Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NAPLEX 2021 > HIV > Flashcards

HIV Flashcards

1
Q

Which cell type does HIV cause death of

A

T-Cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does HIV replicate

A

CD4+ T-helper cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ART

A

antiretroviral therapy (HIV treatment)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

As HIV replicates _____ increases while ____ decreases

A

viral load increases

CD4+ count decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

CD4+ count that causes AIDS diagnosis

A

CD4+ count <200 cells/mm3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Treatment goal

A

normal CD4+ count (800-1200)

undectable HIV viral load

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

HIV viral load indicates _____

A

response to ART

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

High viral load can indicate 2 things

A
  1. medication nonadherence

2. drug resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Lab tests for HIV

A

CD4+ count, HIV viral load, drug resistance genotyping, CMP, CBC with differential, lipid panel, urinary analysis, Hep B+C, pregnancy test, drug-specific allele screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What drug do you screen for HLA-B*5701 allele?

A

abacavir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what drug do you get a tropism assay for?

A

maraviroc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What must a patient be willing to commit to in order to prevent resistance?

A

ADHERENCE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what must the adherence rate be to prevent resistance?

A

> /=95% (no more than one dose/month for once daily dosing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

One pill, once daily initial ART options in treament-naive adults

A

Biktarvy, Triumeq, Dovato

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Biktarvy

A

2 NRTIs: Tenofovir alafenamide, emtricitabine

1 INSTI: Bictegravir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Triumeq

A

2 NRTIs: Abacavir, lamivudine

1 INSTI: Dolutegravir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Dovato

A

1 NRTI: Lamivudine

1 INSTI: Dolutegravir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

2 pill initial ART in treatment naive adults

A

Tivicay + Truvada
Tivicay + Descovy
Isentress + Truvada
Isentress + Descovy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

TDF vs TAF

A

TDF has more renal and bone issues, use TAF if renal impairment or high fracture risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Supplementation while using TDF

A

calcium and vit D.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

HLA-B*5701 present

A

high risk of hypersentivity reaction to ABACAVIR - CONTRAINDICATED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Do not use Dovato when…

A

HIV RNA is >500,000 copies/mL or hep B co-infection present (only has two drugs/not as strong)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

NRTIs MoA

A

competitively block reverse transcriptase preventing viral RNA from being converted into DNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

List of NRTIs

A 
TDF- Viread
TAF - combos and Vemlidy (Hep B) 
Lamivudine - Epivir 
Emtricitabine - Emtriva 
Abacavir - Ziagen 
Zidovudine - Retrovir 
Stavudine + didanosine (old, many AEs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What NRTI is given during labor to protect baby if mother’s IV load is >1000

A

zidovudine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

when do we give zidovudine during labor?

A

if mother’s viral load is >1000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

_____ impairment indicates decrease NRTI dosing (except abacavir)

A

renal!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Tenofovir combo place in therapy

A

ART regmines usually compose of tenofovir and emtricitabine

also used in PrEP & PEP (Truvada and Descovy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Why are 2 NRTIs a backbone of treatment-naive therapy?

A

good tolerability
few interactions
lack of resistance in ART naive patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Caution in older NRTIs (didanosine, zidovudine, + stavudine)

A

HIGHER risk of lactic acidosis and hepatomegaly with steatosis and pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Caution: abacavir

A

hypersensitivity risk - allele testing required prior to use

CI if history of reaction - NEVER rechallenge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Do not use ______ if treating HIV and HBV

A

abacavir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What drug class should a patient avoid if taking TDF (tenofovir disoproxil fumarate)

A

NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Side effects of NRTIs

A

N/D, increase LFTs, headache
Abacavir: rash, increase risk of MI
emtricitabine: hyperpigmentation of palms of hands and soles of feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

______ and _______ can be replaced by each other in treatment regimens, but don’t use together because they are antagonistic

A

emtricitabine and lamivudine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

INSTIs MOA

A

block integrase enzyme preventing viral DNA from integrating into host cell DNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

list of INSTIs

A 
"-tegravir" 
Bictegravir 
Elvitegravir 
Doletegravir 
Raltegravir
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Caution with INSTIs:

A

Don’t mix with cations (Al,Mg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Which INSTI needs to be used with caution with UGT1A1s?

A

Raltegravir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Which drug should be avoided when using INSTIs

A

Rifampin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Which INSTIs can exacerbate HBV if discontinued? (two)

A

bictegravir, elvitegravir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Side effects of INSTIs

A

headache, insomnia, diarrhea, weight gain, rhabdomyolysis, proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

____ can be increased by bictegravir and dolutegravir but _____ is not effected

A

SCr can be increased, GFR not effected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

NNRTIs MoA

A

inhibit reverse transcriptase by non-competitively binding unlike NRTIs (competetitive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

list of NNRTIs

A

efavirenz (Sustiva)

rilpivirine (Edurant)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

NNRTIs place in therapy

A

not-first line

used with 2 NRTIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Rilpivirine administration

A

take with a real meal (not protein drink)

requires acidic gut for absorption, do not use with PPIs and separate from H2RAs and Antacids

48
Q

which drug class can not be used with rilpivirine

A

PPIs

49
Q

Which NNRTI should be taken on an empty stomach at bedtime

A

Efavirenz

50
Q

Atripla

A

efavirenz/emtricitabine/tenofovir

not first-line anymore due to CNS/psych effects

51
Q

NNRTI boxed warnings:

A

hepatotoxicity: do not start in women with a CD4+ count >250 or men >400
rash (SJS)
psych effects

52
Q

Do not use Rilpivirine if_____ (counts)

A

viral load > 100,000 and/or CD4+ counts <200

53
Q

PI (protease inhibitors) MOA

A

inhibits protease enzyme to prevent protein strands from being cut into small pieces needed for assembly of new virions. Replication still occurs but virions produced are immature and non-infectious

54
Q

list of PIs

A 
"-navir" 
atazanavir - Reyataz
darunavir - Prezista 
fosamprenavir - lexiva
indinavir - Crixivan
lopinavir + ritonavir Kaletra (rit is booster)
55
Q

Why are PIs not first line?

A

metabolic porblemcs
lipodystrophy
CVD risk
Interactiosn with CYP3A4

56
Q

What do PIs require that is unique to this class

A

Boosters!

57
Q

_____ and _____ require one of the two boosters ____ or ____

A

atazanavir and darunavir

boosters: ritonavir or cobicistat

58
Q

Which PIs don’t require to be taken with food

A

fosamprenavir solution - don’t take with food

Kaletra (lopi/rito) - with or without

59
Q

Kaletra and Ritonavir have high ______ content

A

ALCOHOL

do NOT take with metronidazole or disulfiram

60
Q

Boxed warning for Tinpranavir

A

hepatitis

intracranial hemorrhage

61
Q

Side Effects with PIs

A

diarrhea, nausea, metalic taste

62
Q

Atazanaivr specific side effects

A

hyperbilirubinemia (“bananavir”)
PR interval prolongation
skin reactions

63
Q

Darunavir, fosamprenavir, tipranavir: caution with ____ allergy

A

sulfa!

SJS

64
Q

PIs are strong ______

A

CYP3A4 inhibitors

65
Q

Drugs that should NOT be used with PIs (could make ART resistant)

A
  • alfuzosin, colchicine
  • dronedarone, amoidarone
  • apixaban, edoxaban, rivaroxaban
  • hormonal contraception
  • lovastatin and simvastatin
66
Q

which statins SHOULD be used with PIs

A

rosuvastatin and atorvastatin

67
Q

Booster MOA

A

CYP3A4 inhibitors preventing the metabolism of ART increasing/enhancing the effect.

68
Q

Why is Ritonavir used as a booster?

A

It has too many metabolic issues when used at its full PI dose

69
Q

What are restrictions with ritonavir and cobicistat?

A

NOT interchangeable

do NOT use together

70
Q

Interactions and boosters:

A

COMMON! can boost other drugs

Any combo with a booster will have many interactions

71
Q

Cobicistat side effects:

A

nausea, diarrhea, headache, ^SCr, hyperbilirubinemia

72
Q

Ritonavir side effects:

A

circumoral paresthesia (tingling, burning around mouth), bitter taste/change in taste

73
Q

Cobicistat Combo Drugs

A
  • Stribild (not for CrCl <50) elvitegrar/cobi/emtricitabine/TDF
  • Genoya (not for CrCl<30) elvitegravir/cobi/emtricitabine/ TAF
    -Symtuza: darunavir, cobi, emtricitabine, TAF
    -Evotaz: atazanavir/cobi
    =Prezcobix: darunavir/cobi
74
Q

Maraviroc is useful if the ___ is present not if it and ____ are present

A

CCR5 receptor is the only one present but not useful if the CXCR4 is also present

75
Q

AIDS defining conditions

A

CD4+ count <200
Opportunistic infections
Cancer types - Kaposi’s sarcoma
HIV Wasting syndrome

76
Q

what is IRIS

A

Immune reconstitution inflammatory syndrome - paradoxical worsening of new or known condition that has been suppressed but becomes unmasked after ART is started or changed to a more effective regimen.
It occurs because the immune system is recovering and could become capable of mounting a response

77
Q

What to do if IRIS occurs

A

Continue ART and treat unmasked condition

78
Q

HIV and pregnancy

A

continue treatment if effective even if dolutegravir is being used.
If not on ART, start either w NRTIs + Boosted PI or INSTI
Do not breastfeed as it can pass HIV to the baby

79
Q

What is PrEP?

A

pre-exposure prophylaxis to prevent infection

80
Q

Requirements before starting PrEP

A
  • confirm HIV-negative with antibody testing
  • CrCl >/= 60
  • Screening for hep B and STIs
81
Q

After starting PrEP (Truvada or Descovy) what needs to be done every 3 months?

A
  • HIV test and document negative result
  • 90 Day supply only
  • document pregnancy status
  • counsel on adherence and safe sex/behaviors
  • Crcl and STI testing q 6 months
82
Q

PrEP options

A

Must have negative HIV test
Truvada
Descovy: not for vaginal-receptive PrEP but less risk of BMD and renal tox

83
Q

PEP options

A

within 72 hours of exposure - taken for 28 days
More drugs needed due to actual possible exposure:
Truvada + Trivicay or Isentress

84
Q

PEP must be started within _____ hours of exposure

A

72! Emergency situtation!

85
Q

Abacavir

A

must be HLA-B*5701 negative

86
Q

Triumeq

A

abacavir/lamivudine/dolutegrative

HLA-B*5701 negative

87
Q

didanosine, stavudine

A

pancreatitis, hepatomegaly w/ steatosis (no alcohol)

88
Q

Emtricitabine

A

hyperpigmentation
Don’t use with lamivudine
headaches

89
Q

Truvada

A

emtricitabine/TDF

PrEP, PEP, and two pill regimens

90
Q

Descovy

A

emtricitabine/TAF

PrEP

91
Q

Lamivudine

A

HBV indication, don’t stop suddenly

headache

92
Q

TDF

A

do not take with didanosine
kidney and fracture issues
supplement with vitamin D and calcium
avoid NSAIDs

93
Q

Retrovir

A 
zidovudine 
myopathy
neutropenia
anemia 
food required
94
Q

Biktarvy

A

bictegravir/emcitritabine/TAF

separate Al and Mg due to bictegravir

95
Q

Stribid

A

elvitegravir/cobicistat/emcitritabine/TDF
take with food
avoid NSAIDS
CrCl should be >/= 50

96
Q

Gentoya

A

elvitegravir/cobicistat/emcitritabine/TAF
take with food
CrCL>30

97
Q

Tivicay

A

dolutegravir
caution if pregnant (neural tube defects)
preferred with descovy or truvada

98
Q

Isentress

A

Raltegravir

Descovy or Truvada

99
Q

Efavirenz

A 
CNS effects (dreams, confusion) goes away in 2-3 weeks 
empty stomach
100
Q

Symfi

A

efavirenz/lamivudine/TDF
empty stomach
bedtime

101
Q

Atripla

A

efavirenz/TDF/emtricitabine
empty stomach
bedtime
calcium + vit D for bone problems (TDF)

102
Q

nevirapine

A

high risk for liver damage and rash

103
Q

etravirine

A

after meaal

104
Q

rilpivirine

A

with water and meal (not protein drink)

105
Q

Prezista

A

darunavir
food
booster
caution with sulfa allergies

106
Q

Reyataz

A

atazanavir
take with food
booster

107
Q

fosamprenavir

A

empty stomach

sulfa allergies

108
Q

indinavir

A

kindey stones

bad metabolic issues

109
Q

Lopinavir/ritonavir

A

empty stomach

solution has high alcohol level

110
Q

Norvir

A

ritonavir
booster in low dose
take with food

111
Q

Saquinavir

A

qt prolongation

112
Q

tipranavir

A

sulfa allergy
liver damage
intracranial hemorrahge

113
Q

recommended treatement for naive patients 1 ____ and 2___- or 1 of each with ____-

A

1 INSTI
2 NRTIs
or one each with Dovato

114
Q

Caution with sulfa allergy

A

tipranavir, fosamprenavir, tipranavir

115
Q

What labs do are PIs known to raise

A

HDL, TGs, BG

116
Q

which drug raises bilirubin and also known as “bananavir”

A

atazanavir

117
Q

If oraquick comes back positive, what is the confirmation test needed?

A

Antibody differentiation assay

NAPLEX 2021 (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions