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NAPLEX Prep > HIV > Flashcards

HIV Flashcards

1
Q

HIV pts susceptible to opportunistic infections (OIs) when CD4 counts are below < ______

A

200

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2
Q

HIV infections mainly attack _______ cells

A

CD4+ helper T cells

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3
Q

HIV can be transmitted via

A

blood, semen, and vaginal secretions (unprotected sex and needle sharing)

or pregnancy, breastfeeding, or birth

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4
Q

The anti-HIV antibodies take about _____ to become positive and ______ to be detected/aka to get diagnosed

A

positive: 4 - 8 weeks after

3 - 6 months to be detected

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5
Q

what are the OTC HIV tests available?

counseling point for patients ?

A

blood test — sends envelope to get results
oral swab test (takes 20-40 mins)

have to wait 3 months after exposure for it to even show up also need another confirmatory lab test for diagnosis

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6
Q

_______ is an indicator of immune function
and
_____ is an indicator of response to ART (antiretroviral therapy)

A

CD4+ count

HIV Viral load

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7
Q

Treatment goals:
CD4+ count want value ____
HIV Viral load want value ______

A

CD4: normal ~ 800 - 1200

HIV viral: undetectable

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8
Q

HIV patients need an adherence rate of ____ or higher to be effective long term

A

95%

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9
Q

____ based regimens with a _______ backbone are recommended as initial therapy for most patients

A

INSTI; NRTI backbone

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10
Q

________ requires testing for HLA-B 5701 allele

A

abacavir

do NOT use this drug if positive for the allele! it is contraindicated

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11
Q

which HIV drug should be used with caution if renal insufficiency?

A

tenofovir disoproxil fumarate

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12
Q

Key Features of NRTIs:

All NRTIs have a boxed warning for ___________ and severe _____________

A
  • lactic acidosis

- severe hepatomegaly with steatosis

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13
Q

Key Features of NRTIs:

T or F: need renal dose adjustment?

A

true – all need it except abacavir

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14
Q

Key Features of NRTIs:

T or F: No CYP450 drug intreactions

A

true

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15
Q

Key Features of NRTIs:

_______ has the hypersensitivity reactions (test for HLA-B 5701)

A

abacavir

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16
Q

Key Features of NRTIs:
Tenofovir toxicities include what 3 things?

– which tenofovir is thought to have less toxicities: disoproxil fumarate or alafenamide

A

nephrotoxicity
osteoporosis
fanconi syndrome

alafenamide is “safer”

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17
Q 
The following drugs are what class of HIV drugs?
abacavir
tenofovir
emtricitabine
lamivudine
zidovudine
didanosine
A

NRTIs

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18
Q

Brand/Generic:

Lamivudine

A

Epivir

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19
Q

Boxed warning for Epivir/lamivudine:

Do not use the ______ formulation for HIV

A

Epivir-HB (aka the hepatitis B formulation…)

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20
Q

Boxed warning for Epivir/lamivudine:

severe/acute exacerbations of _______ can occur

A

hep B

also with emtricitabine, and tenofovir derivatives

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21
Q

these two NRTIs,Lamivudine and Emtricitabine, should not be used together why?

A

they are BOTH cytosine analogs…..

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22
Q

Key Features of NRTIs:

T or F: take without regard to meals

A

true

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23
Q

Truvada for PrEP (pre exposure prophylaxis):

patients must be confirmed as HIV negative prior to use and every ______ during use

A

every 3 months

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24
Q

which NRTI is used as IV option when HIV + mothers are in labor

A

zidovudine

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25
Q

Stavudine and Didanosine come in oral solutions — stability notes about them?

A

stable in fridge for 30 days

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26
Q

Key features of NNRTIs:

T or F: needs renal adjustment

A

false (they do not but majority NRTIs do)

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27
Q

Key features of NNRTIs:

T or F: no CYP 450 interactions

A

false (majority are cyp450 substrates and some are inducers)

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28
Q

Key features of NNRTIs:

Most common ADEs include: _______ and ______

A

hepatotoxicity and rash (SJS/TEN)

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29
Q

Key features of NNRTIs:

Because of rash issues: monitor fro what?

A

erythema, facial edema, skin necrosis, blisters, and tongue swelling

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30
Q

Key features of NNRTIs:

which two are required to be taken with food

A

etravirine, rilpivirine

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31
Q

Key features of NNRTIs:

which one is required to NOT be taken with food

A

efavirenz

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32
Q

Efavirenz warnings and how to decrease incidence?

A

CNS effects (impaired concentrations, abnormal dreams, confusion, dizziness — resolve in 2 - 4 weeks) — TAKE AT BEDTIME

another warning: serious psychiatric symptoms

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33
Q 
Which antiviral drug class are the following drugs from?
Efavirenz
Rilpivirine
Nevirapine
Etravirine
A

NNRTIs

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34
Q

Rilpivirine requires _______ environment for absorption

A

acidic (THUS TAKE WITH FOOD and avoid concurrent use of PPIs and separate from H2RAs and antacids)

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35
Q

which NNRTI needs a 14 day lead in period to prevent the SJS/TEN/rash and hepatoxicity ADEs?

A

nevirapine

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36
Q

Boxed warnings of nevirapine

A

hepatoxicity

SJS/TEN

37
Q

Do not initiate nevirapine if ____ counts above 250 (female) or above 400 (men) because of hepatoxicity risk

A

CD4 counts

38
Q

For rilpivirine: higher rates of failure if viral load > _________

A

100,000 copies/mL

39
Q

_______ levels can be decreased by efavirenz and nevirapine — monitor for withdrawl symptoms

also _____ levels can be decreased

A

methadone;

hormonal contrapceptive counsel for alt or or additional methods

40
Q

what antiviral drugs are “boosting agents”

A

ritonavir

cobicistat

41
Q

Key Features of Protease inhibitors:

all generic names end in -____

A

-navir

42
Q

Key Features of Protease inhibitors:

T or F: There are CYP interactions

A

true- they are CYP INHIBITORS

43
Q

Key Features of Protease inhibitors:

T or F: they need renal adjustment

A

false — they do not

44
Q

Key Features of Protease inhibitors:

Some common side effects include?

A
  • hepatoxicity
  • metabolic abnormalities (hyperlipidemia, lipohypertrophy, hyperglycemia, insulin resistance)
  • increased CVD risk
  • GI upset (N/V/D)
  • bleeding events (mainly hemophilia patients)
  • ECG changes
  • Rash
45
Q 
Which antiviral drug class do the following drugs belong to?
atazanavir
darunavir
lopinavir
nelfinavir
saquinavir
A

PIs (protease inhibitors)

46
Q

Darunavir warnings:
drug induced _____
serious _______
caution for patients with _____ allergy

A

hepatitis;
serious skin reactions;
sulfa allergy

47
Q

T or F: Darunavir MUST be given with ritonavir or cobicistat

A

true

48
Q

Contaminant RitonavirL
which of the following MUST have it and which one is it not recommended to be used with?
Nelfinavir, Saquinavir, Tipranavir

A

Nelfin: NOT recommended

Saquin and Tipra MUST be given with it

49
Q

Drug Interactions for PIs:

Avoid with CYP3A4 inducers (ex:_____ or ______)

A

rifampin or st johns wort

50
Q

Drug Interactions for PIs:

what are some drug classes should be AVOIDED with PIs?

A
  • antiarrhythmics
  • anticoagulants/antiplatelets
  • direct acting antivirals
51
Q

what is the effect of PIs and hormonal contraceptives?

A

ritonavir may decrease levels – use back up or alternative

52
Q

what is the effect of PIs and methadone?

A

ritonavir will decrease levels – monitor for methadone withdrawl

53
Q

what is the effect of PIs and PDE-5 inhibitors?

A

can increase PDE-5 levels – increase toxicity

54
Q

what is the effect of PIs and statins?

which two are completely contraindicated

A

increase statin levels:
lovastatin and simvastatin are CONTRAINDICATED
(atorvastatin and rosuvastatin are preferred)

55
Q

Which PI has to have caution with acid suppressing agents?

A

atazanavir

56
Q

out of the two pk boosters (ritonavir or cobicistat) for PIs which one has antiviral properties

A

ritonavir

57
Q

out of the two pk boosters (ritonavir or cobicistat) for PIs: take with food?

A

both

58
Q

which of the preferred initial regimens contain cobicistat (aka watch out for drug interactions)

A

Genvoya and Stirbild

59
Q

A ritonavir solution as a high content of what?

A

alcohol (43%)

60
Q

For both of the two pk boosters (ritonavir or cobicistat) what drugs are contraindicated

A 
alfuzosin(an alpha blocker)
amiodarone/dronedarone
carbamazepine
lovastatin/simvastatin
rifampin
St. Johns wort
Phenytoin/phenobarbital
61
Q

out of the two pk boosters (ritonavir or cobicistat) for PIs:
which one can be coformulated with other antivirals?

A

cobicistat can be

ritonavir is difficult to coformulate with

62
Q

Key features of INSTIs

generic names end with “ ______”

A

-tegravir

63
Q

Key features of INSTIs:

Any major CYP450 interactions?

A

no

64
Q

Key features of INSTIs:

most common side effects?

A

increased CPK

headache/insomnia

65
Q

Key features of INSTIs:
No renal adjustment needed…but for the drug ______ do not start if CrCl < 70 mL/min
and
Do not start ______ or ______ if CrCl < 30 mL/min

A

Stirbild

Genvoya/Biktarvy

66
Q

Key features of INSTIs:

Drug interaction with _______ - must separate

A

polyvalent cations

67
Q

INSTIs should be taken how in relation to cation containing products?

A

2 hours prior or 6 hours after

68
Q

INSTIs:

T or F: they need to be avoided with H2RAs and PPIs

A

False!! only the polyvalent items affect the absorption

69
Q

which drug is a CCR5 antagonist and what does this MOA mean?

A

maraviroc;
there is a CCR5 receptor on some CD4+ cells – that receptor normally allows/helps HIV get into cells —
blocking CCR5 when present in patients helps prevent HIV from entering cells

70
Q

what kind of test must be done before starting maraviroc?

A

a tropism test (to see if CCR5 receptor is present)

71
Q

Enfuviritide works via a MOA of _______ and is given by what route?

A

fusion inhibitor;

given SQ — 98% of people have local site inj reactions

72
Q

what is IRIS

A

IRIS = immune reconstruction inflammatory syndrome
paradoxical worsening of a PREEXISTING opportunistic infection or malignancy (bc immune system is being stimulated) after ART is started;
-can happen 1 -3 months after starting
-worse when pt has low CD4+ and high viral load

73
Q

if a patient has an Opportunistic infection – do you stop or continue ART?

A

continue it (should be started within at least 2 weeks of OI treatment)

74
Q

difference between lipodystrophy, lipoatrophy, lipohypertrophy

A

dys: changes in fat distribution
atro: loss of SQ fat
hyper: fat accumulation in neck/back = buffalo hump

75
Q

what drug class causes lipoatrophy the most

A

NRTIs (esp stavudine)

76
Q

All ARTs tend to cause ______ but protease inhibitors are typically worse

A

diarrhea

77
Q

what drug is used for PrEP (pre exporsure prophylaxis)

A

Truvada 1 tablet daily

78
Q

what drug options are there for non ocupational post exposure prophylaxis (nPEP)

A

Truvada 1 tablet daily PLUS raltegravir or dolutegravir

aka a 3 drug regimen total – for 4 weeks

79
Q

to get non ocupational post exposure prophylaxis (nPEP) you have to get it ASAP (but at least within ______)

A

72 hours

80
Q

what drugs make up Atripla?

A 
NNRTI based
efavirenz
entricitabine
tenofovir disoproxil fumurate
(aka a complete regimen because it has 3 drug combo)
81
Q

what drugs make up Genvoya?

A

INSTI based
elvitegravir + cobicistat + emtricitabine + tenofovir ALAFENAMIDE
(aka a complete regimen because it has 3 drug combo)

82
Q

what drugs make up Truvada

A

NRTI combo products
Emtricitabine + tenofovir disoproxil fumurate
(aka will need another tablet to be a full regimen)

83
Q

what drugs make up Complera?

A

NNRTI based
Rilpivirine + emtricitabine + tenofovir disoproxil fumurate
(aka a complete regimen because it has 3 drug combo)

84
Q

what drugs make up Stribild?

A

NSTI based
elvitegravir + cobicistat + emtricitabine + tenofovir disoproxil fumurate
(aka a complete regimen because it has 3 drug combo)

85
Q

what drugs make up Triumeq?

A

dolutegravir + abacavir + lamivudine

aka a complete regimen because it has 3 drug combo

86
Q

what drugs make up Epzicom?

A

Abacavir + lamivudine

aka will need another tablet to be a full regimen

87
Q

class effect ADE of NRTIs

A

lactic acidosis

88
Q

class effect ADE of NNRTIs

A

rash

89
Q

class effect ADE of PI’s

A

metabolic abnormalities (hyperlipidemia/ hyperglycemia/ lipohypertrophy)

NAPLEX Prep (19 decks)

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