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NAPLEX - OUR cards > HIV > Flashcards

HIV Flashcards

1
Q

What is HIV?

A

Retrovirus, attacks immune system, mainly the CD4+ T-helper cells

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2
Q

How does HIV spread?

A

Via blood, semen, vaginal secretions

Also can go from mother to child during pregnancy, childbirth, or breastfeeding

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3
Q

When do HIV antibodies show positive on a diagnostic test? What about HIV p24 antigen?

A

4-8 weeks after contracting the disease, up to 3-6 months for some people
HIV p24 antigen shows up 2 weeks after infecgtion

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4
Q

CDC recommended testing algorithm

A

Combination HIV Ab and p24 antigen immunoassay test

If positive, perform confirmatory testing with HIV-1/HIV-2 antibody differentiation immunoassay test

(not underlined but if 2nd test is negative, use an HIV nucleic acid test to confirm)

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5
Q

Why do we monitor CD4

A

Indicator of immune function, also determines need for OI prophylaxis
Monitor every 3-6 months

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6
Q

Why do we monitor HIV viral load

A

Determines response to antiretroviral therapy

Goal: undetectable

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7
Q

Drug specific testing required?

A

HLA-B*5701 for abacavir

Tropism for maraviroc

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8
Q

Where do CCR5 antagonists work?

A

Binding/attachment (stage 1)

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9
Q

Where do fusion inhibitors work?

A

Fusion lol (stage 2)

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10
Q

Where do NRTI’s and NNRTI’s work?

A

Reverse transcription (stage 3)

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11
Q

Where do INSTI’s work?

A

INSTI = integrase strand transfer inhibitors

Work at integration (stage 4)

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12
Q

Where do protease inhibitors work?

A

Budding and maturation (stage 7)

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13
Q

Pregnant women ART regimen

A

2 NRTI’s
PLUS
either a boosted PI or INSTI

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14
Q

Boxed warnings for NRTI’s

A 
Abacavir
Lamivudine
Emtricitabine
Tenofovir disoproxil
Tenofovir alafenamide

Lactic acidosis
Severe hepatomegaly with steatosis

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15
Q

Which drug requires a warning card to be dispensed with the medguide?

A

Abacavir (Ziagen)

and combos - Epzicom, Triumeq

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16
Q

Lamivudine can be used for HBV or HIV. Can you use the same dose?

A

No, dose used in HBV is lower and can result in HIV drug resistance

Epivir-HBV =/= Epivir
If treating both, use higher HIV dose

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17
Q

SE lamivudine

A

N/V/D

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18
Q

SE abacavir

A

hypersensitivity rxn

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19
Q

SE emtricitabine

A 
N/V/D
Rash
Dizziness
HA
Insomnia
Hyperpigmentation
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20
Q

SE tenofovir disoproxil fumarate

A

Renal toxicity, osteoporosis, Fanconi syndrome

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21
Q

SE tenofovir alafenamide

A

Nausea

Less risk of renal toxicity, osteoporosis, Fanconi syndrome vs TDF

22
Q

Which medications should be taken with food?

A

Complera (rilpivirine + 2 NRTI)
Stribild (elvitegravir + cobicistat + emtricitabine + TDF)
Odefsey (rilpivirine + 2 NRTI)
Genvoya (elvitegravir + cobicistat + emtricitabine + TAF)
Prezista (Darunavir)
Reyataz (Atazanavir)

PI’s due to N/V/D (darunavir, atazanavir)

23
Q

1 tab qdaily regimens

A

Atripla (efavirenz + tenofovir DF + emtricitabine)
Complera (rilpivirine + tenofovir DF + emtricitabine)
Genvoya (Stribild w/ TAF instead of TDF)
Stribild (Elvitegravir + cobicistat + tenofovir DF + emtricitabine)
Triumeq (dolutegravir + abacavir + lamivudine)

24
Q

Which medications should be taken on an empty stomach?

A

Atripla (efavirenz)

25
Q

Which medication should be dispensed in its original container?

A

Tenofovir disoproxil fumarate (TDF)

Atripla, complera, stribild, and truvada all have TDF

26
Q

NNRTI class effects

A

No renal dose adjustment needed
Primarily CYP450 inducers (rilpivirine is a substrate)
Hepatotoxicity and rash (including SJS/TEN)

27
Q

Efavirenz SE

A 
Psychiatric symptoms (suicidal ideation, depression)
CNS symptoms (impaired concentration, abnormal dreams, confusion, dizziness) rash, convulsions, QT prolongation
28
Q

Rilpivirine SE

A

Depressive disorders, mood changes, insomnia

CONTRAINDICATED w PPI’s

29
Q

Drug intx NRTI’s

A

None really yay

30
Q

Drug intx NNRTI’s

A

CYP inducers
Efavirenz = CYP inducer and inhibitor
Rilpivirine = contraindicated with strong 3A4 inducers because it is also a 3A4 substrate (carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, PPI’s)

Methadone levels can be reduced with efavirenz
Hormonal contraceptive levels can be reduced with efavirenz

31
Q

Protease inhibitor class things

A 
end in -navir
Mostly CYP inhibitors
No renal dose adjustments
Take with booster (ritonavir, cobicistat) to inc levels
N/V/D
ECG changes (atazanavir)
Rash
Inc CVD risk
Metabolic abnormalities (lipohypertrophy, insulin resistance)
32
Q

Darunavir brand, SE, considerations

A

Prezista
Drug induced hepatitis, serious skin reactions, caution w sulfa allergy
N/V/D, rash, inc LFTs, headache
Must be given with ritonavir or cobicistat
Take with food and swallow whole

33
Q

Atazanavir brand, SE

A

Reyataz
PR interval prolongation, severe skin reactions, hyperbilirubinemia, hepatotoxicity, nephrolithiasis, cholelithiasis
“Bananavir” = hyperbilirubinemia, jaundice
N/V/D, headache, severe skin reactions, depression, myalgia

34
Q

PI drug intx

A 
All metabolized via CYP450; most are strong 3A4 inhibitors
Avoid inducers (rifampin, St Johns wort): can lower PI conc
Avoid dronedarone (contraindicated w all PI's)
Avoid Xa's and ticagrelor
Avoid alfuzosin

PI’s induce 2C9, reduce INR

Dec hormonal levels w contraceptives

Methadone: levels reduced w ritonavir

PI’s inc PDE-5 levels and inc toxicity

Can increase statin levels; rosuvastatin and atorvastatin are preferred; lovastatin and simvastatin are contraindicated

35
Q

Cobicistat vs ritonavir: boxed warnings

A

ritonavir: interacts w many medications, can result in potentially life threatening adverse events (strong 3A4, 2C8 inhib; also moderately inhibs many others)
cobicistat: none

36
Q

Ritonavir vs cobicistat: special considerations

A

Take both with food

ritonavir: 43% alcohol

37
Q

Contraindications w ritonavir, cobicistat

A

Alfuzosin, amiodarone, carbamazepine, dronedarone, lovastatin, phenobarbital, phenytoin, rifampin, simvastatin, St John’s wort

38
Q

INSTI class considerations

A

generic names end in -tegravir
No rena dosing needed but avoid Stibild < 70 mL/min or Genvoya < 30 mL/min
No major CYP intx
Inc CPK
Headache, insomnia
Take without regard to meals EXCEPT elvitegravir - w/ food

39
Q

Elvitegravir side effects

A

Stribild
Genvoya

Proteinuria, headache, insomnia

40
Q

Elvitegravir dose considerations

A

Stribild: CrCL < 70 do not initiate, d/c if drops below 50
Genvoya: CrCL < 30 do not initiate

41
Q

Dolutegravir side effects

A

Tivicay (or combo Triumeq)

Insomnia, headache, inc SCr without affecting GFR

42
Q

Raltegravir side effects

A

Isentress

Inc CPK, myopathy, and rhabdo

43
Q

INSTI drug intx

A

-gravirs (Stribild, Genvoya, Tivicay, Triumeq, Isentress)

Take 2 hours before or 6 hours after cation containing antacids or laxatives

Stribild and Genvoya: contraindicated w Alfuzosin, amiodarone, carbamazepine, dronedarone, lovastatin, phenobarbital, phenytoin, rifampin, simvastatin, St John’s wort (contain cobicistat)

44
Q

Maraviroc considerations

A

Brand is Selzentry

Prevents HIV from entering cell, stage 1 of life cycle

Prior to therapy pts must undergo tropism test; only wokrs in patients with CCR5 tropic disease (must be negative for CXCR4 or dual/mixed tropic disease)

Can cause hepatotoxicity

45
Q

How to handle a patient w lactic acidosis and severe hepatomegaly with steatosis on ART

A

Stop treatment

Most commonly associated with NRTI’s

46
Q

What is IRIS

A

Paradoxical worsening of a pre-existing OI or malignancy when ART is initiated
Inc in immune function = inflammatory reaction at site of preexisting infection

Stands for immune reconstitution inflammatory syndrome

Continue ART, add or continue OI treatment

47
Q

Which meds cause lipodystrophy

A

Lipoatrophy = NRTI’s, specifically stavudine

Lipohypertrophy = buffalo hump, caused by PI’s

48
Q

Which class causes diarrhea

A

PIs

Darunavir [Prezista] / Atazanavir [Reyataz]

49
Q

What is PrEP and how do you monitor?

A

Truvada (emtricitabine/tenofovir) - 1 tab daily

Follow-up every 3 months

50
Q

What is nPEP? What do you use?

A

nonoccupational postexposure prophylaxis

INSTI-based regimens preferred, use within 72 hours of exposure for 28 days

51
Q

What is PEP? What do you use?

A

Occupational exposure prophylaxis

Use ART within 72 hours

Raltegravir (insentress) + emtricitabine/tenofovir (truvada) for 4 weeks

52
Q

TDF powder counseling

A

Measure with dosing scoop only, mix with soft food that does not have to be chewed (ie applesauce), do not mix with liquids; give entire dose right away after mixing

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