, must take 2 hours before or 6 hours after (Al, Ca, Fe, Mg)

29
Q

Which INSTIs “falsely” raise SCr?

A

Bictegravir
Dolutegravir

30
Q

Which INSTIs cause inc in CPK & myopathy?

A

Raltegravir
Dolutegravir

31
Q

Which INSTI is preferred in pregnancy?

A

Dolutegravir

32
Q

All NNRTIs warnings

A

Hepatotoxicity
rash (SJS/TEN) –> highest risk with rilpivarine

33
Q

Rilpivirine (Edurant): administration

A

Take with meal & water
Requires acidic environment (C/I with PPIs, separate with H2RAs and Tums)

34
Q

Efavirenz (Sustiva): administration

A

Empty stomach @ HS to dec. CNS effects

35
Q

Atazanavir: features

A

Hyperbilirubinemia
Needs acidic environment

36
Q

All PIs: warnings

A

Metabolic abnormalities
Hepatic dysfunction
Hypersensitivity reactions (rash, angioedema, anaphylaxis)

37
Q

Which PI should you be concerned with regarding sulfa allergy?

A

Darunavir

38
Q

Which PI is preferred in pregnancy?

A

Darunavir

39
Q

PEP: when to start & end treatment

A

Start within 72 hours and continue for 28 days

40
Q

CrCl and PrEP

A

Must be ≥ 60 mL/min for Truvada or ≥30 mL/min for Descovy

TOP 300 drugs - NAPLEX (12 decks)

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