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Therapeutics > HIV & Antiretrovirals > Flashcards

HIV & Antiretrovirals Flashcards

1
Q

Abacavir

A

ABC
NRTI
Ziagen

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2
Q

Didanosine

A

ddI
NRTI
Videx EC

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3
Q

Emtricitabine

A

FTC
NRTI
Emtriva

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4
Q

Lamivudine

A

3TC
NRTI
Epivir

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5
Q

stavudine

A

d4t
NRTI
Zerit

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6
Q

tenofovir

A

TDF
NRTI
Viread

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7
Q

zidovudine

A

ZDV or AZT
NRTI
Retrovir

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8
Q

Delaviridine

A

DLV
NNRTI
Rescriptor

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9
Q

Efaviranz

A

EFV
NNRTI
Sustiva
Atripla

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10
Q

Nevirapine

A

NVP
NNRTI
Viramune

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11
Q

Rilpivirine

A

RPV
NNRTI
Endurant
Complera

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12
Q

Atazanavir

A

ATV/r or ATV
PI
Reyataz

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13
Q

Darunavir

A

DRV/r
PI
prezista

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14
Q

fosamprenavir

A

FPV/r or FPV
PI
Lexiva

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15
Q

indinavir

A

IDV/r or IDV
PI
crixivan

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16
Q

Lopinavir

A

LPV/r
PI
Kaletra

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17
Q

Neflinavir

A

NFV
PI
viracept

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18
Q

Ritonavir

A

RTV or /r
PI
norvir

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19
Q

Saquinavir

A

SQV/r
PI
Invirase

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20
Q

Tipranavir

A

TPV
PI
Aptivus

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21
Q

enfuvirtide

A

T20

fusion inhibitor

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22
Q

maraviroc

A

MVC

CCR5 antagonist

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23
Q

raltegravir

A

RAL

Integrase inhibitor

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24
Q

Elvitegravir

A

EVG

integrase inhibitor

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25
Q

what is aa normal CD4 count?

A

500-1000 cell/mm3 or greater

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26
Q

what is the cutoff point CD4 count for AIDS?

A

<200 cell/mm3

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27
Q

what does having a low cd4 count pts at risk for?

A

opportunistic infections
malignancies
non-aids related complications

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28
Q

what does the viral load measure?

A

HIV-1 RNA levels in he blood .

Helps you track the effeicacy of ART

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29
Q

which conditions are considered AIDS defining conditions?

A 
Bacteria
-histoplamsosis
-MAC
-TB
-PJP
-salmonelace spticemia recurrent
-toxoplasmosis
Fungus
-recurrent vagina candidasis or candidtiasis of lungs, trachea, esophagus but not oral
Virus
-CMV
-HSV
Malignacies: kaposi's sarcoma, etc
Other: 
-cryptosporidiosis
-encephalopathy
-HIV wasting syndrome
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30
Q

who should be routinely tested for HIV according to the CDC?

A 
All americans 13-64 years old 
-new TB infections
-STD treatemt
-pregnant women
high risk people : MSM , IVDU
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31
Q

what are some of the Non-AIDS releated complications of HIV?

A

CV disease appearing more frequent and at an earlier age
Renal disease
Liver disease progression (leading cause)
cognitive impairment (dementia)

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32
Q

what may be contributing to the increase in the mortality of HIV patients?

A

there is always T cell activation and inflammation. Long term inflamation may be the cause of inc mortality

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33
Q

what are the top 5 signs and simptoms of an acute HIV infection?

A

2-8 weeks after exposure the patient has flu-like symptoms that resolve

  • Fever
  • Lymphadenopathy
  • Pharyngitis
  • Rash
  • Myalgia/arthralgia
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34
Q

how long does it take for an HIV person to have seroconversion?

A

4-8 weeks after exposure

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35
Q

which 5 different test are there to test for HIV?

A
  • Rapid HIV test
  • ELISA (screening test)
  • Western Blot
  • OTC HIV test (Ora Quick)
  • Viral load assay
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36
Q

Which of the tests serves as the confirmatory test for HIV (the final positive diagnosis)?

A

Western blot, all positive tests from other tests must be confirmed by this method

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37
Q

how fast is the rapid HIV test?

A

resuls take less than 60 minutes

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38
Q

how fast is the ELISA?

A

results in 1-2 days

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39
Q

How fast do you get results with the western blot?

A

2-3 weeks, sometimes longer

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40
Q

how quick is the OraQuick at geting reuslts?

A

20-40 mintues

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41
Q

how accurate is the OraQuick ?

A

92% of time catches the HIV+ patients

99% of the time catches the HIV negative patients

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42
Q

what are risk factors for gettign HIV?

A
  • Blood transfusiton before 1985 fro HIV1, before 1992 for HIV 2
  • needle sharing IVDU
  • anal > vaginal sexual episode
  • perinatal transmission through breastfeeding > 50% risk
  • needle stick
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43
Q

Has ART been shown to decrease transmission of HIV?

A

Yes in serodiscordant couples, who started immediate ART , a study showed that there was 97% HIV transmission reduction (HPTN 052 study)

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44
Q

Which medicaitons was approved in July 2012 to reduce HIV transmission? what is this therapy called?

A

Tenofovir/emtricitibine (Truvada) for HIV negative individuals (discordant couples / MSM) before sexual couples with HIV + partner. It hisis called PrEP (Pre-exposure prophylaxis)

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45
Q

By how much is PrEP supposed to stop HIV Transmission?

A

Maximum 73% HIV transmission if > 90%. Drops with decreased adherence

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46
Q

who is eligible for PrEP according to the CDC?

A
  • High risk of acquirng HIV
  • documented HIV/HBV negative
  • Confirmed CrCL >60ml/min (TDF)
  • StD and HCV screened and treat
  • avoid PrEP in breast feeding women
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47
Q

dosing for PrEP

A

Truvada one tablet daily max 90 days supply

must give risk reduction, adherence counseling/condoms

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48
Q

what should you monitor in PrEP patients?

A

HIV ab and preg test q 2-3 motnhs and when PrEP stopped.
Scr and bone loss
-adherence and HIV risk

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49
Q

what are the toxicities of truvada long term?

A

renal toxicity
bone demineralization
uknone about risk to fetus/ hiv negative people long term

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50
Q

who should get Post-exposure prophylaxis? PEP

A
  • After a needle stick
  • mucocutaneous or cutaneous exposure to blood or body fluids
  • after risky sex
  • IVDU
  • sexual assault
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51
Q

which fluids can transmit HIV and which cant?

A

YES: blood, semen, vaginal fluids , breast milk
NO: saliva, vomit, urine, feces , sweat , tears, respiratory secretions

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52
Q

how soon should you take the PEP?

A

ASAP , accoding to CDC 72 hour wind based on animal data, NY up to 36 hours based on amimal data

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53
Q

Dose of PEP agents and duration?

A

Truvada 1 po daily x 28 days or combivir po bid x 28 days

PLUS

Raltegravir 400mg po bid or poretease inhibitors

Avoid NNRTIs

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54
Q

what clinical marker do you follow for HIV therapy?

A

HIV-RNA level (viral load), want it to drop as quick as possible within first 4-6 weeks

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55
Q

goals of HIV therapy? why start treatment?

A 
improve QOL
reduce mortality and morbidity 
reduce progression to AIDS
decrease inflammation and its complications
decrease transmission of HIV
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56
Q

when should you obtain genotype testing for HIV + patients?

A

at the time of diagnosis
before starting ART
if pregnant

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57
Q

what baseline tests should you order before starting ART?

A 
CD$ cell count
Viral load
HLA-B5701 allele (if abacavir)
CBC w/ differential
LFTs
FBG
SCr, BUN, UA
fasting lipids
Hep A, B, C serology
assess adherence!! 
mediations history
comorbidities
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58
Q

what is the typical skeleton of HAART?

A

2 NRTIs + [NNRTI or PI or INSTI]

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59
Q

Efavirenz dose for preferred regimen and MOA

A

NNRTI

60mg po daily

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60
Q

Truvada

A

tenofovir 300 / emtricitabine 200

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61
Q

truvada dose for preferred regimen

A

1 tab po daily

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62
Q

when should you avoid truvada?

A

CrCL < 30 ml/min

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63
Q

Atazanavir dose for preferred regimen?

A

atazanavir 300mg +RTV 100mg po daily

64
Q

darunavir dose for preferred regimen?

A

darunavir 800mg + RTV 100mg po daily

65
Q

raltegravir preferred regimen dose?

A

raltegravir 400mg po bid

66
Q

Preferred regimens to intial treatment

A

Truvada + efavirenz
Truvada + Atazanavir/r
Truvada + Darunavir/r
Truvada + Raltegravir

67
Q

when should you avoid efavirenz?

A

avoid in 1st trimester of pregnancy or women wit hsignificant pregnancy potential

68
Q

Atripla

A

TDF+FTC+EFV

Tenofovir + emtricitabine + efavirenz

69
Q

which of the agents in the preferred regimen are dosed daily vs BID

A

raltegravir is the only BID dosing, all other agents are once daily

70
Q

Alternative treatment regimen for initial treatment

A

Epzicom or Truvada once daily PLUS

  • rilpivirine or efavirenz
  • atazanavir/r, darunavir/r, FosAPV/r , or Lopinavir/r
  • raltegravir or elvitegravir/cobicistat (added with TRUVDA= Strilbild)
  • marafirgoc
71
Q

which medication is interchangeable in HIV regimens with emtricitiabine?

A

Lamivudine

72
Q

dose of rilpivirine in alternative regimen

A

25mg po daily

73
Q

dose of fosamprenavir in alternative regimen?

A

FOS 1400mg +RTV 100 or 200mg po daily

FOF 700 bid + RTV 100 po bid

74
Q

lopinavir dosing for alternative regiment

A

200mg/ RTV 50mg: 4 tablets daily or 2 tablets bid

75
Q

dose of maraviroc in alternative regimen?

A

150- 300mg po bid

76
Q

How many drugs must you have minumum for a good HIV regimen?

A

3 at least

77
Q

which are the only 3 NRTIs that can be used all together in a regimen?

A

abacavir/lamivudine/zidovudine

maybe tenofovir/lamivudine/zidovudine

78
Q

Which two-drug combinations should never bus used together?

A

IDV + ATV
D4T +AZT
FTC+ 3 TC
2 NNRTIs

79
Q

which always requred ritonavir?

A

DRV
TPV
SQV

80
Q

Complera

A

TDV+FTC+RPV

tenofovir+emtricitabine+rilpivirine

81
Q

Epzicom

A

ABC+3TC

abacavir + lamivudine

82
Q

stribild

A

elvitegravir/cobicistatin + TDF +FTC

83
Q

Kaletra

A

lopinavir/r

84
Q

lamivudine dosing

A

300mg po qd

or 150mg po bid

85
Q

abacavir dosing

A

600mg po qd or 300mg po bid

86
Q

tenofovir dosing?

A

300mg po qd

87
Q

emtricitabine dosing?

A

200mg po qd

88
Q

which of the NRTIs must be taken on an empty stomach?

A

Didanosine is the only one, the rest are with or without food

89
Q

combivir dosing

A

AZT 300mg/ 3TC 150mg 1 po bid

90
Q

Trizivir dosing

A

Azt 300/3tc 150/ABC 300 1 po bid

91
Q

epzicom dosing

A

ABC 600/ 3tc 300 1 po qd

92
Q

Atripla dosing

A

TDF 300/ FTC 200/EFV 600 1 po daily empty stomach

93
Q

which of the NRTI does not require dosage adjustment in renal insufficiency?

A

Abacavir, the rest require dosage adjustment or CI if ClCr < 50ml/min

94
Q

which are the three NRTIs that have anti Hep B activity?

A

3tc
FTC
TDF

95
Q

do any of the NRTIs have p450 interactions ?

A

None!! but other DDIs

96
Q

what are the calls NRTIs side effects?

A

N/V/D HA
Delayed AE: mitochondrial toxicity
Black box warning Lactic acidosis and hepatic steatosis

97
Q

Aside from the typical class effects, what three conditions can occur in patients taking Tenofovir?

A

BBW if you D/C TDF, can get HBV flare
Fanconi’s syndrome (<2%)
Bone loss/osteoporosis

98
Q

what is Fanconi’s syndrome? effects?

A

reabsorption failure in the proximal tubule

inc SCr and BUN, dec K and PO4, glycosuria, metabolic acidosis

99
Q

who is a tr irks for developing fanconi’s syndrome?

A 
renal disease
dehydration
DM
HTN
nephrotoxins
low CD4 count
older
100
Q

when should you stop TDF for fanconi’s syndrome? patient educaition?

A

if proteins > 500mg/24 hours
or increase in BUN/Scr
educated patient on hydration and avoiding nephrotoxins
reversible effect if stopping TDF

101
Q

what drug should always be ritonavir boosted when used with TDF?

A

Atazanavir

102
Q

at what level should you dose adjust tenofovir?

A

ClCr <50

103
Q

at what CLCr should you avoid Truvada?

A

< 30ml/min

104
Q

viread

A

tenofovir

105
Q

Mutation M148V and lamivudine

A

study by manufacture where there was reduced viral fitness when this mutaiton appeared. Mutation made it resistant to lamivudine but the viral load rebounded to a lower level than expected. Lamivudine may still have partial effect even with this mutation.

106
Q

lamivudine dosing for HBV/

A

100mg po daily

107
Q

at what renal function to adjust lamivudine dosing?

A

cl cr < 50ml/min

108
Q

AE of 3tC

A 
well tolerated, minimal toxicity 
rarely rash
 pancreatitis in children
BBW : lactic acidosi, hepatic steatosis
HBV flare if d/c 3tc
109
Q

Emtriva

A

Emtricitabine

110
Q

difference betewen embticitabine and lamivudine?

A

emtricitabine is flouorinated, hence FTC vs 3TC

111
Q

AE of FTC

A

Well tolerated
rash and skin discoloration in palms and soles
BBW lactic acidosis
risk of HBV flare after d/c

112
Q

when to renally adjust 3 tc?

A

clcr <50ml/min

113
Q

FTC dosing

A

200mg po daily

114
Q

when does abacavir have an inferior virologic responsce compared to truvada?

A

when viral load is > 100K

115
Q

renal adjustment for abacavir?

A

none

116
Q

ABC dosing

A

600mg po qd o r 300mg po bid

117
Q

AE of ABC?

A

BBW of ABC hypersensitivity reaction (HLAB5701 testing )
lactic acidosis and hepatic steatosis
associated w possible inc in CV events and MI (?)

118
Q

ABC and MI risk , what to do?

A

be cautious/ avoid if strong CV risk factors (alternatives)
lifestyle modification to dec CV risk factors
Switch to another NRTI if feasible but avoid d4t
Don’t stop ART

119
Q

what is the clinical presentaiton of hypersensitivity to ABC?

A 
Maculopapular or urticarial rash
and greater or = 2 of :
-Fever
-GI (N/V)
-lethargy, myalgia, flu-like Sx
-pharyngitis
120
Q

what to do if Hypersensitive to ABC?

A

STOP

nevery rechallage because can be fatal

121
Q

when to screen for HLA B5701?

A

before using abacavir

recording positivity as allergy

122
Q

what arethe 5 non-nucleoside reverse transcriptase inhibitors?

A 
nevirapine NVP
Delaviridine DLV
Efavirenz EFV
Etravirine ETR
Rilpivirin RPV
123
Q

Etravirine

A

ETR
NNRTI
Intelence

124
Q

efavirenz dosing

A

600mg po daily avoid high fat meal

atripla, one po dialy empty stomach

125
Q

Rilpivirine dosing

A

25mg po daily with high fat meal (> 400kCal)

126
Q

Efavirenz advantages

A 
(+) less dyslipdemia vs PI
preserve PI's 
1 po daily in atripla
no food reqmts
no renal dosing
long t1/2 life to forgive missed pills
127
Q

EFV disadvantages

A

(-) K103N mutaiton confers ressint and X resistance to nevirapine
3A4 inhibtor and inducer
rash
hepatotoxicy/CNT toxicity (dreams, depression)
Preg D
llong t1/2 inc tox and resistance potential
can inc LFTs

128
Q

what kind of rash wit EFV? what to do if rash

A

Onset in first few weeks, can be sever to SJ

Can treat through rash with antihistamines if not SJ, if SJ D/C

129
Q

patient counseling EFV

A

cha have changes in dreams take PM
take on an empty stomach
avoid alcohol

130
Q

can you use rilpiverine if K103 mutaiton?

A

yes!

131
Q

Radvantages rilpivrine

A 
can treat inf K103 N mutated
long 1/2 allows once daily dosing 
take with food
as effective as efavirenz  do dc vl 
Same side effects as EFB but less
-inc
132
Q

contrainidcations with RPV?

A

PPI’s (Acid labile)
St john’s wart (CYP substrate), Anticonfulstants
Antimycopacterials: rif-
more than one dose of dexamethasone

133
Q

renal adjustment for complera

A

avoid if ClCr < 50

134
Q

dose of atazanavir boosted and unboosted

A

400mg po qd

or 300mg / R 100mg

135
Q

fosamprenavir boosted unboosted dose?

A

1400mg po bid

700mg po bid /100 RTV po bid

136
Q

Tipranaivir boosted dose ?

A

no unboosted dose

500mg po bid / RTV 200mg po bidf

137
Q

Darunavir boosted dose?

A

600mg /100mg RTV 100mg po BID

800mg /100mg po QD

138
Q

of ATV, FOS, TPV, DRV, which should be taken w/ or without food?

A

ATV, TPV, DRV with food

F-APV either or

139
Q

what are the class Side effects of protease inhibitors?

A 
fat accumulation
dyslpidemia
insulin resistnace 
MI risk 
hepatitis
CYP 3A4 inhibition strong esp w/ ritonavir
140
Q

advantages of protease inhibitors

A 
potent vs other regimens 
no dosing adjustment in renal dysfunction
high resistnace bairer
less rash and hepatic toxicity
better inc in CD4 vs NNRTIs
141
Q

which of the PI’s are P450 inducers?

A

ritonavir (dual), NFV, APV, f-APV, LPV/r

142
Q

disadvantages of Protease inhibitors

A 
higher risk of GI side effects 
risk of sulfa corss reactivity ,: fosAPV, TPV, DRV
Class tosixicities
CYP3A4 interactions
higher pill bureden
143
Q

what are the advantages of using ritonavir for boosting?

A

increase drug bioavailability
decrease resistnace
lower doses of PI
overcome food restrictions or DDI’s

144
Q

normal dosage range for ritonavir

A

100-200mg po once or twice daily

145
Q

patient ed for ritonaivr

A

check with doctor before starting any new meds
referigeriate caps (room tecmp 30 days) but not tablet or liquid
tablet is not bioequivaltent with capsules
oral solution cotains 43% alcohol
no renal adjustment

146
Q

Atazanavir advantages

A

decrease lipid abnormaliities if unboosted
once daily dosing
lowest pill burden

147
Q

adverse evetns of ATV?

A 
NVD
Rash (can treat through if not too uncomfortable)
Jaundice due to inc bilirubin
kidney stone (precipitates) 
delayed PI class toxicity
P450 inhibitor
148
Q

counseling ofr atazanavir

A

can cause yellowing of skin and eyes. if bothersome, can change. Cosmetic only
Dizzness, abd pain or rash, contact doctor ASAP
Take with food at tsame time as RTV
stay hydrated
if starting new meds inc OTC antacids, tell clinician

149
Q

darunavir adverse evets

A

NVD abd pain
URI
Rash Pi calls toxicity and hepatottoxicity

150
Q

what must you always dispense with darunaivr?

A

ritonavir at the same time

151
Q

which PI is inital tx for preganncey?

A

Lopinavir/r

152
Q

AE of Lopinavir

A

NVD especially if QD
HLD, esp TG
Class Tox
PR prolongation

153
Q

AE of fosamprenavir

A 
NVD
Rash
nephorlithiasis (kidney stones)
class delayed toxicity
DDIS
154
Q

integrase inhibitors

A

raltegravir

elvitegravir

155
Q

disadvvantages with raltegravir inc adverse effects

A

-low geneticbarrier to recisitance
-comparable to evafirenz in trx naive patients
once daily dosing inferior to BID dosing and not recommnended

Therapeutics (23 decks)

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