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NAPLEx > HIV (last infection disease section) > Flashcards

HIV (last infection disease section) Flashcards

1
Q

OraQuick

A

in-home HIV test, OTC
use after 3 months of exposure… minimum

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2
Q

stage 1: bindin/attachment

A

HIV attaches to a CD4 receptor and CCR5 and/or CXCR4.

CCR5 antagonist: Maraviroc
attachment inhibitor: fostemsavir
post-attachment inhibitor:
ibalizumab-uiyk

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3
Q

stage 2: fusion

A

HIV viral envelope fuses with he CD4 cell membrane. HIV enters the host cell and releases HIV RNA, viral proteins and enzyme needed for replication

Fusion inhibitor: enfuvirtide

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4
Q

stage 3: Reverse Transcription

A

HIV RNA is conveted to the HIV DNA by reverse transcriptase.. HIV DNA can enter the CD4 cell nucleus

nucleoside reverse transcriptase inhibitors (NRTIs): emtricitabine, tenofovir, etc.

non-nucleoside reverse transcriptase inhibitors (NNRTIs): efavirenz, rilpivirine, etc.

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5
Q

stage 4: integration

A

once inside the CD4 cell nucleus integrase is released and used to insert HIV DNA into the host cell DNA

integrase strand transfer inhibitors (INSTIs): bictegravir, dolutegravir, raltegravir

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6
Q

stage 5: replication

A

host ell machinery is used to transcribe and translate HIV DNA into HIV RNA

no med

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7
Q

stage 6: assembly

A

New HIV RNA assembled into a immature HIV

no med

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8
Q

Stage 7: budding and maturation

A

immature HIV pushes out of the CD4 and protease breaks up the long viral protein chain creating mature virus that can infect other cells

protease inhibitors: atazanavir, darunavir

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9
Q

Biktarvy

A

Bictegravir/ Emtricitabine/ Tenofovir alafenamide

one pill daily

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10
Q

Triumeq

A

Dolutegravir/ Abacavir/ Lamivudine

one pill daily

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11
Q

Dovato

A

Dolutegravir/ Lamivudine

one pill daily

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12
Q

Tivicay +
Truvada

A

Dolutegravir +
Emtricitabine/ Tenofovir disoproxil fumarate

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13
Q

Tivicay +
Descovy

A

Dolutegravir +
Emtricitabine/ Tenofovir alafenamide

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14
Q

Most preferred regiments contain

A

2 NRTIs 1 INSTI

Truvada or Descovy make up the NRTI backbone in most regiments

Lamivudine and emtricitabine are interchangeable but should not be used together

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15
Q

Davato (1 NRTI and 1 INSTI)

A

an exception to above
- do not use in tx naive pt if HIV RNA >500,000 copies/ml,
- there is a known hep B co-infection (or status unknown)
- or HIV genotypic test is not yet available

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16
Q

Trimeq contains abacavir

A

extra testing is required

test for HLA-B*5701 allele before using. A positive result indicates a higher risk for a severe hypersensitivity reaction (HSR) and any abacavir- containing product is contraindicted

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17
Q

Fixed- dose

A

combo have less flexibility with renal dosing
Biktarvy, triumeq, dovato, truvada, descovy: do not use if CrCl <30 ml/min

except for biktarvy, individuals components of these drugs can be given separately to allow for more flexible renal dose adjustment

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18
Q

Alternative ART regiments

A

one “base” plus two NRTs to serve as the “backbone”
the “base” can be, PI, an NNRTI, or an INSTI

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19
Q

Alternative ART regiment
PI-based (boosted w/cobicistat or ritonavir)

A

Darunavir or atazanavir

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20
Q

Alternative ART regiments
NNRTI-based

A

Efavirenz or rilpivirine

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21
Q

Alternative ART regiments
INSTI-based

A

Elvitegravir (only available in combo products)
Raltegravir

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22
Q

Alternative ART regiments
NRTI backbone?

A

TDF or TAF or abacavir PLUS
Emtricitabine or lamivudine

TDF= tenofovir disoproxil fumarate
TAF= tenofovir alafenamide

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23
Q

Alternative ART regiments
complete regimen examples

A

Rilpivirine + TDF + emtricitabine
Raltegravir + TAF + emtricitabine

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24
Q

abacavir

A

ziagen
screen for HLA-B*5701
pt must carry med card for HSR
never rechallenge pt w/ history of HSR
consider avoid in CVD pt due to increased risk of MI
all NRTIs except abacavir require renal dose adjustment
- NRTIs

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25
Q

Emtricitabine

A

Emtriva
hyperpigmentation of the palms of the hands and soles of the feet
- NRTIs

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26
Q

Lamivudine

A

Epivir
- NRTIs

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27
Q

Tenofovir alafenamide

A

TAF
only in combo products for HIV;
Vemlidy is a single-entity product for HBV

renal impairment, dose adjust with other renal toxic drugs,
can decrease bone mineral density consider calcium/vitamin D supplement and DEXA scan if at risk

monitor lipid if switching from TDF to TAF
- NRTIs

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28
Q

Zidovudine

A

Retrovir
hematologic toxic: neutropenia and anemia (increased MCV is a sign of adherence)
myopathy SE
- NRTIs

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29
Q

NRTIs general info

A

warning: lactic acidosis and hepatomegaly with steatosis (fatty liver)
SE: nausea, diarrhea, headache, increased LFTs

Severe acute HBV exacerbation can occur if emtricitabine, lamivudine, or tenofovir-containing products are D/C (some NRTs tx HBV)
do now use epivir-HBV to tx HIV (low dose of lamivudine)

30
Q

Bictegravir

A

only in combo with Biktarvy
renal <30 ml/min do not start Biktarvy or Genvoya
increases SCr
- INSTIs

31
Q

Dolutegravir

A

Tivicay
increases SCr
hypersensitivity reaction (HSR) w/ severe rash and organ dysfunction, including hepatotoxicity
small risk of neural tube defects in developing fetus (still preferred drug for HIV tx during prego)
increased CPK and myalgia
- INSTIs

32
Q

Elvitegravir

A

only in combo, Genvoya and Stribild
CrCl< 70ml/min do not start Stribild
CrCl<50ml/min d/c Stribild

proteinuria
- INSTIs

33
Q

Raltegravir

A

Isentress, Isentress HD
increased CPK, myopathy, and rhabdo
- INSTIs

34
Q

All - INSTIs general

A

headache, insomnia, diarrhea, weight gain, rare risk of depression, and suicidal ideation in pt with pre-existing psychiatric condition (except bictegravir)

Take INSTIs 2hrs before or 6hrs after: aluminum, calcium, mag, or iron-containing products
Dolutegravir and bictegravir can be taken with oral calcium or iron if taken w/food
dose separation with raltegravir may not be effective, avoid polyvalent cations if possible

35
Q

Efavirenz

A

Sustiva
- psychiatric symptoms (depression, suicidal thoughts)
- CNS effects (impaired concentration, abnormal dreams, confusion), generally resolve in 2-4 weeks
- increases total cholesterol and triglycerides
-NNRTIs

36
Q

Rilpivirine

A

Edurant
- depression
- increased SCr w/ no effect on GFR
- do not use if viral load >100,000 copies/ml and/or CD4 count <200 cells (higher failure rate)

DO NOT USE WITH PPIs
Separate H2RAs at least 12hrs before or 4hrs after rilpivirine
-NNRTIs

37
Q

Doravirine
Etravirine
Nevirapine

A

Pifeltro
Intelence
Viramune XR
-NNRTIs

38
Q

NNRTIs general

A

hepatotoxicity and rash/severe rash, including SJS/TEN: highest risk with nevirapine

all NNRTIs major cyp3A4 substrate
Rilpivirine and doravirine: do not use with strong cyp3A4 inducer (carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, rifapentine, st. john’s wort)

38
Q

Doravirine
Etravirine
Nevirapine

A

Pifeltro
Intelence
Viramune XR
NNRTI

39
Q

Atazanavir

A

Reyataz
hyperbilirubinemia (bananavir)
requires acid for absorption
- antacids 2hrs before or 1hr after
- H2RAs avoid or 2hrs before or 10 hrs after
- PPIs avoid with unboosted atazanavir, take boosted at least 12hrs after (do not exceed 20mg of omeprazole or equivalent)
- PIs

40
Q

Darunavir

A

Prezista
sulfa allergy
- PIs

41
Q

Fosamprenavir

A

Lexiva
sulfa allergy
- PIs

42
Q

Lopinavir/ritonavir

A

Kaletra
ritonavir is a booster
oral solution contains 42% alcohol: can cause disulfiram reaction if taken with metronidazole
- PIs

43
Q

Saquinavir

A

Invirase
- PIs

44
Q

Tipranavir

A

Aptivus
sulfa allergy
intracranial hemorrhage
- PIs

45
Q

PIs general

A

decrease HDL, increase LDL and TG
increase CVD
hepatic dysfunction
hypersensitivity reaction (SJS/TENS)
increase BG
insulin resistance
abdominal adiposity

46
Q

PIs CYP

A

cyp3A4
do not use with:
- alfuzosin
- colchicine
- dronedarone
- lova and simva (rosuva and atorva preffered)
- inducers (carbamazepine, phenytoin, rifampin, st. john’s wort
- direct-acting antivirals for hep C
- hormonal contraceptives
- steroids

47
Q

ritonavir

A

Norvir
with food, oral solution contains 43% alcohol
strong inhibitor of cyp3A4, cyp2D6, some OAT family and P-gp transporter
- boosters

48
Q

cobicistat

A

tybost
with food
strong inhibitor of cyp3A4, cyp2D6, some OAT family and P-gp transporter
- boosters

49
Q

Maraviroc

A

Selzentry
CCR5 antagonist
- Entry and attachment inhibitor

50
Q

Fostemsavir

A

Rukovia
attachment inhibitor
- entry and attachment inhibitor

51
Q

ibalizumab-uiyk

A

trogarzo- IV
post-attachment inhibitor
- entry and attachment inhibitor

52
Q

Enfuvirtide

A

Fuzeion
fusion inhibitor
- entry and attachment inhibitor

53
Q

bictegravir/ emtricitabine/ tenofovir alafenamide

A

biktarvy
- INSTI- based

54
Q

Dolutegravir/ abacavir/ lamivudine

A

Triumeq
- INSTI- based

55
Q

Dolutegravir/ lamivudine

A

Dovato
- INSTI- based

56
Q

Elvitegravir/ clobistat/ emtricitabine/ tenofovir disoproxil fumarate

A

Stribild
- INSTI- based

57
Q

Elvitegravir/ cobicistat/ emtricitabine/ tenofovir alafenamide

A

Genvoya
- INSTI- based

58
Q

Efavirenz/ emtricitabine/ tenofivr disoproxil fumarate

A

Atripla
- NNRTI- based

59
Q

Rilpivirine/ emtricitabine/ tenofovir disoproxil fumarate

A

Complera
- NNRTI- based

60
Q

Rilpivirine/ emtricitabine/ tenofovir alafenamide

61
Q

Abacavir/ lamivudine

A

Epzicom
- NRTI combo

62
Q

Emtricitabine/ tenofovir alafenamide

A

Descovy
- NRTI combo

63
Q

Emtricitabine/ tenofovir disoproxil fumarate

A

Truvada
- NRTI combo

64
Q

Prego NRTI combo

A
  • abacavir/ lamivudine
  • Tenofovir disoproxil fumarate/ emtricitabine
  • tenofovir disoproxil fumarate/ lamivudine
65
Q

prego INSTI

A
  • raltegravir
  • Dolutegravir
66
Q

Boosted PI

A
  • atazanavir+ ritonavir
  • Darunavir + ritonavir
67
Q

PrEP

A

before high-risk activity
1 oral drug taken daily, truvada or descovy

68
Q

PEP

A

after HIV- exposure within 72 hrs taken for 28 days
Truvada (if CrCL >60) +
Dolutegravir (Tivicay) or
Raltegravir (Isentress)

69
Q

prego and HIV

A

zidovudine to prevent HIV transmission to infant
- NRTI

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