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NAPLEX > HIV > Flashcards

HIV Flashcards

1
Q

Describe the HIV virus and its target in the human body

A

RNA retrovirus, single stranded. Mainly attacks CD4 T cells weakens the patients immune system.

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2
Q

How can HIV be transmitted?

A

Blood, semen, vaginal secretions

Mom–> baby and through breastfeeding

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3
Q

How long does it take to detect HIV after transmission?

A

4-8 weeks

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4
Q

How do you confirm a diagnosis of HIV?

A

2 + HIV test (one confirmatory)

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5
Q

How to treat a HAART naive pregnant patient?

A

Always use NRTI backbone (2 NRTI’s) + boosted PI OR INSTI

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6
Q

All NRTI’s have a BBW for what?

A

lactic acidosis and severe hepatomegaly with steatosis

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7
Q

What drugs are NRTIs?

A 
Abacavir
Lamivudine
Zidovudine
Emtricitabine
Tenofovir
Stavudine
Didanosine
-Bines/sines/vir at the end
2 NRTI backbone
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8
Q

What is the most severe contraindication with abacavir? What test must be negative to use this drug?

A

Severe Hypersensistivity reactions, screen for HLA-B *5701 (should be negative prior to starting)
* do not rechallenge if develops hypersensitivity rxn

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9
Q

Epzicom generic

A

Abacavir + lamivudine

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10
Q

Triumeq generic

A

Abacavir + Lamivudine + dolutegravir

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11
Q

What is the mechanism of action of the NRTI’s?

A

They are structurally similar to nucleotides and inhibit the actions of reverse transcriptase which results in chain termination and stops further DNA synthesis

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12
Q

Generic of Ziagen?

A

Abacavir

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13
Q

What is the only NRTI that does NOT require renal dose adjustment?

A

Abacavir

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14
Q

Which NRTI’s cause CYP450 DDI’s?

A

None of them- this is a good thing

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15
Q

Generic of Epivir?

A

Lamivudine

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16
Q

What is the BBW associated with lamivudine specifically?

A

Do NOT use Epivir-HBV for treating HIV, it contains lower dose of lamivudine which can result in HIV resistance

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17
Q

Generic of Emtriva? What is the recommended daily dose?

A

Emtricitabine, 200mg PO daily

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18
Q

What is in Truvada?

A

Emtricitabine + Tenofovir Disoproxil (TDF)

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19
Q

What is in Descovy?

A

Emtricitabine + TAF

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20
Q

What is in Complera?

A

Emtricitabine + TDF + rilpivirine

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21
Q

What is in Odefsey?

A

Emtricitabine + TAF + rilpivirine

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22
Q

What is in Stribild?

A

Emtricitabine + TDF + elvitegravir + cobicistat

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23
Q

What is in Genvoya?

A

Emtricitabine + TAF + elvitegravir + cobicistat

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24
Q

What is in Atripla? How should this drug be taken?

A

Emtricitabine + efavirenz + TDF

Empty stomach preferably at HS

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25
Q

Which HIV combo’s containing emtricitabine are once daily?

A

Truvada, atripla, complera, stribild, descovy, odefsey, genvoya

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26
Q

What combo products should be taken with food?

A

Complera, Stribild, Genvoya, Odefsey

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27
Q

6 common side effects associated with using emtricitabine?

A

N/V/D, rash, dizziness, HA, insomnia, hyperpigmentation

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28
Q

What is the generic of Viread? What is the recommended daily dose?

A

TDF, 300mg PO daily

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29
Q

Which NRTI is not approved for treatment of chronic hepatitis B?

A

Any product containing TAF (descovy, Odefsey, Genvoya)

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30
Q

Warnings associated with the use of tenofovir?

A

Renal toxicity (less with TAF), fanconi syndrome, osteomalacia, and decreased bone mineral density

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31
Q

BBW associated with zidovudine?

A

Hematologic toxicities (anemia, neutropenia)

32
Q

Side effects associated with zidovudine? (3)

A

Muscle pain, macrocytic anemia (monitor MCV), increased LFT’s

33
Q

Which NRTI is administered in the setting of labor for HIV infected pregnant women?

A

IV zidovudine

34
Q

How long is stavudine and didanosine suspension stable in the refrigerator?

A

30 days

35
Q

Side effects associated with stavudine?

A

N/V/D, peripheral neuropathy, increased LFTs, Hyperbili, lipoatrophy

36
Q

BBW for didanosine?

A

Pancreatitis

37
Q

Side effects of didanosine? How should this medication be taken?

A

N/V/D, peripheral neuropathy, Increased amylase

Take on an empty stomach

38
Q

How do NNRTI’s work?

A

Non-competitive binders to reverse transcriptase

39
Q

What is in Sustiva? Typical daily dose? How should it be taken? Warning and side effects?

A

Efavirenz 600mg daily, take on empty stomach at HS
Warnings: Suicidal ideation, depression, CNS symptoms that usually resolve 2-4 weeks, convulsions, QT prolongation
Side effects: CNS effects, rash

40
Q

What is in Edurant? How should it be taken? Contraindication? Side effects?

A

Rilpivirine. take with food, keep in original container
Contraindications: Use with PPI
Side effects: Depression, mood changes, insomnia

41
Q

What are the 2 contraindications with nevirapine that requires a 14 day lead in period to help minimize these side effects?

A

Hepatotoxicity (fatal), SJS/TEN

Lead in period can help decrease risk of liver and rash

42
Q

For nevirapine do not initiate therapy in women with CD4 count > ____ or men > ___

A

Women >250

Men >400

43
Q

All NNRTI’s are substrates of which CYP enzyme?

A

3A4

44
Q

Which NNRTI is both an inhibitor and inducer of 3A4?

A

Efavirenz

45
Q

Which 2 NNRTIs are 3A4 inducers?

A

Nevirapine, etravirine

46
Q

Which NNRTIs should be taken with food?

Which one on an empty stomach?

A

With food: etravirine, rilpivirine

Without food: efavirenz

47
Q

What is Prezista? What are warnings associated with its use? How is it taken?

A

Darunavir
Warnings: Drug induced hepatitis, SJS/TEN, Sulfa allergy
Swallow whole, take with food

48
Q

What is Reyataz? How is it taken? Warnings? Side effects?

A

Atazanavir, take with food
Warnings: Prolonged PR interval, severe skin reactions, hyperbilirubinemia, hepatotoxicity, nephrolithiasis and cholelithiasis
Side effects are the same as the warnings with the addition of N/V/D, depression and myalgia

49
Q

What is the only major warning with fosamprenavir?

A

Sulfa allergy

50
Q

All Protease inhibitors end in what? Which ones don’t have to be taken with food?

A

-navir

All except fosamprenavir must be taken with food

51
Q

Which protease inhibitor contains 42% alcohol?

A

Lopinavir

52
Q

All protease inhibitors need to be boosted with which one of these two drugs?

A

Ritonavir or cobicistat

Most are ritonavir boosted

53
Q

Most PIs are substrates of which enzyme? Which drugs should generally be avoided with PIs?

A 
CYP3A4
3A4 inducers, they can lower PI levels
Antiarrhythmics (dronedarone is contraindicated)
Anticoagulants (Xa)
Alfuzosin
54
Q

A protease inhibitor will have what effect on the INR of someone taking warfarin?

A

INR will decrease because warfarin metabolism is induced through 2C9

55
Q

What effect do PIs have on hormonal contraceptives?

A

Decrease efficacy, counsel on back up method

56
Q

What effect do PIs have on statins and methadone?

A

Methadone levels can decrease and patient can withdrawal.

Statin levels can increase and patient can get muscle/liver toxicity

57
Q

What statins are preferred to use in someone who must take PI?

A

Atorvastatin

Rosuvastatin

58
Q

Which PI should be used cautiously with acid suppressing medications?

A

Atazanavir

59
Q

Ritonavir is contraindicated with medications that are inducers/inhibitors of CYP3A4. What drugs are contraindicated?

A

Inducers: CBZ, PHT, VPA, PHB SJW Rifampin
Inhibitors: Alfuzosin, statins (except ator/rosu), dronedarone

60
Q

Stribild should not be used in CrCl < _____

A

70 mL/min

61
Q

Genvoya should not be used in CrCl < _____

A

30 mL/min

62
Q

What is the only integrase inhibitor that needs to be taken with food?

A

Elvitegravir

63
Q

Which class of HIV medications need to be separated from polyvalent cations?

A

Integrase inhibitors

64
Q

Which class of HIV medications cause increase in CPK levels and generally require baseline CPK levels?

A

Integrase inhibitors

65
Q

What are the 3 integrase inhibitors (brand and generic)? They all end in what?

A

-tegravir
Elvitegravir (Not avail as single agent, only in combo with Stribild and Genvoya)
Raltegravir (Isentress)
Dolutegravir (Tivicay)

66
Q

Which integrase inhibitor can increase SCr without changing GFR?

A

Dolutegravir

67
Q

How many hours before and after taking a polyvalent cation must the patient wait to take an integrase inhibitor?

A

2 hours before or 6 hours after cation drug

68
Q

What drug is a CCR5 antagonist? What is the mechanism of action of this drug? What test must the patient undergo before starting this drug?

A

Maraviroc (Selzentry)
Tropism test: Patient must be negative for anything other than CCR5 tropism. If they are positive, this drug won’t work. It prevents HIV from entering the cell.

69
Q

What drug is a fusion inhibitor? What is the mechanism of action? Formulation?

A

Enfuvirtide–> SQ injection (local injection site RXN)

70
Q

Which class of HIV drugs are worst for causing diarrhea?

A

PIs

71
Q

Which HIV drug is the worst for causing lipoatrophy?

What drug is approved for treating this adverse effect associated with its use

A

Stavudine, and zidovudine to a lesser extent

72
Q

What is PREP and what drug and dose do these people take? How frequently should these patients have follow up apt?

A

Pre exposure prophylaxis, for those who do not have HIV. Take truvada 1 tablet PO daily
Follow up apt should occur Q 3 months

73
Q

How to treat nonoccupational post exposure prophylaxis (nPEP)? Ideally, when should these patients been treated after known exposure?

A

INSTI-based preferred: Truvada + raltegravir OR dolutegravir
PI based alternative: Truvada + darunavir/ritonavir
Patient should start ASAP and definitely within 72 hours

74
Q

How to treat occupational post exposure prophylaxis (PEP)?

A

Treatment should be started within 72 hours with 3 drug regimen
Raltegravir + truvada X 4 weeks

75
Q

Important counseling points to patients starting HIV medications for this first time. 3 or 4 big ones

A
  1. This is not a cure
  2. Adherence is essential otherwise it’s pointless
  3. Other generalities regarding side effects/ drug interactions. (Most all will cause N/V/D and have warnings for liver shit. Also always double check with RPH before starting/stopping any medications)
76
Q

Which HIV medication can cause darkening of skin color?

A

Emtricitabine

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