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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
Types of NNRTIs?
1. Doravirine 2. Efavirenz 3. Etravirine 4. Nevirapine 5. Rilpivirne
26
Common ADR of NNRTIs?
IRIS, hypersensitivity
27
ADR of efavirenz?
Psychiatirc sx, CNS effects, elevated serum cholestrol and TG
28
ADR of rilpivirine?
1. Depression (psychiatric effects) 2. Elevated serum cholesterol and TG
29
Which NNRTIs should not be given with strong CYP3A4 INDUCERS?
Rilpivirine or doravirine
30
DDI with rilpivirine?
Antacids disrupt acidic environments (separted from admin)
31
NNRTIs possess a ___-genetic barrier to resistance
Low
32
Counseling when using efavirenz?
Take on an empty stomach at bedtime to decrease CNS effects
33
CI for rilpivirine?
>100,000 copies and <200 CD4
34
Counseling for Rilpivirine?
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
CI for nevirapine?
Treatment naive patients
36
Types of INSTis?
1. Bictegravir 2. Cabotegravir 3. Doltegravir 4. ELvitegravir 5. Raltegravir
37
COmmon ADR of All INSTIs?
IRIS, weight gain, psychiatric effects, elevated cholesterol
38
ADR of cabotegravir?
Inj site rx due to LA injectable form
39
ADR and CI of doltegravir?
Nural tube defects -> CI in pregnancy
40
What INSTis are **NOT** susceptible to CYP metabolism? Why?
Cabotegravir, doltegravir, raltegravir is metabolized by UGT1A1
41
What INSTIs are metabolized by CYP3A4?
Bictegravir and elvitegravir
42
DDI of INSTIs?
Polyvalent cations: adminsiter 2 hrs before or 6 hr after cation product
43
InSTIs possess a ___-genetic barrier to resistance
High
44
Why is it important to look at past med history before using InSTIs?
Doltegravir is associated with CNS/psychiatric effects
45
Types of PIs?
1. Atazanavir 2. Darunavir 3. FOsamprenavir 4. Lopinavir/ritonavir
46
ADRs associated with PIs?
1. Hyperglycemia 2. HLD 3. IRIS 4. GI intolerance 5. Metabolic changes 6. Hepatotoxicity
47
What PIs are associated with increased CVD risk?
Darunavir and lopinovir/ritonavir
48
What PIs are associated with sulfa allergy?
Darunavir and fosamprenavir
49
ADR of atazanavir?
Hyperbilirubinemia
50
ADR of lopinavir/ritonavir?
Disulfiram rx
51
DDI associated with atazanavir?
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
Metabolism of PIs?
CYP3A4 substrates affected by inhibitors
53
Protease Inhibitors (PIs) possess a ___genetic barrier to resistance
high
54
Counseling with PIs?
Take with food to decrease GI intolerance Co-formulated with PK boosters Increased risk for CVD
55
What statins are CI with PIs?
Simvastatin and lovastatin
56
Which PIs are not recomended for initial HIV tx regimens?
Lopinavir/ritonavir & fosamprenavir
57
Examples of PK boosters?
1. Cobicstat 2. Ritonavir
58
DDI of PK boosters?
Inhibition of CYP3A4
59
Counseling of PK boosters?
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
Types of CCR5 antagonsit?
Maraviroc
61
Maraviroc | ADR, DDI, MP
**ADR:** IRIS, GI intolerance **DDI:** Moderate and strong CYP3A4 inhibitors or inducers **MP:** LFTs, tropism testing
62
Counseling points of Maraviroc?
1. Take with or without food 2. No effect on CXCR4
63
Types of fusion inhibitors?
Enfuvirtide
64
Enfuvirtide | ADR, Indication, Formulation, Storage
**ADR:** Inj site rx, IRIS **Indication:** Treatment-expeirenced patients **Form:** SC **Storage:** Unused at room temp, refrigerate and use within 24 hrs once reconstituted
65
66
Types of CD4+ Post-attachment inhibitors?
Ibalizzumab-uiyk
67
Ibalizzumab-uiyk | ADR, Indication, Formulation
**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
Gp120 attachment inhibitors?
Fostemsavir
69
Fostemsavir | ADR, DDI, Formulation, Idication
**ADR:** Hepatotoxicity, QT prolongation **DDI:**CYP3A4 inhibitos and induceers **Formulation:** PO ER tablet **Indication:** heavily tx-experienced adults
70
Capisid inhibitor?
Lenacapavir
71
Lenacapavir | CI, ADR, DDI, Formulation, Indication
**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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