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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
what is aa normal CD4 count?
500-1000 cell/mm3 or greater
26
what is the cutoff point CD4 count for AIDS?
<200 cell/mm3
27
what does having a low cd4 count pts at risk for?
opportunistic infections malignancies non-aids related complications
28
what does the viral load measure?
HIV-1 RNA levels in he blood . | Helps you track the effeicacy of ART
29
which conditions are considered AIDS defining conditions?
``` 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 ```
30
who should be routinely tested for HIV according to the CDC?
``` All americans 13-64 years old -new TB infections -STD treatemt -pregnant women high risk people : MSM , IVDU ```
31
what are some of the Non-AIDS releated complications of HIV?
CV disease appearing more frequent and at an earlier age Renal disease Liver disease progression (leading cause) cognitive impairment (dementia)
32
what may be contributing to the increase in the mortality of HIV patients?
there is always T cell activation and inflammation. Long term inflamation may be the cause of inc mortality
33
what are the top 5 signs and simptoms of an acute HIV infection?
2-8 weeks after exposure the patient has flu-like symptoms that resolve - Fever - Lymphadenopathy - Pharyngitis - Rash - Myalgia/arthralgia
34
how long does it take for an HIV person to have seroconversion?
4-8 weeks after exposure
35
which 5 different test are there to test for HIV?
- Rapid HIV test - ELISA (screening test) - Western Blot - OTC HIV test (Ora Quick) - Viral load assay
36
Which of the tests serves as the confirmatory test for HIV (the final positive diagnosis)?
Western blot, all positive tests from other tests must be confirmed by this method
37
how fast is the rapid HIV test?
resuls take less than 60 minutes
38
how fast is the ELISA?
results in 1-2 days
39
How fast do you get results with the western blot?
2-3 weeks, sometimes longer
40
how quick is the OraQuick at geting reuslts?
20-40 mintues
41
how accurate is the OraQuick ?
92% of time catches the HIV+ patients | 99% of the time catches the HIV negative patients
42
what are risk factors for gettign HIV?
- 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
43
Has ART been shown to decrease transmission of HIV?
Yes in serodiscordant couples, who started immediate ART , a study showed that there was 97% HIV transmission reduction (HPTN 052 study)
44
Which medicaitons was approved in July 2012 to reduce HIV transmission? what is this therapy called?
Tenofovir/emtricitibine (Truvada) for HIV negative individuals (discordant couples / MSM) before sexual couples with HIV + partner. It hisis called PrEP (Pre-exposure prophylaxis)
45
By how much is PrEP supposed to stop HIV Transmission?
Maximum 73% HIV transmission if > 90%. Drops with decreased adherence
46
who is eligible for PrEP according to the CDC?
- 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
47
dosing for PrEP
Truvada one tablet daily max 90 days supply | must give risk reduction, adherence counseling/condoms
48
what should you monitor in PrEP patients?
HIV ab and preg test q 2-3 motnhs and when PrEP stopped. Scr and bone loss -adherence and HIV risk
49
what are the toxicities of truvada long term?
renal toxicity bone demineralization uknone about risk to fetus/ hiv negative people long term
50
who should get Post-exposure prophylaxis? PEP
- After a needle stick - mucocutaneous or cutaneous exposure to blood or body fluids - after risky sex - IVDU - sexual assault
51
which fluids can transmit HIV and which cant?
YES: blood, semen, vaginal fluids , breast milk NO: saliva, vomit, urine, feces , sweat , tears, respiratory secretions
52
how soon should you take the PEP?
ASAP , accoding to CDC 72 hour wind based on animal data, NY up to 36 hours based on amimal data
53
Dose of PEP agents and duration?
Truvada 1 po daily x 28 days or combivir po bid x 28 days PLUS Raltegravir 400mg po bid or poretease inhibitors Avoid NNRTIs
54
what clinical marker do you follow for HIV therapy?
HIV-RNA level (viral load), want it to drop as quick as possible within first 4-6 weeks
55
goals of HIV therapy? why start treatment?
``` improve QOL reduce mortality and morbidity reduce progression to AIDS decrease inflammation and its complications decrease transmission of HIV ```
56
when should you obtain genotype testing for HIV + patients?
at the time of diagnosis before starting ART if pregnant
57
what baseline tests should you order before starting ART?
``` 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 ```
58
what is the typical skeleton of HAART?
2 NRTIs + [NNRTI or PI or INSTI]
59
Efavirenz dose for preferred regimen and MOA
NNRTI | 60mg po daily
60
Truvada
tenofovir 300 / emtricitabine 200
61
truvada dose for preferred regimen
1 tab po daily
62
when should you avoid truvada?
CrCL < 30 ml/min
63
Atazanavir dose for preferred regimen?
atazanavir 300mg +RTV 100mg po daily
64
darunavir dose for preferred regimen?
darunavir 800mg + RTV 100mg po daily
65
raltegravir preferred regimen dose?
raltegravir 400mg po bid
66
Preferred regimens to intial treatment
Truvada + efavirenz Truvada + Atazanavir/r Truvada + Darunavir/r Truvada + Raltegravir
67
when should you avoid efavirenz?
avoid in 1st trimester of pregnancy or women wit hsignificant pregnancy potential
68
Atripla
TDF+FTC+EFV | Tenofovir + emtricitabine + efavirenz
69
which of the agents in the preferred regimen are dosed daily vs BID
raltegravir is the only BID dosing, all other agents are once daily
70
Alternative treatment regimen for initial treatment
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
which medication is interchangeable in HIV regimens with emtricitiabine?
Lamivudine
72
dose of rilpivirine in alternative regimen
25mg po daily
73
dose of fosamprenavir in alternative regimen?
FOS 1400mg +RTV 100 or 200mg po daily | FOF 700 bid + RTV 100 po bid
74
lopinavir dosing for alternative regiment
200mg/ RTV 50mg: 4 tablets daily or 2 tablets bid
75
dose of maraviroc in alternative regimen?
150- 300mg po bid
76
How many drugs must you have minumum for a good HIV regimen?
3 at least
77
which are the only 3 NRTIs that can be used all together in a regimen?
abacavir/lamivudine/zidovudine | maybe tenofovir/lamivudine/zidovudine
78
Which two-drug combinations should never bus used together?
IDV + ATV D4T +AZT FTC+ 3 TC 2 NNRTIs
79
which always requred ritonavir?
DRV TPV SQV
80
Complera
TDV+FTC+RPV | tenofovir+emtricitabine+rilpivirine
81
Epzicom
ABC+3TC | abacavir + lamivudine
82
stribild
elvitegravir/cobicistatin + TDF +FTC
83
Kaletra
lopinavir/r
84
lamivudine dosing
300mg po qd | or 150mg po bid
85
abacavir dosing
600mg po qd or 300mg po bid
86
tenofovir dosing?
300mg po qd
87
emtricitabine dosing?
200mg po qd
88
which of the NRTIs must be taken on an empty stomach?
Didanosine is the only one, the rest are with or without food
89
combivir dosing
AZT 300mg/ 3TC 150mg 1 po bid
90
Trizivir dosing
Azt 300/3tc 150/ABC 300 1 po bid
91
epzicom dosing
ABC 600/ 3tc 300 1 po qd
92
Atripla dosing
TDF 300/ FTC 200/EFV 600 1 po daily empty stomach
93
which of the NRTI does not require dosage adjustment in renal insufficiency?
Abacavir, the rest require dosage adjustment or CI if ClCr < 50ml/min
94
which are the three NRTIs that have anti Hep B activity?
3tc FTC TDF
95
do any of the NRTIs have p450 interactions ?
None!! but other DDIs
96
what are the calls NRTIs side effects?
N/V/D HA Delayed AE: mitochondrial toxicity Black box warning Lactic acidosis and hepatic steatosis
97
Aside from the typical class effects, what three conditions can occur in patients taking Tenofovir?
BBW if you D/C TDF, can get HBV flare Fanconi's syndrome (<2%) Bone loss/osteoporosis
98
what is Fanconi's syndrome? effects?
reabsorption failure in the proximal tubule | inc SCr and BUN, dec K and PO4, glycosuria, metabolic acidosis
99
who is a tr irks for developing fanconi's syndrome?
``` renal disease dehydration DM HTN nephrotoxins low CD4 count older ```
100
when should you stop TDF for fanconi's syndrome? patient educaition?
if proteins > 500mg/24 hours or increase in BUN/Scr educated patient on hydration and avoiding nephrotoxins reversible effect if stopping TDF
101
what drug should always be ritonavir boosted when used with TDF?
Atazanavir
102
at what level should you dose adjust tenofovir?
ClCr <50
103
at what CLCr should you avoid Truvada?
< 30ml/min
104
viread
tenofovir
105
Mutation M148V and lamivudine
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
lamivudine dosing for HBV/
100mg po daily
107
at what renal function to adjust lamivudine dosing?
cl cr < 50ml/min
108
AE of 3tC
``` well tolerated, minimal toxicity rarely rash pancreatitis in children BBW : lactic acidosi, hepatic steatosis HBV flare if d/c 3tc ```
109
Emtriva
Emtricitabine
110
difference betewen embticitabine and lamivudine?
emtricitabine is flouorinated, hence FTC vs 3TC
111
AE of FTC
Well tolerated rash and skin discoloration in palms and soles BBW lactic acidosis risk of HBV flare after d/c
112
when to renally adjust 3 tc?
clcr <50ml/min
113
FTC dosing
200mg po daily
114
when does abacavir have an inferior virologic responsce compared to truvada?
when viral load is > 100K
115
renal adjustment for abacavir?
none
116
ABC dosing
600mg po qd o r 300mg po bid
117
AE of ABC?
BBW of ABC hypersensitivity reaction (HLAB5701 testing ) lactic acidosis and hepatic steatosis associated w possible inc in CV events and MI (?)
118
ABC and MI risk , what to do?
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
what is the clinical presentaiton of hypersensitivity to ABC?
``` Maculopapular or urticarial rash and greater or = 2 of : -Fever -GI (N/V) -lethargy, myalgia, flu-like Sx -pharyngitis ```
120
what to do if Hypersensitive to ABC?
STOP | nevery rechallage because can be fatal
121
when to screen for HLA B5701?
before using abacavir | recording positivity as allergy
122
what arethe 5 non-nucleoside reverse transcriptase inhibitors?
``` nevirapine NVP Delaviridine DLV Efavirenz EFV Etravirine ETR Rilpivirin RPV ```
123
Etravirine
ETR NNRTI Intelence
124
efavirenz dosing
600mg po daily avoid high fat meal | atripla, one po dialy empty stomach
125
Rilpivirine dosing
25mg po daily with high fat meal (> 400kCal)
126
Efavirenz advantages
``` (+) 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
EFV disadvantages
(-) 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
what kind of rash wit EFV? what to do if rash
Onset in first few weeks, can be sever to SJ | Can treat through rash with antihistamines if not SJ, if SJ D/C
129
patient counseling EFV
cha have changes in dreams take PM take on an empty stomach avoid alcohol
130
can you use rilpiverine if K103 mutaiton?
yes!
131
Radvantages rilpivrine
``` 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
contrainidcations with RPV?
PPI's (Acid labile) St john's wart (CYP substrate), Anticonfulstants Antimycopacterials: rif- more than one dose of dexamethasone
133
renal adjustment for complera
avoid if ClCr < 50
134
dose of atazanavir boosted and unboosted
400mg po qd | or 300mg / R 100mg
135
fosamprenavir boosted unboosted dose?
1400mg po bid | 700mg po bid /100 RTV po bid
136
Tipranaivir boosted dose ?
no unboosted dose | 500mg po bid / RTV 200mg po bidf
137
Darunavir boosted dose?
600mg /100mg RTV 100mg po BID | 800mg /100mg po QD
138
of ATV, FOS, TPV, DRV, which should be taken w/ or without food?
ATV, TPV, DRV with food | F-APV either or
139
what are the class Side effects of protease inhibitors?
``` fat accumulation dyslpidemia insulin resistnace MI risk hepatitis CYP 3A4 inhibition strong esp w/ ritonavir ```
140
advantages of protease inhibitors
``` 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
which of the PI's are P450 inducers?
ritonavir (dual), NFV, APV, f-APV, LPV/r
142
disadvantages of Protease inhibitors
``` higher risk of GI side effects risk of sulfa corss reactivity ,: fosAPV, TPV, DRV Class tosixicities CYP3A4 interactions higher pill bureden ```
143
what are the advantages of using ritonavir for boosting?
increase drug bioavailability decrease resistnace lower doses of PI overcome food restrictions or DDI's
144
normal dosage range for ritonavir
100-200mg po once or twice daily
145
patient ed for ritonaivr
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
Atazanavir advantages
decrease lipid abnormaliities if unboosted once daily dosing lowest pill burden
147
adverse evetns of ATV?
``` NVD Rash (can treat through if not too uncomfortable) Jaundice due to inc bilirubin kidney stone (precipitates) delayed PI class toxicity P450 inhibitor ```
148
counseling ofr atazanavir
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
darunavir adverse evets
NVD abd pain URI Rash Pi calls toxicity and hepatottoxicity
150
what must you always dispense with darunaivr?
ritonavir at the same time
151
which PI is inital tx for preganncey?
Lopinavir/r
152
AE of Lopinavir
NVD especially if QD HLD, esp TG Class Tox PR prolongation
153
AE of fosamprenavir
``` NVD Rash nephorlithiasis (kidney stones) class delayed toxicity DDIS ```
154
integrase inhibitors
raltegravir | elvitegravir
155
disadvvantages with raltegravir inc adverse effects
-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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