HIV/AIDS Flashcards
***Focus on ______***
Pharmacotherapy awareness
(whatever the fuck that means…)
_______ block CD4 receptors on the surface of certain immune cells that HIV needs to enter the cells.
Post-attachment inhibitors
8 classes of HIV medications
(PPP)
(NN)
(CIF)
- PE: Pharmacokinetic Enhancer
- PI: Protease Inhibitor
- PAI: Post Attachment Inhibitor
- NNRTI: Non-nucleoside Reverse Transcriptase Inhibitor
- NRTI: Nucleoside Reverse Transcriptase Inhibitor
- CA: CCRS Antagonists
- INSTI: Integrase Inhibitor
- FI: Fusion Inhibitor
Some of the barriers to Adherence to Antiretroviral Therapy
- Lack of education/understanding of HIV disease
- Denial / Anxiety
- Depression / Mental illness
- Substance abuse
- Medication SE
- Complicated dosing regimen
- Poor social situation
- Lack of family / community support
- Inadequate health insurance
- Poor clinician - patient relationship
MOA of which drug class?
- NRTIs block reverse transcriptase, an enzyme HIV needs to make copies of itself
NRTIs: Nucleoside Reverse Transriptase Inhibitors
- Abacavir
- Tenofovir
- Emtricitabine
- Lamivudine
- Zidovudine
MOA of which drug class?
- Bind to and later alter reverse transcriptase, an enzyme HIV needs to make copies of itself
NNRTIs: Non-Nucleoside Reverse Transcriptase Inhibitors
- Doravirine
- Etravirine
- Rilpivirine
- Efavirenz
- Nevirapine
MOA of which drug class?
- Block HIV protease, an enzyme HIV needs to make copies of itself
PIs: Protease Inhibitors
- Atazanavir
- Darunavir
- Fosamprenavir
- Ritonavir
- Saquinavir
- Tipranavir
(All end in AVIR)
MOA of which drug class?
- Block HIV from entering the CD4 cells of the immune system
Fusion Inhibitors
- Enfuvirtide
MOA of which drug class?
- Block coreceptors on the surface of certain immune cells that HIV needs to enter the cells
CCR5 Antagonists
- Maraviroc
MOA of which drug class?
- Block HIV integrase, an enzyme HIV needs to make copies of itself
Integrase Inhibitors
- Dolutegravir
- Raltegravir
MOA of which drug class?
- Block CD4 receptors on the surface of certain immune cells that HIV needs to enter the cells
Post-Attachment Inhibitors
- Ibalizumab-uiyk
MOA of which drug class?
- Used in HIV treatment to increase the effectiveness of an HIV medicine included in an HIV regimen
Pharmacokinetic Enhancers
- Cobicstat
What are the 5 Combination HIV Medications?
- Triumeq: Abacavir, dolutegravir, lamivudine
- Trizivir: Abacavir, lamivudine, zidovudine
- Epzicom: abacavir & lamivudine
- Evotaz: Atazanavir, cobicistat
- Biktarvy: bictegravir, emtricitabine, tenofovir, alafenamide
(TTEEB)
Key Concepts:
- HIV infects cells expressing CD4 receptors, what does CD4 stand for?
- What are the 5 types of cells infected?
- Infection is via an interaction between glycoprotein 160 (gp 160) on HIV with CD4 (primary interaction) and _________ (secondary interactions) present on the surfaces of these cells
- Cluster of Differentiation 4
- T-helper lymphocytes
- Monocytes
- Macrophages
- Dendritic cells
- Brain Microglia
- Chemokine Co-receptors
Key Concepts:
- Hallmark of UNTREATED HIV infection is _________ and _________.
- 2 Current goal of combination anti-retroviral therapy (ART) ?
- Profound CD4 T-lymphocyte depletion & Severe immunosuppression
- Suppression of HIV replication
- Increase in CD4 lymphocytes
Key Concepts:
- Initial treatment of HIV advocate a minimum of ____ active antiretroviral agents from at least _____ drug classes.
- First HIV regimen includes:
- _____ + ______, an _____, or a ____ w/ _____ or ______
- ____ or _____ boost the effectiveness of the ____.
- 3
- 2
- 2 NRTIs + INSTI, an NNRTI, or a PI boosted w/ cobicistat (Tybost) or Ritonavir (Norvir)
- Cobicistat or Ritonavir increase/boost effectivness of the PI
(Key point: Start out with TWO NRTIs & most individuals also need an INSTI)**
Short or Long Term SE of HIV meds?
- Fatigue
- Nausea
- Vomiting
- Diarrhea
- HA
- Fever
- Muscle Pain
- Occasional dizziness
- Insomnia
Short Term
Short or Long Term SE of HIV meds?
- Lipodystrophy
- Hyperlipidemia
- Osteoporosis
- Nephrotoxicity
- Hepatotoxicity
- Cardiovascular - HLD
- Diabetes / Insulin Resistance
- Peripheral neuropathy
- Mental health related effects
Long Term
There is a relationship of CD4 count to the development of _______.
Opportunistic Infections
- TB
- Herpes simplex
- Kaposi sarcoma
- Cocci
- MAC
- CMV retinitis
- CNS lymphoma
AIDS tx for Ois (opportunistic infections)
- Primary Prophylaxis for P jirovecci?
Trimethoprim-Sulfamethoxazole (Bactrim)
(single strength or DS tablet daily)
AIDS tx for Ois
- Primary prophylaxis for Toxoplasmosis
Trimethoprim-Sulfamethoxazole (Bactrim)
(single strength or DS tablet daily)
AIDS tx for Ois
- Primary Prophylaxis for Mycobacterium avium
Azithromycin weekly
AIDS tx for Ois
- Secondary prophylaxis for Mycobacterium TB
Isoniazid (depending on sensitivities)
AIDS tx for Ois
- Secondary prophylaxis for Cryptococcosis
Fluconazole
AIDS tx for Ois
- Secondary Prophylaxis for Coccidomycosis
Fluconazole or Itraconazole
AIDS tx for Ois
- Secondary Prophylaxis for Histoplasmosis
Itraconazole
AIDS tx for Ois
- Secondary Prophylaxis for Cytomegalovirus (CMV)
Ganciclovir
- Combination of what 2 HIV meds are used for Pre-exposure prophylaxis (PrEP)?
- Indicated for pts at very high risk for HIV
- Taken how often to lower their risk?
- Adherence is critical
- PrEP reduces risk by more than ___%
- IVDU risk is reduced by more than ___%
- Combine PrEP w/ condoms and any other prevention method is recommended
- Tenofovir & Emtricitabine (Truvada)
- Daily
- 90%
- 70%
PrEP (Pre-exposure prophylaxis) = Truvada
-
Reaches maximum protection from HIV
- receptive anal sex at about __ days of daily use
- receptive vaginal sex and injection drug use at about __ days of daily use
- no data yet available about how long it takes to reach maximum protection for ____ anal or _____ vaginal sex
- 7
- 20
- insertive
Emergency Sharps Information
- What are the 5 “Initial Steps”
(WFIRI)
- Wash needlesticks and cuts w/ soap and water
- Flush splashes to the nose, mouth, or skin w/ water
- Irrigate eyes w/ clean water, saline, or sterile irrigants
- Report the incident to your supervisor
- Immediately seek medical treatment
Emergency Sharps Information
- What are the 2 medications?
- Duratioin?
-
Truvada
- 1 tablet by mouth once daily
-
PLUS raltegravir
- (400mg by mouth twice daily or dolutegravir once daily)
28 days
What are the 3 websites used for info?
- FDA
- CDC
- AidsInfo
What antiretroviral is used during pregnancy?
NRTIs
- Abacavir
(No change in dose, PK not altered, no evidence of tetratogenicity)
Vaccine Recommended w/ HIV
- What are the 6?
(HHTIMP)
- Hep B
- HPV (for those up to 26 y/o)
- Influenza
- Meningococcal
- Pneumococcal
- TDAP (tetanus, diptheria, and Pertussis)
