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Spring 15 - Pharm Unit III > HIV/AIDS > Flashcards

HIV/AIDS Flashcards

1
Q

Tx of Candida Infections in AIDS

A

-fluconazole

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2
Q

Fluconazole Dose for Candida Infections

A

100-200 mg daily until resolved then PRN

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3
Q

Primary Prophylaxis Drug for Pneumocystis Pneumonia

A

-TMP/SMX

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4
Q

Primary Prophylaxis Alternatives for Pneumocystis Pneumonia

A
  • clindamycin + pyrimethamine
  • atovaquone
  • pentamidine
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5
Q

Long Term Management of Pneumocystis Pneumonia

A

ongoing secondary prophylaxis

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6
Q

Primary Prophylaxis for Toxoplasmosis gondii

A

-TMP/SMX

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7
Q

Treatment of Toxoplasmosis gondii

A
  • sulfadiazine: wt based dose qid

- pyrimethaine: high loading dose then 50-75 mg daily

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8
Q

Long Term Management of Toxoplasmosis

A

-secondary prophylaxis and ongoing suppressive therapy

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9
Q

Primary Prophylaxis for Cryptococcal Infections

A

primary prophylaxis not indicated

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10
Q

Cryptococcus Treatment

A

-liposomal amphotericin

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11
Q

AEs of Amphotericin

A
  • HoTN
  • fever/rigors
  • anemias
  • low Mg, low K
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12
Q

Amphotericin Toxicities

A
  • renal dysfunction

- marrow suppression

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13
Q

Long Term Management of Cryptococcus

A
  • consolidation: fluconazole 400 mg daily x8 wks

- secondary prophylaxis: fluconazole 1 year

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14
Q

Cytomegalovirus Prophylaxis

A

-not used b/c of therapy toxicity

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15
Q

Cytomegalovirus Treatment

A

-ganciclovir or valganciclovir

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16
Q

Mycobacterium Avium Intercellulare Primary Prophylaxis

A

azithromycin 1200 mg/wk

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17
Q

Treatment of Mycobacterium Avium Intercellulare

A

-azithromycin 600 mg/day PO
-plus ethambutol
+/- rifampin or rifabutin

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18
Q

Primary Goals of Opportunistic Infection Therapy

A
  • reduce HIV associated morbidity
  • prolong the duration and quality of survival
  • preserve and restore immunologic function
  • maximally and durably suppress HIV
  • prevent future transmissions
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19
Q

Drawbacks of Early Therapy

A
  • unknown long term ARV-related toxicities
  • life long tx and pill fatigue = non-adherence
  • costs to the pt and the healthcare system
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20
Q

What conditions might favor earlier treatment?

A
  • pregnancy
  • HIV associated nephropathy
  • HBV-HIV or HCV-HIV co-infection
  • acute or recent infx
  • HIV associated dementia
  • AIDS defining condition
  • lower CD4 <200
  • acute opportunistic infxs
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21
Q

When should deferral of therapy be considered?

A
  • significant adherence barriers (clinical, personal, psychosocial)
  • serious comorbidity: incurable CA, end stage liver dz, life expectancy shorter than time for QOL benefits
  • long term non-progressor
  • elite controller
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22
Q

MOA NRTIs

A
  • drugs compete with nucleotides
  • terminate viral DNA chain
  • block HIV replication
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23
Q

How are NRTIs administered?

A

PO

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24
Q

What is the bioavailability of NRTIs?

A
  • variable

- not affected by food

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25
Q

How are NRTIs excreted?

A

renally cleared

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26
Q

MOA of N-NRTIs

A
  • binds non-competitively adjacent to active site

- prevents HIV RNA conversion to proviral DNA

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27
Q

How are N-NRTIs administered?

A

PO

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28
Q

What is the bioavailability of N-NRTIs?

A
  • very good

- increased with food

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29
Q

How are N-NRTIs metabolized?

A
  • extensive hepatic metabolism

- many drug-drug interactions due to CYP450

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30
Q

MOA of Protease Inhibitors

A

-blocks process that stimulates viral maturation

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31
Q

How are PIs administered?

A

PO

32
Q

How are PIs metabolized?

A
  • extensive hepatic metabolism

- many drug-drug interactions due to CYP450

33
Q

What do all preferred HIV treatment regimens have?

A

TWO NRTIs

34
Q

Emtricitabine-Tenofovir (Truvada) AEs

A
  • fatigue
  • cramps
  • elevated creatine kinase
  • hypophosphatemia
35
Q

Emtricitabine-Tenofovir (Truvada) Toxicities

A
  • renal insufficiency (Fanconi’s syndrome)

- changes in bone density

36
Q

Emtricitabine-Tenofovir (Truvada) Lab Follow-up

A
  • renal function

- DEXA scan

37
Q

Lamivudine-Abacavir (Epzicom) Toxicities

A
  • hypersensitivity reaction

- may have additive effects if combined w/ other meds with overlapping AEs

38
Q

Lamivudine-Abacavir (Epzicom) Pre-treatment Lab and Why It Is Done

A
  • HLA B5701

- if positive, 50-50 chance for severe hypersensitivity reaction

39
Q

Lamivudine-Abacavir (Epzicom) Lab Follow-up

A
  • hepatic function

- renal function

40
Q

NNRTI Efavirenz (Sustiva) AEs

A
  • vivid dreams, insomnia, depression
  • rash
  • increased LFTs
  • dizziness
  • high triglycerides
41
Q

NNRTI Efavirenz (Sustiva) Toxicities

A
  • hepatitis

- hepatic necrosis

42
Q

NNRTI Efavirenz (Sustiva) Metabolism

A

-inducer/inhibitor of CYP450

43
Q

When should NNRTI Efavirenz (Sustiva) be taken?

A

-take on empty stomach qHS to reduce AEs

44
Q

NNRTI Rilpivirine (Edurant) AEs

A
  • depression
  • insomnia
  • HA
  • rash
45
Q

NNRTI Rilpivirine (Edurant) Toxicities

A
  • QT prolongation
  • dyslipidemia
  • increased LFTs
46
Q

NNRTI Rilpivirine (Edurant) Metabolism

A

hepatic via CYP3A4

47
Q

How should NNRTI Rilpivirine (Edurant) be taken?

A

-with food b/c it needs an acidic environment to be absorbed

48
Q

What is contraindicated with NNRTI Rilpivirine (Edurant)?

A

taking PPIs (can cause therapeutic failure)

49
Q

INSTI Raltegravir (Isentress) AEs

A
  • elevated BGs, including lipase and ALT

- myopathy

50
Q

INSTI Raltegravir (Isentress) Lab Follow-up

A
  • blood glucose
  • CK
  • LFTs
51
Q

How is INSTI Raltegravir (Isentress) dosed?

A
  • PO tablet

- must be BID (2 pills @ once may cause therapeutic failure)

52
Q

INSTI Elvitegravir (Vitekta) AEs

A
  • well tolerated

- N/D

53
Q

INSTI Elvitegravir (Vitekta) Lab Follow-up

A

fasting lipid panel

54
Q

How should INSTI Elvitegravir (Vitekta) be taken?

A
  • oral tablet once daily

- WITH food and a PK booster (blocks metabolism of elvitegravir so it stays in body longer)

55
Q

What is a PK booster (eg Cobicistat/Tybost)?

A
  • pharmacokinetic enhancer: blocks metabolism of a drug so it stays in body longer
  • NO antiviral properties
56
Q

Cobicistat/Tybost AEs

A
  • nausea, loose stool

- elevated SCr, cholesterol and triglyceride

57
Q

INSTI Dolutegravir (Tivicay) AEs

A
  • well tolerated
  • HA
  • hyperglycemia
  • elevated lipase and transaminases
58
Q

INSTI Dolutegravir (Tivicay) Lab Follow-up

A
  • blood glucose (HbA1c)

- CK

59
Q

How should INSTI Dolutegravir (Tivicay) be taken?

A
  • PO once daily
  • may take w/o food
  • does not require a PK booster
60
Q

PI Atazanavir (Reyataz) AEs

A
  • rash

- hyperbilirubinemia

61
Q

PI Atazanavir (Reyataz) Toxic Effects

A
  • AV block
  • nephrolithiasis
  • elevated transaminases
62
Q

PI Atazanavir (Reyataz) Lab Follow-up

A
  • fractionated bilirubin

- LFTs

63
Q

How should PI Atazanavir (Reyataz) be taken?

A
  • once daily
  • take w/ food (needs acidic enviro to be absorbed)
  • needs PK booster
64
Q

PK Booster Ritonavir (Norvir) AEs

A
  • HA
  • N/V/D
  • taste perversion
  • elevated CK
  • hyperglycemia
  • elevated LFTs
  • hyperlipidemia
65
Q

PK Booster Ritonavir (Norvir) Lab Follow-up

A
  • LFTs
  • fasting lipids and BGs
  • possible EKG
66
Q

PI Darunavir (Prezista) AEs

A
  • rash (SJS)
  • diarrhea
  • hypercholesterolemia/TGs
  • hyperglycemia
67
Q

PI Darunavir (Prezista) Lab Follow-up

A
  • LFTs
  • fasting lipid panel
  • BGs
68
Q

How should PI Darunavir (Prezista) be taken?

A
  • qday or BID
  • take with food
  • always take with PK booster
69
Q

Are there major drug interactions with NRTIs?

A
  • not really
  • all but one (abacavir) are renally cleared)
  • dose adjust all except abacavir for renal impairment/failure
70
Q

Are there major drug interactions with N-NRTIs?

A
  • YES!

- varying CYP450 influences (+ or -)

71
Q

What drugs are contraindicated with N-NRTIs?

A
  • dexamethasone
  • PPIs
  • certain anticonvulsants (phenytoin, CBZ, etc)
72
Q

Are there major drug interactions with PIs?

A
  • YES
  • all PIs have extensive CYP450 interactions
  • LOTS of contraindications with commonly used medications
73
Q

What drugs are contraindicated with PIs?

A
  • alprazolam, triazolam
  • simvastatin, lovastatin
  • all ergot alkaloids
  • amiodarone, propafenone
  • salmeterol
  • caution with fluticasone, ethinyl estradiol, warfarin
74
Q

What lab monitoring should be done with ARVTx?

A
  • absolute CD4 count should be stable or improved

- viral load should decrease

75
Q

Based on lab values, when is tx considered a failure?

A

VL > 400 copies/mL @ 24 weeks

OR VL > 48-75/mL @ 48 weeks

76
Q

What factors can contribute to ARV resistance?

A
  • improper administration
  • improper absorption (delayed or malabsorption)
  • improper storage
  • missing doses
  • wide variability or inconsistent dosing schedule

Spring 15 - Pharm Unit III (12 decks)

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