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NAPLEX ID > HIV > Flashcards

HIV Flashcards

1
Q

All NRTIs

A
  • Warning: lactic acidosis and hepatomegaly with steatosis (fatty liver); boxed warning for zidovudine
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2
Q

HBV and HIV coinfection boxed warnings

A
  • Severe acute HBV exacerbation can occur if emtricitabine, lamivudine or tenofovir-containing products are discontinued (some NRTIs treat HBV)
  • Do not use Epivir-HBV for the treatment of HIV (contains a lower dose of lamivudine)
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3
Q

Abacavir

A
  • Screen for HLA-B*5701 allele before starting; abacavir is contraindicated if positive (boxed warnings: risk for hypersensitivity reaction)
  • Consider avoiding with CVD due to a potential risk of MI
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4
Q

Emtricitabine

A

Hyperpigmentation of the palms of the hands or soles of the feet

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5
Q

Tenofovir-containing products

A
  • Nephrotoxicity
  • Osteoporosis/osteopenia
  • Fanconi syndrome

Fanconi syndrome: renal tubular injury and electrolyte abnormalities

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6
Q

Zidovudine safety issues

A
  • Hematologic toxicity: neutropenia and anemia
  • Myopathy
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7
Q

All INSTIs

A
  • Headache
  • Insomnia
  • Diarrhea
  • Weight gain
  • Rare risk of depression and suicial ideation in patients with pre-existing psuchiatric conditions
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8
Q

INSTI interactions with polyvalent cations

A

Separate from INSTIs from polyvalent cations: take INSTIs 2 hours before or 6 hours after aluminum, calcium, magnesium and iron-containing products; exceptions:
* Dolutegravir and bictegravir can be taken with oral calcium or iron if also taken with food
* Dose separations with raltegravir may not be effective; avoid polyvalent cations if possible

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9
Q

ART that ↑ SCr with no effect on GFR

A
  • Bictegravir
  • Dolutegravir
  • Rilpivirine
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10
Q

ART that cause muscle damage (↑ CPK, myopathy and rhabdomyolysis)

A
  • Raltegravir
  • Dolutegravir
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11
Q

Dolutegravir

A
  • A preferred drug for treatment of HIV during pregnancy
  • Hepatotoxicity
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12
Q

All NNRTIs

A
  • Hepatotixicity
  • Rash/severe rash, including SJS/TEN
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13
Q

NNRTI drug interactions

A
  • All NNRTIs are CYP3A4 substrates
  • Efavirenz is a moderate CYP3A4 inducer
  • Do not use rilpivirine with PPIs and separate from H2RAs and antacids
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14
Q

Efavirenz (Sustiva) safety issues

A
  • Psychiatric symptoms (depression, suicidal thoughts)
  • CNS effects (impaired concentration, abnormal dreams, confusion), generally resolve in 2-4 weeks
  • ↑ total cholesterol and triglycerides

Food increases the bioavailability and risk for CNS effects; take on an empty stomach QHS to ↓ (and sleep through) CNS effects

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15
Q

Rilpivirine (Edurant)

A
  • Take with food (with a meal, do not substitute with a protein drink)
  • Depression
  • Do not use if viral load > 100,000 copies/mL and/or CD4 count < 200 cells/mm3 (higher failure rate)
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16
Q

All PIs

A
  • Metabolic abnormalities: hyperglycemia/insulin resistance, dyslipidemia (↑ LDL, ↑ TGs), ↑ body fat and lipodystrophy
  • Hepatic dysfunction: ↑ LFTs
  • Hypersensitivity reactions: rash (including SJS/TEN), angioedema, bronchospasm, anaphylaxis
  • Common side effects: diarrhea, nausea
  • Take with food (except for fosamprenavir oral solution in adults)
17
Q

Atazanavir (Reyataz)

A
  • Hyperbilirubinemia (jaundice or scleral icterus, remember with “bananavir”): reversible, dose not require discontinuation
  • Requires acidic gut for absorption
18
Q

Darunavir (Prezista)

A
  • Caution with sulfa allergy
19
Q

PI drug interactions

A

All PIs are CYP3A4 substrates and most are strong CYP3A4 inhibitors

20
Q

Ritonavir and cobicistat drug interactions

A
  • Strong CYP3A4 inhibitors
  • Also inhibit CYP2D6 and P-gp
21
Q

Take ritonavir and cobicistat with/without food?

A

Take with food

22
Q

Maraviroc

A

Must have tropism assay results before starting

23
Q

Tenofovir-containing products CrCl cutoff

A
  • CrCl < 50: do not start TDF-containing products (< 70 for Stribild)
  • CrCl < 30: do not start TAF-containing products
24
Q

PrEP

A
  • BEFORE high-risk activity
  • Do not start PrEP without a NEGATIVE HIV test
  • Treatment option 1: oral regimen of either Truvada or Descovy, taken daily, with no more than a 90-day supply provided at a time
  • Treatment option 2: a long-acting intramuscular injection of cabotegravir (Apretude); administered by a healthcare provider monthly for 2 doses, then every 2 months
25
Q

PEP

A
  • AFTER HIV-exposure, start within 72-hours and take for 28 days
  • Truvada (if CrCl ≥ 60) + Tivicay or Isentress

NAPLEX ID (5 decks)

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