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pharmacy > HIV > Flashcards

HIV Flashcards

1
Q

HIV properties

A

retrovirus
target CD4
serocoversion occurs w/in 4-10wks

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2
Q

stage of HIV

A 
1st infection 
seroconversion 
latent 
early symptom of HIV infection 
AIDS
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3
Q

HIV transmission

A

Sexual
parenteral
perinatal ( immediately before and after birth)

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4
Q

HIV presentation

A 
Wt loss (avg 5kg), painful mucocutaneous ulceration, 
HIV viral load elevated; CD4 count low (normal: 800-1100 cells/mm3, 40-70% total lymphocytes, monitor every 3-6 months in HIV patients), aseptic meningitis
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5
Q

HIV latent phase

A

seroconversion - cell counts and viral load stay in near

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6
Q

HIV reservoirs

A

Infected CD4 cells but not actively producing HIV, can be established early on, continue to survive despite HAART (since they are not marked, they are not destroyed)

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7
Q

HIV early Sx

A

Thrush, STDs, fever or diarrhea >1 month,

+ ELISA and Weastern blot

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8
Q

AIDS

A

CD4 count < 200, HIV+ with AIDs- defining illness, advance aids  CD4 count <50

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9
Q

HIV diagnosis

A

4th generation antigen/antibody assay - 30 min
HIV antibody differentiation assay
HIV RNA testing if acute infection is suspected

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10
Q

HIV labs

A

CD4 count, VL, CBC, Chem 7, LFT, UA, hepatitis screening, FBG and FLP

Co-receptor tropism assays (maraviroc )
HLA-B 5701 (abacavir) renal function

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11
Q

HIV VL

A

indicator for ART therapy: decrease by 30-100 fold in 6 wks
GOAL: undetectable VL
virologic failure: >200 copies

suppression of VL: decrease inflammation and immune activation, prevents selection of drug - resistant mutations, preserves CD4 cell numbers

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12
Q

HIV resistance test

A

Genotype preferred over phenotype
done at baseline and after virologic failure

should be done when viral load >1000

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13
Q

HIV backbone (HAART)

A

2 NRTI + PI/NNRTI/INSTI

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14
Q

HIV complications

A

AIDS
HIV-Associated Nephropathy (HIVAN): occurs almost exclusively in black patients, most common cause of ESRD in HIV patient , more rapid progression of HBV/HCV complications, CVD, non-AIDs defining malignancies, neurologic disease, immune cell activation and inflammation

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15
Q

HAART toxicity

A

Common early toxicities: GI intolerance, anemia, sleep disturbance, hyperbilirubinemia, rash Immediately life-threatening: ABC hypersensitivity, pancreatitis, lactic acidosis, hepatitis, Stevens-Johnson Syndrome Long-term complications: Peripheral nervous system : neuropathy, myopathy Metabolic: Glucose disorders (insulin resistance, hyperglycemia, diabetes), Dyslipidemia (↑TG, ↑Cholesterol, ↓HDL) Cardiovascular: CVD-MI Morphologic: Fat accumulation (abdominal, buffalo hump, gyneocomastia), Fat loss Bone, Renal, Malignancy Nausea counseling: Sx usually decrease over first month, avoid greasy, fried food, eat small frequent snacks or meals, mint and/or simethicone for gas/bloating, consider antiemetics

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16
Q

NRTIs

A

SE: lipoatrophy,
BBW: lactic acidosis, fatty liver

Emtric DID Lift TV ABove Star Zone

Abacavir (ABC), Didanosine (DDI), Emtricitabine (FTC),
Lamivudine (3TC), Stavudine(D4T) Tenofovir(TDF), Zidovudine (AZT,ZDV)

all Require Renal adjustment except Abacavir

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17
Q

Ziagen

A

abacavir
must test for HLA-B 5701 before use
increase LDL & TG

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18
Q

Videx

A

Didanosine
pancreatitis, neuropathy,
No food and alcohol

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19
Q

Emtriva

A

Emtrictabine
M184 V mutation = no
skin discoloration
1st line for HBV co-infection

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20
Q

Epivir

A

Lamivudine
M184V mutation = no
1st line for HBV co-infection

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21
Q

Zerit

A

Stavudine
peripheral neuropathy
pancreatitis
DO NOT TAKE WITH ZIDOVUDINE

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22
Q

Viread

A

Tenofovir
Fanconi syndrome
decrease mineral density
1st line for HBV co- infection

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23
Q

Retrovir

A

Zidovudine
bone marrow suppression
dyslipidemia
not take with stavu

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24
Q

NNRTI

A

SE: rash (NVP> DLV>ETR>efv/rpv), increase LFT, dyslipidemias

Delavirdine (DLV), Rilpivirine (RLP), Efavirenz (EFV), Etravirine(ETR), Nevirapine (NVP)

No use in K103N mutation except etravirine
no renal adjustment needed
higher chance for resistance
a lot DDIs

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25
Q

Rescriptor

A

Delavirdine
avoid antacid
CI: alprazolam, midazolam
Not recommended as part of initial regimen

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26
Q

Edurant

A

Rilpivirine
Take with fatty meal
cause depression, insomia, increase LDL, TG
Not recommended if baseline VL >100,000

27
Q

Sustiva

A 
Efavirenz
High potency 
hangover effect 2-3 weeks
false positive THC test 
avoid high fat meal 
not for in 1st trimester
28
Q

Intelence

A

Etravirine
Rash, nausea
take with food

29
Q

viramune

A

Nevirapine
Hepatotoxicity Rash
Not recommended if baseline CD4 count >400 in males or >250 in females

30
Q

Complera

A

(RLP+ TDF+ FTC)
take with fatty food
good for HBV co-infection
Faconi syndrome, decrease bone mineral density

31
Q

Protease Inhibitor

A

SE: N/V, lipodystrophy, liver toxicity, dyslipidemia, insulin resistance, increase risk of MI,

mostly take with food except indinavir
low chance for resistance
no renal adjustment needed

  • navir
32
Q

Reyataz

A

Atazanavir
Avoid use of antacids
bilirubin, including jaundice and sclearal icterus

33
Q

Prezista

A

Darunavir
sulfa allergy - rash
take with food

34
Q

Lexiva

A

Fosamprenavir

sulfa allergy

35
Q

Crixivan

A

Indinavir
Kidney stone (1.5 L of Water)
TAKE 1 HR BEFORE OR 2 HRS AFTER MEALS

36
Q

Kaletra

A

Lopinavir + Ritonavir
Sever diarrhea, nausea, Risk of increase TG
DDIs due to Ritonavir
GI issues- NV (b/c must be given with higher dose ritonavir [200mg])

37
Q

Viracept

A

Nelfinavir
diarrhea
DO NOT USE BOOSTER

38
Q

Invirase

A

Saquinavir
highest pill burden,
avoid in arrhythmias
Do not use with IDV

39
Q

Aptivus

A

Tipranavir
Fanconi syndrome
good for PI resistant

40
Q

Norvir

A 
Ritonavir
Only used as booster 
must be refrigerate 
severe GI and DDI 
Cross resistance with Indinavir
41
Q

Fuzeon

A

Enfuvirtide
Binds to the HIV-1 transmembrane fusion protein gp41
must be reconstituted prior to each injection (site RXn)
unknown renal

42
Q

Selzentry

A

Maraviroc
only effective if CCR5 positive
BBW: hepatotxity and allergic RXN
renal adjustment

43
Q

Integrase inhibitors

A
  • gravir

no renal required

44
Q

Tivicay

A

Dolutegravir
hyperglycemia
insomnia,
headache

45
Q

Isentress

A

Raltegravir

increase CPK

46
Q

Atripla

A

TDF + FTC + EFV
1 NNRTI
2 NRTIs

47
Q

Combivir

A

ZDV + 3TC

Lamivudine + Zidovudine

48
Q

Epzicom

A

ABC + 3TC

49
Q

Stribild

A

Elvitegravir + cobicistat + TDF + FTC (Tenofovir, Emtricitabine)

N/D 
risk for kidney failure 
DDi with 3A4 due to cobicistat 
Cobicistat used to boost Elvitegravir level  
- No antiretroviral activity
50
Q

Trizivir

A

AZT + 3TC + ABC

51
Q

Truvada

A

TDF + FTC

52
Q

Women in HIV

A

higher risk for transmission
higher risk for SE
back up methods for birth control
Zidovudine - preventing intrapartum transmission

53
Q

Pregnancy drugs

A

Lam + zidovudine
Abacavir, Tenofovir,
Nevirapine: Avoid in starting in ALL women with baseline CD4>250

Lopinavir/r : Avoid once daily dosing
Atazanavir/r

54
Q

HIV-2

A

west Africa

longer latent, lower VL, lower mortality rate
intrinsically resistant to NNRTI and enfuvirtide

resistance commonly develops

55
Q

HIV/ HBV co-infection

A

TDF + FTC should form backbone of therapy
- Lamivudine, entecavir also active
Do NOT abruptly discontinue agents with anti-HBV
activity
All Pt should screen for HCV before ART
ART slow progression of liver disease

Due to DDIs
defer ART if baseline CD4 >500, until HCV treatment is finished
Vice versa, if baseline CD4 <200, may defer HCV treatment

56
Q

Prophylaxis

A

post: 2 NRTIs + PI 4 wks
pre: Truvada + safe sex

57
Q

IRIS

A

Immune Reconstitution Inflammatory Syndrome

Extent of immunosuppression before HAART
Degree of viral suppression and immune recovery after HAART

Corticosteroids or NSAIDs

58
Q

Toxoplasma gondii Encephalitis Prophylaxis

A

Initiate when CD4 cells 200 for 3 month

59
Q

Toxoplasma gondii Encephalitis treatment

A

pyrimethamine +sulfadiazine + leucovorin

6 weeks

60
Q

Fanconi Syndrome

A

TENOFOVIR

Manifested by increases in SCr, and electrolyte and
protein wasting via urine
Should monitor SCr, UA, electrolytes when taking TDF

61
Q

Elvitegravir

A

inhibits secretion of creatinine - increase Scr
watch for increase Scr >0.4 mg/dl
not treat naive Pt with Scr <70
DDIs with 3A4

62
Q

DDIs:

A

NNRTIs & PIs : NO Sim & lova statin
NO MIdazolam, trazolam, alprazolam (zolams)

lower antidepression dose
increase dose for OC

No PIs with Budesonide, Fluticasone, Prednisone

63
Q

Risks and Benefits of Early Initiation of ART

A

Benefits:
Prevention of progressive immune dysfunction
Delayed progression to AIDS and prolonged survival
Decreased risk of nonAIDS/HIV-related morbidity
Decreased risk for ARV toxicities
Decreased HIV transmission
Decreased emergence of resistance

Risks
Reduced quality of life
Development of drug resistance if adherence is suboptimal
Limitation in future choices of ART if drug resistance occurs
Long-term drug toxicities
Cost

pharmacy (15 decks)

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