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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
Which HIV combo's containing emtricitabine are once daily?
Truvada, atripla, complera, stribild, descovy, odefsey, genvoya
26
What combo products should be taken with food?
Complera, Stribild, Genvoya, Odefsey
27
6 common side effects associated with using emtricitabine?
N/V/D, rash, dizziness, HA, insomnia, hyperpigmentation
28
What is the generic of Viread? What is the recommended daily dose?
TDF, 300mg PO daily
29
Which NRTI is not approved for treatment of chronic hepatitis B?
Any product containing TAF (descovy, Odefsey, Genvoya)
30
Warnings associated with the use of tenofovir?
Renal toxicity (less with TAF), fanconi syndrome, osteomalacia, and decreased bone mineral density
31
BBW associated with zidovudine?
Hematologic toxicities (anemia, neutropenia)
32
Side effects associated with zidovudine? (3)
Muscle pain, macrocytic anemia (monitor MCV), increased LFT's
33
Which NRTI is administered in the setting of labor for HIV infected pregnant women?
IV zidovudine
34
How long is stavudine and didanosine suspension stable in the refrigerator?
30 days
35
Side effects associated with stavudine?
N/V/D, peripheral neuropathy, increased LFTs, Hyperbili, lipoatrophy
36
BBW for didanosine?
Pancreatitis
37
Side effects of didanosine? How should this medication be taken?
N/V/D, peripheral neuropathy, Increased amylase | Take on an empty stomach
38
How do NNRTI's work?
Non-competitive binders to reverse transcriptase
39
What is in Sustiva? Typical daily dose? How should it be taken? Warning and side effects?
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
What is in Edurant? How should it be taken? Contraindication? Side effects?
Rilpivirine. take with food, keep in original container Contraindications: Use with PPI Side effects: Depression, mood changes, insomnia
41
What are the 2 contraindications with nevirapine that requires a 14 day lead in period to help minimize these side effects?
Hepatotoxicity (fatal), SJS/TEN | Lead in period can help decrease risk of liver and rash
42
For nevirapine do not initiate therapy in women with CD4 count > ____ or men > ___
Women >250 | Men >400
43
All NNRTI's are substrates of which CYP enzyme?
3A4
44
Which NNRTI is both an inhibitor and inducer of 3A4?
Efavirenz
45
Which 2 NNRTIs are 3A4 inducers?
Nevirapine, etravirine
46
Which NNRTIs should be taken with food? | Which one on an empty stomach?
With food: etravirine, rilpivirine | Without food: efavirenz
47
What is Prezista? What are warnings associated with its use? How is it taken?
Darunavir Warnings: Drug induced hepatitis, SJS/TEN, Sulfa allergy Swallow whole, take with food
48
What is Reyataz? How is it taken? Warnings? Side effects?
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
What is the only major warning with fosamprenavir?
Sulfa allergy
50
All Protease inhibitors end in what? Which ones don't have to be taken with food?
-navir | All except fosamprenavir must be taken with food
51
Which protease inhibitor contains 42% alcohol?
Lopinavir
52
All protease inhibitors need to be boosted with which one of these two drugs?
Ritonavir or cobicistat | Most are ritonavir boosted
53
Most PIs are substrates of which enzyme? Which drugs should generally be avoided with PIs?
``` CYP3A4 3A4 inducers, they can lower PI levels Antiarrhythmics (dronedarone is contraindicated) Anticoagulants (Xa) Alfuzosin ```
54
A protease inhibitor will have what effect on the INR of someone taking warfarin?
INR will decrease because warfarin metabolism is induced through 2C9
55
What effect do PIs have on hormonal contraceptives?
Decrease efficacy, counsel on back up method
56
What effect do PIs have on statins and methadone?
Methadone levels can decrease and patient can withdrawal. | Statin levels can increase and patient can get muscle/liver toxicity
57
What statins are preferred to use in someone who must take PI?
Atorvastatin | Rosuvastatin
58
Which PI should be used cautiously with acid suppressing medications?
Atazanavir
59
Ritonavir is contraindicated with medications that are inducers/inhibitors of CYP3A4. What drugs are contraindicated?
Inducers: CBZ, PHT, VPA, PHB SJW Rifampin Inhibitors: Alfuzosin, statins (except ator/rosu), dronedarone
60
Stribild should not be used in CrCl < _____
70 mL/min
61
Genvoya should not be used in CrCl < _____
30 mL/min
62
What is the only integrase inhibitor that needs to be taken with food?
Elvitegravir
63
Which class of HIV medications need to be separated from polyvalent cations?
Integrase inhibitors
64
Which class of HIV medications cause increase in CPK levels and generally require baseline CPK levels?
Integrase inhibitors
65
What are the 3 integrase inhibitors (brand and generic)? They all end in what?
-tegravir Elvitegravir (Not avail as single agent, only in combo with Stribild and Genvoya) Raltegravir (Isentress) Dolutegravir (Tivicay)
66
Which integrase inhibitor can increase SCr without changing GFR?
Dolutegravir
67
How many hours before and after taking a polyvalent cation must the patient wait to take an integrase inhibitor?
2 hours before or 6 hours after cation drug
68
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?
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
What drug is a fusion inhibitor? What is the mechanism of action? Formulation?
Enfuvirtide--> SQ injection (local injection site RXN)
70
Which class of HIV drugs are worst for causing diarrhea?
PIs
71
Which HIV drug is the worst for causing lipoatrophy? | What drug is approved for treating this adverse effect associated with its use
Stavudine, and zidovudine to a lesser extent
72
What is PREP and what drug and dose do these people take? How frequently should these patients have follow up apt?
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
How to treat nonoccupational post exposure prophylaxis (nPEP)? Ideally, when should these patients been treated after known exposure?
INSTI-based preferred: Truvada + raltegravir OR dolutegravir PI based alternative: Truvada + darunavir/ritonavir Patient should start ASAP and definitely within 72 hours
74
How to treat occupational post exposure prophylaxis (PEP)?
Treatment should be started within 72 hours with 3 drug regimen Raltegravir + truvada X 4 weeks
75
Important counseling points to patients starting HIV medications for this first time. 3 or 4 big ones
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
Which HIV medication can cause darkening of skin color?
Emtricitabine

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