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Infectious Disease > HIV > Flashcards

HIV Flashcards

1
Q

All HIV infected individuals initiate ART if

A

CD4 count < 350, 350 to 500, or > 500

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2
Q

Initiate ART regardless of CD4 Count when

A

Hx of AIDs defining illness, prego, HIV associated nephropathy, Co-infected w hepatitis B, HIV infected individuals at risk for transmitting disease to their sexual partners

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3
Q

ART for Na_ve HIV patients

A

NNRTI + 2NRTI or PI (pref. boosted w ritonavir) + 2NRTI or INSTI + 2NRTI

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4
Q

Preferred Regimens NNRTI based

A

efavirenz/tenofovir/emtricitabine (Atripla)

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5
Q

Preferred regimen PI based

A

atazanavir + ritonavir + tenofovir/emtricitabine and darunavir + ritonavir + tenofovir/emtricitabine

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6
Q

Preferred Regimen INSTI based

A

raltegravir + tenofovir/emtricitabine

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7
Q

Preferred for prego

A

lopinavir + ritonavir + zidovudine/lamivudine

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8
Q

NRTIs Nucleoside/tide Reverse Transcriptase Inhibitors MOA

A

NRTIs work by binding to the catalytic site of reverse transcriptase, interfering with HIV viral RNA-dependent DNA polymerase and resulting in inhibition of viral replication

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9
Q

NRTIs entire class side effects

A

lactic acidosis, severe hepatic steatosis, sometimes fatal, especially with stavudine, didanosine, and zidovudine

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10
Q

Ziagen

A

abacavir ABC, serious possibly fatal hypersiensitivity reaction, must screen for HLA-B*5701 allele prior to starting and if + cannot use

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11
Q

Epzicom

A

abacavir + lamivudine

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12
Q

Trizivir

A

abacavir + lamivudine + zidovudine, one tab BID

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13
Q

Videx, EC

A

didanosine ddl, BBW: pancreatitis, SE: peripheral neuropathy, NVD, EC = take on empty stomach (1 hr before or 2 hrs after meal), decrease dose CrCl < 60, store med in tightly closed bottles at room temp

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14
Q

Emtriva

A

emtricitabine 3TC, BBW: may exacerbate hepatitis B once drug is D/C or HBV resistance may develop SE: hyperpigmentation

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15
Q

Truvada

A

emtricitabine + tenofovir, one tab daily

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16
Q

Atripla

A

emtricitabine + efavirenz + tenofovir, one tabe daily, take on EMPTY STOMACH preferably at bedtime

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17
Q

Stribild

A

emtricitabine + tenofovir and elvitegravir + cobicistat, one tab daily with FOOD

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18
Q

Epivir

A

lamivudine FTC, BBW: do not use Epivir-HBV for trmt of HIV bc contains lower lamuvidine, may exacerbate hep B once drug is DC or resistance may develop, decrease dose CrCl < 50

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19
Q

Combivir

A

lamivudine + zidovudine, one tab BID

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20
Q

Zerit

A

stavudine d4T, weight based dosing >= 60kg give 40mg Q12H, < 60 kg give 30 mg, decrease dose when CrCl < 50

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21
Q

Retrovir

A

zidovudine ZDV, BBW: bone marrow suppression, hematologic toxicities, decrease dose CrCl < 15

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22
Q

Viread

A

tenofovir TDF, BBW: may exacerbate hep B once drug is DC or resistance may develop, SE: fanconi syndrome, renal insufficiency, osteomalacia, decrease bone density

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23
Q

NRTIs Drug interaction

A

NRTIs do not undergo hepatic transformation via CYP metabolism pathway so fewer D/I’s, ribivarin may increase levels of NRTIs, avoid didanosine + stavudine bc pancreatitis, peripheral neuropathy and hyperlactatemia, avoid didanosine + tenofovir bc resitance and virologic failure and increased didansoine concentration, avoid emtricitabine + lamivudine bc no benefit, avoid zidovudine + stavudine bc antagonist effect on HIV-1

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24
Q

NNRTIs Non-Nucleoside Reverse Transcriptase Inhibitors MOA

A

NNRTIs work by binding to reverse transcriptase and blocking the RNA dependent and DNA dependent DNA polymerase activities including HIV-1 replication

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25
Q

NNRTIs Entire class side effects

A

Rash (SJS/TEN) monitor for erythema, facial edema, skin necrosis, blisters, tongue swelling,

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26
Q

Rescriptor

A

delaviridine DRV

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27
Q

Sustiva

A

efavirenz EFV, TAKE ON EMPTY STOMACH PREF QHS, SE: CNS (impaired concentration, drowsiness, vivid dreams) and PSYCH symptoms (depression, mania, suicide), hyperlipidemia, PREGO D

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28
Q

Intelence

A

Etravirine, ETR

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29
Q

Viramune, XR

A

nevirapine NVP, BBW: severe hepatotoxic rxns may occur (liver failure, death), severe life threatening skin rxns SJS,TENS, need 14 day lead-in period

30
Q

Edurant

A

rilpivirine RPV, take w meal, C/I: PPI’s, keep in OG container to protect from light

31
Q

NNRTIs Drug interactions

A

metabolized in the liver via CYP 450 system so MANY drug interactions.

32
Q

PI’s Protease Inhibitors MOA

A

PI’s work by inhibiting HIV-1 protease and rendering the enzyme incapable of cleaving the Gag-Pol polyprotein, resulting in the production of immature, noninfectious virions

33
Q

PI’s Entire class Side effects

A

hyperglycemia/insulin resistance, lipodystrophy (loss of fat in face, butt, arms, legs), lipohypertrophy (fat accumulation), dyslipidemia, hepatitis and hepatic decomensations (highest w tipranavir), immune reconstitution syndrome

34
Q

Reyataz

A

atazanavir ATV, take with food, SE: PR interval prolongation, indirect hyperbilirubinemia, rash, nephrolithiasis (take w H20 may reduce risk),H2 blockers - Take at least 2 hours before or 10 hours after H2 blockers, Antacids - take 2 hours before or 1 hour after, PPIs: atazanavir + ritonavir take at least 12 hours before PPIs

35
Q

Prezista

A

darunivir DRV, SE: N,D, rash (including SJS/TEN), caution with sulfa allergy, take with food swallow whole

36
Q

Lexiva

A

fosamprenavir FPV

37
Q

Crixivan

A

Indinavir IDV, SE: Nausea, nephrolithiasis, must dispense in the original container with the desiccant to protect from moisture

38
Q

Viracept

A

nelfinavir NFV

39
Q

Norvir

A

ritonavir, primarily used as a booster agent and not as a sole PI, take with food, capsules require refrigeration and dispense in OG container, SE: NVD, paresthesias, asthenia, altered taste, PR prolongation

40
Q

Kaletra

A

lopinavir + ritonavir, LPV/r, preferred in prego

41
Q

Invirase

A

saquinivir SQV

42
Q

Aptivus

A

tipranavir, TPV, BBW: intracranial hemorrhage

43
Q

PI’s Drug Interaction

A

can alter INR mainly decreasing, increase levels of trazodone and TCAs, metabolized in liver via the CYP 450 system and have many drug interactions, avoid concomitant use with alfuzosin, amiodarone, conivaptan, dronedarone, eplernone, ergot derivatives, lovastatin, midazolam, nilotinib, nisoldipine, sildenafil for PAH, pimozide, quinidine, ranolazine, rifampin, rivaroxaban, salmeterol, silodosin, simvastatin, st johns wort, tamsulosin, triazolam, and voriconazole, and many PIs should not be used w boceprevir or telaprevir

44
Q

Fusion Inhibitor

A

also known as cell entry inhibition, fusion inhibitors block the attachment (or fusion) of the HIV-1 virus with the CD4 cells by blockin the conformational change in gp41 required for membrane fusion and entry into CD4 cells.

45
Q

Fuzeon

A

enfuvirtide T20, for treatment experienced pts, SE: local injection side rxns in almost 100% pts

46
Q

CCR5 Antagonist

A

CCR5 inhibitors bind to the CCR5 co-receptor on the CD4 cells and prevent the confirmational change required for HIV cell entry

47
Q

Selzentry

A

maraviroc MVC, black box warning: hepatotoxicity, SE: rash including SJS, avoid use with st johns worts, monitor: prior to starting therapy, pts must be screened to determine tropism of their HIV since this agent will only work for pts with CCR5-tropic disease

48
Q

Integrase inhibitors MOA

A

intergrase inhibitors block the integrase enzyme needed for viral DNA to enter into the host nucleus

49
Q

Isentress

A

raltegravir RAL, levels will decrease if taken with rifampin, avoid st johns worts, PPIs can increase raltegravir

50
Q

Opportunistic infection, Pneumocystis pneumonia (PCP)

A

CD4 count < 200, 1st line: Bactrim DS PO daily or SS po daily, alternative: Bactrim DS po TIW or dapsone 100 mg po daily

51
Q

Opportunistic infection, toxoplasma gondii

A

CD4 count < 100, 1st line: Bactrim 1 DS po daily, alternative: Bactrim 1 DS po TIW or 1 SS po daily or (dapsone 50 mg po daily + pyrimethamime 50 mg po weekly + leucovorin 25 mg po weekly)

52
Q

Opportunistic infection, Mycobacterium avium complex MAC

A

CD4 count < 50 after r/o MAC infxn, 1st line: azithromycin 1,200 mg PO weekly or 600mg twice weekly or clarithromycin 500 mg po BID

53
Q

Sandostatin

A

octreotide, analogue of somatostatin, treatment for managing acute variceal bleeding

54
Q

Pitressin

A

vasopressin, antidiuretic hormone analog, not 1st line, usually used with NTG IV

55
Q

Enulose, Generlac

A

lactulose, treatment for hepatic encephalopathy, first line therapy

56
Q

Neomycin

A

treatment for hepatic encephalopathy

57
Q

Xifaxan

A

Rifaxamin, 2nd line treatment for hepatic encephalopathy

58
Q

Flagyl

A

Metronidazole, treatment for hepatic encephalopathy

59
Q

Ascites

A

duiretic therapy combo of furosemide and spironolactone

60
Q

Intron A

A

interferon alpha 2b, for HBV HCV many cancers, 3 million units SC, 3 times weekly

61
Q

PegIntron

A

Pegylated interferon alpha 2b, HCV, pegylated formulations are given once weekly

62
Q

Pegasys

A

pegylated interferon alpha 2a, for HBV and HCV, pegylated formulations are given once weekly

63
Q

Infergen

A

interferon alfacon-1, for HCV

64
Q

Rebetron

A

combo product: interferon alpha 2b, and ribavirin

65
Q

Rebetol, Ribasphere, RibaPak, Copegus, Virazole

A

ribivarin, an antiviral agent that inhibits replication of RNA & DNA viruses, indicated for hep C in combo w interferon alpha-2a/2b not used for monotherapy for Hep C, not recommend Crcl<50, BBW: significant tertogenic effects prego X can stay in your body for as long as 6 months, SE: hemolytic anemia (primary toxicity),

66
Q

Victrelis

A

boceprevir, protease inhibitor for Hep C, used in combo w peginterferon and ribavirin, C/I: prego SE: fatigue, anemia, neutropenia, taste distortion, never reduce dose, never use as monotherapy

67
Q

Incivek

A

telaprevir, protease inhibitor for hep C, used in combo w peginterferon and ribavirin, C/I: prego SE: serious skin rash, fatigue, itching, taste disortion, anemia, anorectal disorders, never reduce dose, never use as monotherapy

68
Q

Epivir HBV

A

lamivudine, NRTI, do not use for HIV contains lower doses of lamivudine, pancreatitis

69
Q

Hepsera

A

adefovir, BBW: may cause HIV resistance with unrecognized or untreated HIV, use caution in patients with renal impairment or those at risk of renal toxicity

70
Q

Viread

A

tenofovir, used for Hep B & HIV, SE: faconi syndrome, renal insufficiency osteomalacia, and decrease bone density

71
Q

Baraclude

A

entecavir, take on empty stomach

72
Q

Tyzeka

A

telbivudine, SE: myopathy, myalgia

Infectious Disease (7 decks)

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