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HIV Drugs- Block 3 Flashcards

1
Q

How is HIV transmitted?

A
  1. Sex (most common method)
  2. IVDU
  3. Mother to child
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2
Q

What is the rule of thumb when looking at HIV prevention

A

U=U (undetectable is untransmittable)

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3
Q

Who qualifies for HIV screening?

A

Age 13-64 YO annually

Specific risk factors:
* MSM (Screen 3-6 months)
* Multiple partners
* IVDU
* Sex for money or drugs

Pregnancy

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4
Q

OTC screening tool of HIV?

A

Oraquick: not as sensitive as blood assays
(false - prone)

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5
Q

Counseling points for Oraquick?

A

15 min before test: no eating/drinking
30 min before test: no cleaning products

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6
Q

What is your most sensitive HIV diagnostic test?

A

4th gen ELISA that detects p24 antigen (high sensitive and specific)

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7
Q

What do you do if HIV1/2 differential assay it is indeterminate?

A

HIV NAT

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8
Q

Normal range of CD4

A

500-1600

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9
Q

What are your HIV1 biomarkers?

A
  1. Cd4 cell count
  2. HIV-RNA (Viral load)
  3. Genotypic and phenotypic resistance testing
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10
Q

Criteria for AIDs?

A
  1. CD4 <200
  2. AIDS defining condition
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11
Q

What is the tool used for HIV drug resistance detection?

A

Stanford HIVdb Program

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12
Q

What is the objective considerations of undetectable HIV?

A

<20-50 copies

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13
Q

Examples of NRTIs?

A
  1. Abacavir
  2. Emtricitabine
  3. Lamivudine
  4. TAF
  5. TDF
  6. Zidovudine
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14
Q

CI and BBW of abacavir?

A
  1. Hypersensitivity reactions: CI in patients with HLA*5701 allele
  2. CVD
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15
Q

What NRTIs that can cause Hep B reactivation?

A
  1. TDF, TAF
  2. Emtricitabine
  3. Lamivudine
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16
Q

All NRTIs have what common ADR?

A

IRIS, lactic acidosis, hepatomegaly with steotosis

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17
Q

ADR of emtricitabine?

A

Skin hyperpigmentation

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18
Q

ADR of zidovudine?

A

Hematologic toxicities

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19
Q

ADR of tenofovir?

A

TDF: Decreased bone mineral density

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20
Q

MP of NRTIs?

A
  1. Viral load
  2. CD4
  3. CBC
  4. LFTs
  5. Renal function
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21
Q

Which of the NRTIs do not require renal adjustment?

A

Abacavir

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22
Q

Indications for Zidovudine?

A
  1. Women with HIV-RNA viral load >1000 copies
  2. Unknown HIV viral load status
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23
Q

What are the recommended NRTIs based on base analogs?

A

A: Tenofovir
T: zidovudine
C: emtricitabine, lamivudine
G: abacavir

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24
Q

What NRTIs are used for HIV/Hep B coinfection?

A

Lamivudine
Emtricitabine
Tenofovir

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25
Q

Types of NNRTIs?

A
  1. Doravirine
  2. Efavirenz
  3. Etravirine
  4. Nevirapine
  5. Rilpivirne
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26
Q

Common ADR of NNRTIs?

A

IRIS, hypersensitivity

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27
Q

ADR of efavirenz?

A

Psychiatirc sx, CNS effects, elevated serum cholestrol and TG

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28
Q

ADR of rilpivirine?

A
  1. Depression (psychiatric effects)
  2. Elevated serum cholesterol and TG
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29
Q

Which NNRTIs should not be given with strong CYP3A4 INDUCERS?

A

Rilpivirine or doravirine

30
Q

DDI with rilpivirine?

A

Antacids disrupt acidic environments (separted from admin)

31
Q

NNRTIs possess a ___-genetic barrier to resistance

32
Q

Counseling when using efavirenz?

A

Take on an empty stomach at bedtime to decrease CNS effects

33
Q

CI for rilpivirine?

A

> 100,000 copies and <200 CD4

34
Q

Counseling for Rilpivirine?

A

Avvoid PPIs
Separtate H2 antagonist by at least 12 hr before or 4 hrs after
Separate antacids at least 2 hrs before or 4 hrs after

Contains LA injectable

35
Q

CI for nevirapine?

A

Treatment naive patients

36
Q

Types of INSTis?

A
  1. Bictegravir
  2. Cabotegravir
  3. Doltegravir
  4. ELvitegravir
  5. Raltegravir
37
Q

COmmon ADR of All INSTIs?

A

IRIS, weight gain, psychiatric effects, elevated cholesterol

38
Q

ADR of cabotegravir?

A

Inj site rx due to LA injectable form

39
Q

ADR and CI of doltegravir?

A

Nural tube defects -> CI in pregnancy

40
Q

What INSTis are NOT susceptible to CYP metabolism? Why?

A

Cabotegravir, doltegravir, raltegravir is metabolized by UGT1A1

41
Q

What INSTIs are metabolized by CYP3A4?

A

Bictegravir and elvitegravir

42
Q

DDI of INSTIs?

A

Polyvalent cations: adminsiter 2 hrs before or 6 hr after cation product

43
Q

InSTIs possess a ___-genetic barrier to resistance

44
Q

Why is it important to look at past med history before using InSTIs?

A

Doltegravir is associated with CNS/psychiatric effects

45
Q

Types of PIs?

A
  1. Atazanavir
  2. Darunavir
  3. FOsamprenavir
  4. Lopinavir/ritonavir
46
Q

ADRs associated with PIs?

A
  1. Hyperglycemia
  2. HLD
  3. IRIS
  4. GI intolerance
  5. Metabolic changes
  6. Hepatotoxicity
47
Q

What PIs are associated with increased CVD risk?

A

Darunavir and lopinovir/ritonavir

48
Q

What PIs are associated with sulfa allergy?

A

Darunavir and fosamprenavir

49
Q

ADR of atazanavir?

A

Hyperbilirubinemia

50
Q

ADR of lopinavir/ritonavir?

A

Disulfiram rx

51
Q

DDI associated with atazanavir?

A

Requires acidic gut environment:
Antacids: administer atazanavir 2 hours before or 1 hour after
H2RA: Avoid or administer atazanavir 2 hours before or 1 hour after
PPI: Avoid or use boosted 12 hrs after PPI

52
Q

Metabolism of PIs?

A

CYP3A4 substrates affected by inhibitors

53
Q

Protease Inhibitors (PIs) possess a ___genetic barrier to resistance

54
Q

Counseling with PIs?

A

Take with food to decrease GI intolerance

Co-formulated with PK boosters

Increased risk for CVD

55
Q

What statins are CI with PIs?

A

Simvastatin and lovastatin

56
Q

Which PIs are not recomended for initial HIV tx regimens?

A

Lopinavir/ritonavir & fosamprenavir

57
Q

Examples of PK boosters?

A
  1. Cobicstat
  2. Ritonavir
58
Q

DDI of PK boosters?

A

Inhibition of CYP3A4

59
Q

Counseling of PK boosters?

A
  1. Take with food
  2. Ritonavir is formulated with PI to CYP3A4 inhibiting effect -> less PI ADR
  3. Cobicistat does NOT demonstrate any ART activity
60
Q

Types of CCR5 antagonsit?

61
Q

Maraviroc

ADR, DDI, MP

A

ADR: IRIS, GI intolerance
DDI: Moderate and strong CYP3A4 inhibitors or inducers
MP: LFTs, tropism testing

62
Q

Counseling points of Maraviroc?

A
  1. Take with or without food
  2. No effect on CXCR4
63
Q

Types of fusion inhibitors?

A

Enfuvirtide

64
Q

Enfuvirtide

ADR, Indication, Formulation, Storage

A

ADR: Inj site rx, IRIS
Indication: Treatment-expeirenced patients
Form: SC
Storage: Unused at room temp, refrigerate and use within 24 hrs once reconstituted

66
Q

Types of CD4+ Post-attachment inhibitors?

A

Ibalizzumab-uiyk

67
Q

Ibalizzumab-uiyk

ADR, Indication, Formulation

A

ADR: IRIS, Infusion-related rx
Indication: activity against R-5 tropic, X4-tropic, dual tropic viruses
* Heavily treatment-experienced adults

Indications: IV infusion
* 1 hour after initial infusion. If no reaction occurs, reduce the post-infusion observation time to 15 minutes

68
Q

Gp120 attachment inhibitors?

A

Fostemsavir

69
Q

Fostemsavir

ADR, DDI, Formulation, Idication

A

ADR: Hepatotoxicity, QT prolongation
DDI:CYP3A4 inhibitos and induceers
Formulation: PO ER tablet
Indication: heavily tx-experienced adults

70
Q

Capisid inhibitor?

A

Lenacapavir

71
Q

Lenacapavir

CI, ADR, DDI, Formulation, Indication

A

CI: CYP3A4 inducers
ADR: IRIS and inj site rx
DDI: CYP3A4 inhibitors and inducers
Formulation: PO tablet or LA SC inj
* 2 inj for a complete dose

Indicaation: heavily tx experienced adults

Therapeutics IV (39 decks)

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