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Spring 2015 PNT Exam 5 > HIV > Flashcards

HIV Flashcards

1
Q

Routes of HIV transmission

A

Blood, Vaginal fluids, semen

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2
Q

behavioral prevention strategies for HIV transmission

A 
Abstinence
Condoms
Clean Needles
Safe Sex education
Limiting sex partners
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3
Q

Interventional prevention strategies for HIV transmission

A 
Circumcision
post-exposure prophylaxis
ART in pregnant females
Microbicides
Pre-exposure prophylaxis
Vaccine
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4
Q

ELISA test what fluids

A

blood
saliva
rapid tests

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5
Q

ELISA test works how

A

detects antibodies against HIV1

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6
Q

time after infection to test positive

A

3-4 weeks up to 6 months

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7
Q

Western blot advantage

A

more specific than ELISA

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8
Q

HIV diagnosed through what tests

A

2 + ELISA and a + western blot

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9
Q

CD4 is a surrogate marker for

A

immune function

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10
Q

During acute infection what is the viral load and CD4

A

low CD4, high viral load >100K

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11
Q

What is acute retroviral syndrome

A

flu-like s/s

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12
Q

how long is latency phase of HIV infection

A

10-15 years

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13
Q

Who should be tested for HIV

A

everyone 13-65 yo

women during 3rd trimester of pregnancy

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14
Q

Who should be tested for HIV

A

everyone 13-65 yo

women during 3rd trimester of pregnancy

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15
Q

Who should start ART

A

everyone HIV +

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16
Q

Which conditions favor more rapid initiation of ART

A 
pregnancy 
AIDS defining conditions
Acute opportunistic infections (NOT cryptococcal meningitis or non-TB mycobacterial infection) 
CD4  100/year) 
Higher viral loads (>100K)
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17
Q

Conditions where deferral of therapy may be considered

A

significant barriers to adherence
comobidities that complicate of prohibit ART (temporary)
Long term nonprogressors and elite controllers

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18
Q

goals of ART

A

Reduce HIV morbidity and prolong duration and quality of survival
Restore and preserve immunological function
Maximally and durably suppress plasma HIV viral load
Prevent HIV transmission

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19
Q

normal CD4 count

A

500-1500

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20
Q

per year decline in cd4 count without treatment

A

50-80

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21
Q

per year increase in CD4 count with treatment

A

50-150

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22
Q

when does hiv viral load suppression begin after starting treatment

A

12-24 weeks

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23
Q

when does hiv viral load suppression begin after starting treatment

A

12-24 weeks

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24
Q

What labs need to be done prior to ART?

A 
CD4 count
HIV-1 RNA viral load
chemistries
LFTs
CBC w/ differential 
Fasting lipids
Fasting glucose
Urinalysis 
Hep B/C serologies
Resistance testing
Pregnancy test
HLA B*5701
Tropism assay
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25
Q

What labs need to be done prior to ART?

A 
CD4 count
HIV-1 RNA viral load
chemistries
LFTs
CBC w/ differential 
Fasting lipids
Fasting glucose
Urinalysis 
Hep B/C serologies
Resistance testing
Pregnancy test
HLA B*5701
Tropism assay
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26
Q

What % adherence is needed in ART

A

> 95%

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27
Q

Barriers to adherence

A 
non acceptance of diagnosis
busy lifestyle
inconsistent work schedule
homelessness
drug use
depression/psych issues
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28
Q

6 steps of HIV replication

A
  1. binding and fusion
  2. reverse transcription
  3. integration
  4. transcription
  5. translation
  6. viral assembly
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29
Q

6 steps of HIV replication

A
  1. binding and fusion
  2. reverse transcription
  3. integration
  4. transcription
  5. translation
  6. viral assembly
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30
Q

what occurs in the binding and fusion step

A

HIV glycoprotein gp120 binds to CD4 receptor and the co-receptor chemokine receptor 5 (CCR5)

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31
Q

what occurs in the reverse transcription step

A

viral enzyme reverse transcriptase makes a double stranded DNA copy of the viral RNA

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32
Q

what occurs in the integration step

A

proviral DNA enters the cell nucleus and is incorporated into the CD4 genome via viral enzyme integrase

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33
Q

What occurs in the transcription step

A

the DNA is transcribed into viral m-RNA by human RNA polymerase

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34
Q

What occurs in the translation step

A

viral mRNA leaves the nucleus and is translated into long strings of viral protein

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35
Q

What occurs in the viral assembly step

A

viral protease reassembles viral proteins into mature virus particles which can bud from the cell membrane and infect new cells

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36
Q

name 4 complete regimens brand names

A

Atripla
Complera
Stribild
Triumeq

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37
Q

atripla contains what drugs

A

efavirenz
tenofovir
emtricitabine

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38
Q

complera contains what drugs

A

rilpivirine
tenofovir
emtricitabine

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39
Q

stribild contains what drugs

A

elvitegravir
cobicistat
tenofovir
emtricitabine

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40
Q

triumeq contains what drugs

A

dolutegravir
abacavir
lamivudine

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41
Q

name 4 nrti combinations (brands)

A

truvada
epzicom
combivir
trizivir

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42
Q

truvada contains what drugs

A

tenofovir

emtricitabine

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43
Q

epzicom contains what drugs

A

abacavir

lamivudine

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44
Q

combivir contains what drugs

A

zidovudine

lamivudine

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45
Q

trizivir contains what drugs

A

abacavir
zidovudine
lamivudine

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46
Q

name 3 protease inhibitor with booster combination brands

A

kaletra
prezcobix
evotaz

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47
Q

kaletra contains what drugs

A

lopinavir

ritonavir

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48
Q

prezcobix contains what drugs

A

darunavir

cobicistat

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49
Q

evotaz contains what drugs

A

atazanavir

cobicistat

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50
Q

evotaz contains what drugs

A

atazanavir

cobicistats

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51
Q

initial haart therapy should include

A

2 nucleoside analogs +
NNRTI or
PI or
Integrase inhibitor

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52
Q

name 7 NRTIs

A 
abacavir
emtricitabine
lamivudine
tenofovir
zidovudine
didanosine
stavudine
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53
Q

abacavir brand and abbreviation

A

ziagen

ABC

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54
Q

emtricitabin brand and abbreviation

A

emtriva

FTC

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55
Q

lamivudine brand and abbreviation

A

Epivir

3TC

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56
Q

tenofovir brand and abbreviation

A

Viread

TDF

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57
Q

Zidovudine brand and abbreviation

A

Retrovir

AZT/ZDV

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58
Q

Didanosine brand and abbreviation

A

Videx EC

ddI

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59
Q

Stavudine brand and abbreviation

A

Zerit

d4T

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60
Q

BBW for NRTIs

A

Lactic acidosis

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61
Q

which drug check for HLA B*5701

A

abacavir

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62
Q

which drug check for HLA B*5701

A

abacavir

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63
Q

Abacavir has diminished efficacy when

A

viral load >100,000

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64
Q

Abacavir interacts with

A

Alcohol - alcohol dehydrogenase

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65
Q

Abacavir interacts with

A

Alcohol - alcohol dehydrogenase

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66
Q

Don’t give emtricitabine with what other medication

A

lamivudine

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67
Q

AEs of emtricitabine

A

GI upset, rash, hyperpigmentation of palms/soles

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68
Q

Emtricitabine special uses

A

Prep with tenofovir

Active against HBV

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69
Q

Emtricitabine special uses

A

Prep with tenofovir

Active against HBV

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70
Q

Lamivudine AEs

A

nausea
insomnia
fatigue

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71
Q

Lamivudine special uses

A

Active against HBV

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72
Q

Tenofovir special dosing

A

Renal dose adjustments

take with food

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73
Q

Tenofovir AEs

A

Fanconi’s syndrome (AEs)
Loss of BMD
least likely for lactic acidosis

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74
Q

Tenofovir special uses

A

PREP

Active against HBV

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75
Q

Zidovudine AEs

A 
GI intolerance
HA
malaise
myopathy
dysphoria
hepatitis
Lactic acidosis
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76
Q

Zidovudine long term AEs

A

Bone marrow suppression: anemia, neutropenia

Lipoatrophy

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77
Q

Zidovudine long term AEs

A

Bone marrow suppression: anemia, neutropenia

Lipoatrophy

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78
Q

which 2 drugs cause pancreatitis and peripheral neuropathy

A

didanosine

stavudine

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79
Q

didanosine special dosing

A

wt based
renal dose adjust
empty stomach

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80
Q

didanosine AEs

A 
Pancreatitis
peripheral neuropathy
diarrhea
hepatic dysfunction
esophageal ulceration
cardiomyopathy
CNS toxicity 
Hypertriglyceridemia
Hyperuricemia
Retinal changes - optic neuritis
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81
Q

Stavudine special dosing

A

wt based

renal dose adjustments

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82
Q

Stavudine AEs

A 
Rash
peripheral neuropathy
hepatitis/pancreatitis
arthralgias
lipodystrophy
neuromuscular weakness
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83
Q

name 5 nnrtis

A 
delavirdine
efavirenz
nevirapine
etravirine
rilpivirine
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84
Q

delavirdine brand and abbreviation

A

rescriptor

DLV

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85
Q

efavirenz brand and abbreviation

A

sustiva

EFV

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86
Q

Nevirapine brand and abbreviation

A

viramune

NVP

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87
Q

Etravirine brand and abbreviation

A

Intelence

ETR

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88
Q

Etravirine brand and abbreviation

A

Intelence

ETR

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89
Q

Rilpivirine brand and abbreviation

A

Edurant

RPV

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90
Q

Rilpivirine brand and abbreviation

A

Edurant

RPV

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91
Q

1st generation NNRTIs

A

delavirdine
nevirapine
efavirenz

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92
Q

2nd generation NNRTIs

A

etravirine

rilpivirine

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93
Q

metabolism of NNRTIs

A

CYP3A4

all inducers of 3A4 except rilpivirine

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94
Q

Class AE of NNRTIs

A

rash

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95
Q

Class AE of NNRTIs

A

rash

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96
Q

which 2 NRTIs are BID

A

zidovudine

stavudine

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97
Q

which 2 NRTIs are BID

A

zidovudine

stavudine

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98
Q

Special dosing for Efavirenz

A

bedtime

empty stomach

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99
Q

Nevirapine AEs

A

Rash, hepatitis

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100
Q

Which NNRTI isn’t started in those with a good immune system (CD4 > 250 for women, >400 men)

A

Nevirapine

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101
Q

efavirenz AEs

A 
dysphoria/neuropsych symptoms
dizziness
vivid dreams
rash
elevated triglycerides
PREG CAT D
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102
Q

Etravirine special dosing

A

BID

after a meal

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103
Q

Etravirine AEs

A

Rash
nausea
peripheral neuropathy

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104
Q

Etravirine AEs

A

Rash
nausea
peripheral neuropathy

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105
Q

Rilpivirine special dosing

A

need acid for absorption

500 calorie meal

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106
Q

Rilpivirine AEs

A

elevated cholesterol
elevated liver enzymes
depression
rash

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107
Q

rilpivirine not recommended when

A

viral load > 100,000

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108
Q

rilpivirine not recommended when

A

viral load > 100,000

109
Q

Name 9 Protease Inhibitors

A 
Atazanavir
darunavir
fosamprenavir
lopinavir
ritonavir
indinavir
nelfinavir
saquinavir
tipranavir
110
Q

atazanavir brand and abbrevation

A

reyataz

ATZ

111
Q

Darunavir brand and abbreviation

A

Prezista

DRV

112
Q

Fosamprenavir brand and abbrevation

A

Lexiva

FPV

113
Q

Lopinavir brand and abbreviation

A

Kaletra

LPV/r

114
Q

Ritonavir brand and abbreviation

A

Norvir

RTV

115
Q

Indinavir brand and abbreviation

A

Crixivan

IDV

116
Q

Indinavir brand and abbreviation

A

Crixivan

IDV

117
Q

Nelfinavir brand and abbreviation

A

Viracept

NFV

118
Q

Saquinavir brand and abbreviation

A

Invirase

SQV

119
Q

Tipranavir brand and abbreviation

A

Aptivus

TPV

120
Q

PI class metabolism

A

CYP3A4 inhibitors

121
Q

PI class AEs

A

Hyperlipidemia
Insulin resistance - Diabeetus
Lipodystrophy
Elevated LFTs

122
Q

Ritonavir use

A

Booster

123
Q

Ritonavir AEs

A

N/V/D
Loss of appetite
dyslipidemia
paresthesias

124
Q

Ritonavir AEs

A

N/V/D
Loss of appetite
dyslipidemia
paresthesias

125
Q

ritonavir drug interactions

A

inhibits: 3A4, 2D6, 2C9/2C19
induces: 1A3

126
Q

ritonavir drug interactions

A

inhibits: 3A4, 2D6, 2C9/2C19
induces: 1A3

127
Q

ritonavir drug interactions

A

inhibits: 3A4, 2D6, 2C9/2C19
induces: 1A3

128
Q

Atazanavir metabolism

A

3A4, UGT1A1

129
Q

Atazanavir special dosing

A

daily with food
boosted with ritonavir + tenofovir
Acid needed

130
Q

Atazanavir AEs

A

Hyperbilirubinemia
N/V/D
Nephroliathisis
NO METABOLIC COMPLICATIONS

131
Q

Atazanavir AEs

A

Hyperbilirubinemia
N/V/D
Nephroliathisis
NO METABOLIC COMPLICATIONS

132
Q

Darunavir special dosing

A

based on treatment experience QD/BID with ritonavir

133
Q

Which medication most forgiving of missed doses

A

darunavir

134
Q

Darunavir AEs

A 
N/V/D
Rash
Hyperlipidemia
Increases in LFTs
Sulfa moeity!
135
Q

Fosamprenavir special dosing

A

QD/BID with ritonavir based on treatment experience

136
Q

Fosamprenavir AEs

A 
N/V/D
rash
paresthesias
depression
insomnia
fatigue
sulfonamide moiety!
137
Q

Lopinavir/ritonavir special dosing

A

BID with food

138
Q

Lopinavir/ritonavir AEs

A

N/V/D
gas/bloating
increased LFTs
hypertriglyceridemia

139
Q

Indinavir special dosing

A

TID/BID with ritonavir
empty stomach
12 oz of water
48 oz water per day

140
Q

Indinavir AEs

A 
Nephrolithasis
asymptomatic hyperbilirubinemia
N/V
Insulin resistance
Acute hemolytic anemia
141
Q

Nelfinavir metabolism

A

Inhibits CYP 3A4, 2C19, 2D6, and 2C9

142
Q

Nelfinavir special dosing

A

BID/TID with food

143
Q

PI that is NEVER boosted with ritonavir

A

Nelfinavir

144
Q

Nelfinavir AEs

A

diarrhea

flatulence

145
Q

Nelfinavir AEs

A

diarrhea

flatulence

146
Q

Saquinavir special dosing

A

BID with ritonavir and food

147
Q

Saquinavir AEs

A

GI upset, N/V/gas/bloating/diarrhea
dyspepsia
Prolonged QT and PR interval

148
Q

Tipranavir Special dosing

A

BID with ritonavir and food

149
Q

Tipranavir AEs

A 
Rash
N/V/D
abdominal pain
lipid abnormalities
elevated LFTs
intracranial hemorrhage
150
Q

Tipranavir AEs

A 
Rash
N/V/D
abdominal pain
lipid abnormalities
elevated LFTs
intracranial hemorrhage
151
Q

name 3 integrase inhibitors

A

raltegravir
elvitegravir
dolutegravir

152
Q

raltegravir brand and abbreviation

A

isentress

RAL

153
Q

elvitegravir brand and abbreviation

A

combo only - stilblid

EVG

154
Q

dolutegravir brand and abbreviation

A

trivicay

DTG

155
Q

raltegravir metabolism

A

No CYPS -> glucuonidation

156
Q

raltegravir special dosing

A

BID

157
Q

raltegravir AEs

A

Diarrhea
HA
nausea
elevated creatinine kinase -> myopathies/rhabdo

158
Q

Elvitegravir metabolism

A

inhibits 3A4, 2D6

induces 2C9

159
Q

Elvitegravir special dosing

A

CrCl > 70 to start, > 50 to continue, must give cobicistat booster with food

160
Q

Elvitegravir AEs

A 
Nausea
diarrhea
HA
renal insufficiency 
Fatigue
161
Q

Cobicistat use

A

booster

162
Q

Cobicistat metabolism

A

Inhibits CYP3A4, 2D6

163
Q

cobicistat AEs

A

increase in SCr

164
Q

Dolutegravir metabolism

A

NO CYP -> glucuronidation

165
Q

Dolutegravir AEs

A

insomnia
nausea
diarrhea
HA

166
Q

name one fusion inhibitor

A

enfuviritide

167
Q

enfuviritde brand and abbreviation

A

fuzeon

T20

168
Q

name one CCR5 inhibitor

A

Maraviroc

169
Q

Maraviroc brand and abbreviation

A

Seizentry

MVC

170
Q

Enfuviritide special dosing

A

BID, SUBQ

171
Q

enfuviritide AEs

A

injection site reactions
nodules/indurations
bacterial pneumonia

172
Q

enfuviritde use

A

salvage therapy

173
Q

enfuviritde use

A

salvage therapy

174
Q

Which retroviral requires tropism testing

A

maraviroc

175
Q

tropism testing success rate drops when

A

viral load

176
Q

what does tropism testing detect

A

benefit from CCR5 antagonist

177
Q

Maraviroc metabolism

A

3A4

178
Q

Maraviroc special dosing

A

BID

179
Q

maraviroc AEs

A 
fever
URI
cough
rash
hepatotoxicity
180
Q

rilpivirine not recommended when

A

viral load > 100,000 and CD4

181
Q

maraviroc AEs

A 
fever
URI
cough
rash
hepatotoxicity
182
Q

Is the following a recommended, alternative, other, or not recommended regimen?
Tenofovir + emtricitabine + darunavir/ritonavir

A

recommended

183
Q

Is the following a recommended, alternative, other, or not recommended regimen?
Tenofovir + emtricitabine + raltegravir

A

recommended

184
Q

Is the following a recommended, alternative, other, or not recommended regimen?
Tenofovir + emtricitabine + elvitegravir (stribild)

A

recommended

185
Q

Is the following a recommended, alternative, other, or not recommended regimen?
tenofovir + emtricitabine + dolutegravir

A

recommended

186
Q

Is the following a recommended, alternative, other, or not recommended regimen?
abacavir + lamivudine + dolutegravir

A

recommended

187
Q

Is the following a recommended, alternative, other, or not recommended regimen?
Tenofovir + emtricitabine + Efavirenz

A

alternative

188
Q

Is the following a recommended, alternative, other, or not recommended regimen?
tenofovir + emtricitabine + rilpivirine

A

alternative

189
Q

Is the following a recommended, alternative, other, or not recommended regimen?
Tenofovir + emtricitabine + darunavir/cobicistat

A

alternative

190
Q

Is the following a recommended, alternative, other, or not recommended regimen?
Tenofovir + emtricitabine + atazanavir/ritonavir

A

alternative

191
Q

Is the following a recommended, alternative, other, or not recommended regimen?
Tenofovir + emtricitabine + atazanavir/cobicistat

A

alternative

192
Q

Is the following a recommended, alternative, other, or not recommended regimen?
Abacavir + lamivudine + darunavir/ritonavir

A

alternative

193
Q

Is the following a recommended, alternative, other, or not recommended regimen?
abacavir + lamivudine + Darunavir/cobicistat

A

alternative

194
Q

Is the following a recommended, alternative, other, or not recommended regimen?
Tenofovir + emtricitabine + lopinavir/ritonavir

A

other

195
Q

Is the following a recommended, alternative, other, or not recommended regimen?
Tenofovir + emtricitabine + lopinavir/ritonavir

A

other

196
Q

Is the following a recommended, alternative, other, or not recommended regimen?
abacavir + lamivudine + raltegravir

A

other

197
Q

Is the following a recommended, alternative, other, or not recommended regimen?
abacavir + lamivudine + efavirenz

A

other

198
Q

Is the following a recommended, alternative, other, or not recommended regimen?
Abacavir + lamivudine + atazanavir/ritonavir

A

other

199
Q

Is the following a recommended, alternative, other, or not recommended regimen?
abacavir + lamivudine + atazanavir/cobicistat

A

other

200
Q

Is the following a recommended, alternative, other, or not recommended regimen?
abacavir + lamivudine + lopinavir/ritonavir

A

other

201
Q

Is the following a recommended, alternative, other, or not recommended regimen?
darunavir/ritonavir + raltegravir

A

other - when tonofovir/abacavir can’t be used

viral load 200

202
Q

Is the following a recommended, alternative, other, or not recommended regimen?
Lopinavir/ritonavir + lamivudine

A

other - when tenofovir/abacavir can’t be used

203
Q

Is the following a recommended, alternative, other, or not recommended regimen?
monotherapy

A

not recommended

204
Q

Is the following a recommended, alternative, other, or not recommended regimen?
monotherapy

A

not recommended

205
Q

Is the following a recommended, alternative, other, or not recommended regimen?
2 NNRTIs

A

not recommended

206
Q

Is the following a recommended, alternative, other, or not recommended regimen?
Triple NRTI

A

not recommended

207
Q

Is the following a recommended, alternative, other, or not recommended regimen?
unboosted DRV, SQV, TPV

A

not recommended

208
Q

Is the following a recommended, alternative, other, or not recommended regimen?
Didanosine (ddI) + stavudine (d4T)

A

not recommended

209
Q

Is the following a recommended, alternative, other, or not recommended regimen?
Stavudine + zidovudine

A

not recommended

210
Q

Is the following a recommended, alternative, other, or not recommended regimen?
Emtricitabine + lamivudine

A

not recommended

211
Q

Is the following a recommended, alternative, other, or not recommended regimen?
Etravirine + unboosted PI

A

not recommended

212
Q

Is the following a recommended, alternative, other, or not recommended regimen?
Etravirine + ATV/r, FPV/r, TPV

A

not recommended

213
Q

Is the following a recommended, alternative, other, or not recommended regimen?
EVG/Cobicistat/TDF/FTC + other ARVs

A

not recommended

214
Q

When to monitor HIV viral load

A

2-8 weeks after starting ART

q3-6 months

215
Q

When to monitor HIV viral load

A

2-8 weeks after starting ART

q3-6 months

216
Q

When to monitor CD4

A

q 3-6 months: first 2 years, viremia on ART, CD4

217
Q

When to monitor chemistries and LFTs

A

2-8 weeks after starting ART

q3-6 months

218
Q

Define virologic failure

A

persistent or rebound viral laod

219
Q

virologic failure causes

A

non-adherence
resistance
drug-drug interactions
altered absorption

220
Q

define immunologic failure

A

inability to restore CD4 count

221
Q

immunologic failure causes

A

lower baseline CD4 (

222
Q

What impact does resistance have to the patient

A

drugs with resistance will never work again

more complex regimen - more tablets/times per day

223
Q

what impact does resistance have to the provider

A

more challenge to find a regimen

224
Q

HIV goal during pregnancy

A

undetectable viral load prior to birth

225
Q

Preferred NRTIs in pregnancy

A 
zidovudine
lamivudine
emtricitabine
tenofovir
abacavir
226
Q

Preferred PIs in pregnancy

A

atazanavir/ritonavir
lopinavir/ritonavir
alternative: darunavir/ritonavir

227
Q

Preferred NNRTI in pregnancy

A

Nevirapine

228
Q

What is used for intrapartum ART

A

zidovudine continuous infusion

optional if viral load

229
Q

What is used for intrapartum ART

A

zidovudine continuous infusion

optional if viral load

230
Q

Postpartum ART medications

A

Zidovudine and Nevirapine

231
Q

When to test for HIV in infants

A

birth, 1 month, 4-6 month, and 1 year

232
Q

HIV positive and breastfeeding

A

not recommended

233
Q

3 ARVs active against Hep B

A

lamivudine
emtrictiabine
tenofovir

234
Q

When should hep c treatment start

A

when HIV viral load is undetectable

235
Q

infectious body fluids

A 
blood
bloody fluids
CSF
pleural
peritoneal 
amniotic
vaginal
semen
236
Q

non-infectious body fluids

A 
urine
stool
nasal
sputum
tears
vomit
sweat
237
Q

When should PEP be started

A

within 72 hours of exposure and continued for 4 weeks

238
Q

Preferred regimen for PEP

A

tenofovir + emtricitabine + raltegravir

239
Q

PREP which medication

A

truvada

240
Q

who is high risk and gets PREP

A

partner with HIV-1
engage in sexual activity within a high prevalence area or social network
inconsistent/no condom use
Diagnosis of sexually transmitted disease
exchange sex for commodities
use of illicit drugs or alcohol dependence
incarceration
partner of unknown HIV-1 status / has risk factors

241
Q

who is high risk and gets PREP

A

partner with HIV-1
engage in sexual activity within a high prevalence area or social network
inconsistent/no condom use
Diagnosis of sexually transmitted disease
exchange sex for commodities
use of illicit drugs or alcohol dependence
incarceration
partner of unknown HIV-1 status / has risk factors

242
Q

4 things to do when prescribing PREP

A

part of a comprehensive prevention strategy
counsel all uninfected patients to strictly adhere
confirm negative HIV-1 test prior to start
Retest for HIV-1 at least every 3 months

243
Q

Prior to initiation of prep

A

HIV test to ensure HIV negative
Confirm CrCl > or = 60
Screen for Hep B

244
Q

Monitoring for PREP

A 
HIV q 2-3 months
STI symptom screening q 2-3 months
SCr: 3 months after starting 
STI screening q 6 months irrespective of symptoms
Max 90 days per script
Regular monitoring of risk behaviors
245
Q

Which 2 medications interact with acid suppressants

A

atazanavir

rilpivirine

246
Q

Which 2 medications interact with acid suppressants

A

atazanavir

rilpivirine

247
Q

Which 2 medications interact with acid suppressants

A

atazanavir

rilpivirine

248
Q

how to handle drug interaction between NNRTIs and statins

A

titrate to lipid response

249
Q

Do not give which statins with PIs or elvitegravir/cobicistat

A

simvastatin

lovastatin

250
Q

Which statins should be given with PIs or elvitegravir/cobicistat

A

Atorvastatin max 20 mg
rosuvastatin max 10 mg
pitavastatin
pravastatin

251
Q

Which statins should be given with PIs or elvitegravir/cobicistat

A

Atorvastatin max 20 mg
rosuvastatin max 10 mg
pitavastatin
pravastatin

252
Q

Avoid fluticasone and budesonide with which ARVs

A

PIs and elvitegravir/cobicistat

253
Q

Avoid Salmeterol with which ARVs

A

PIs and EVG/cobicistat

254
Q

Avoid Salmeterol with which ARVs

A

PIs and EVG/cobicistat

255
Q

Avoid which anticonvulsants with PIs, NNRTIs, elvitegravir and maraviroc

A

phenytoin
phenobarbital
carbamazepine
oxcarbazepine

256
Q

Good anticonvulsants to use with ARVs

A

levetiracetam
gabapentin
topiramate

257
Q

Good anticonvulsants to use with ARVs

A

levetiracetam
gabapentin
topiramate

258
Q

Do not give which anticoagulants with boosted PIs or elvitegravir/cobicistat

A

apixaban
rivaroxiban
ticagrelor
vorapaxar

259
Q

When is it ok to give dabigatran with boosted PIs or elvitegravir/cobicistat

A

CrCl > 50

260
Q

When is it ok to give dabigatran with boosted PIs or elvitegravir/cobicistat

A

CrCl > 50

261
Q

Don’t give clopidogrel with which ARV

A

etravirine

262
Q

NNRTIs and PDE 5 inhibitors management

A

treat to effect

263
Q

PIs and EVG/cobicistat with PDE5 inhibitors management

A

Sildenafil: Start 25 mg Q48
Tadalafil: Start 5 mg Q72. Max 10 mg Q72
Vardenafil: Start 2.4 mg Q72

264
Q

PIs and EVG/cobicistat with PDE5 inhibitors management

A

Sildenafil: Start 25 mg Q48
Tadalafil: Start 5 mg Q72. Max 10 mg Q72
Vardenafil: Start 2.4 mg Q72

265
Q

Which benzo don’t you use with PIs and EVG/cobicistat

A

alprazolam
diazepam
triazolam

266
Q

which benzos are ok with PIs and EVG/cobicistat

A

lorazepam
oxazepam
tempazepam

267
Q

Which benzos don’t you use with efavirenz

A

triazolam

268
Q

Which herbals are contraindicated with ARVs

A

ST. John’s wort

Garlic

Spring 2015 PNT Exam 5 (6 decks)

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