Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacotherapy > HIV - Opportunistic Disease > Flashcards

HIV - Opportunistic Disease Flashcards

1
Q

Goal for HAART therapy

A

Reduce HIV-associated morbidity and prolong the duration and quality of survival

Restore and preserve immunologic function

Preserving future therapeutic options

Maximally and durably suppress plasma HIV viral load
(< 20 copies/mL)

Prevent HIV transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Truvada = and dosing

A

tenofovir (TDF) + emtricitabine

QD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Descovy = and dosing

A

tenofovir (TAF) + emtricitabine

QD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Epzicom = and dosing

A

abacavir + lamivudine

QD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Combivir = and dosing

A

zidovudine 300 mg + lamivudine 150 mg

BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Integrase Strand Transfer Inhibitors (INSTI) list of drugs

A

raltegravir (Isentress) – RAL
elvitegravir (STRIBILD STR only) – EVG
dolutegravir (Tivicay) – DTG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

raltegravir (Isentress) - RAL

A

400mg BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

elvitegravir (STRIBILD STR only) – EVG

A

150 mg QD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

dolutegravir (Tivicay) – DTG

A

50 mg QD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Protease Inhibitors list of drugs and what should remember about PI?

A

atazanavir (Reyataz) – ATV
darunavir (Prezista) – DRV
ritonavir (Norvir) – RTV or r

Most associated with long-term side effects compared to other HIV antivirals
SE includes elevated TG and LDL, insulin resistance, increase fat accumulation , nephrotoxicity (kidney stone), GI disturbances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

atazanavir (Reyataz) – ATV

A

300 mg QD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

darunavir (Prezista) – DRV

A

800 mg QD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ritonavir (Norvir) – RTV or r

A

100 mg QD
Booster of protease inhibitors
TAKE WITH FOOD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Non-Nucleoside Reverse Transcriptase Inhibitors

A

efavirenz (Sustiva) – EFV

rilpivirine (Edurant) – RPV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

efavirenz (Sustiva) – EFV

A

600mg QD
Empty stomach (or low-fat snack)
At bedtime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

rilpivirine (Edurant) – RPV

A

25 mg QD

With at least 400 kcalories!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Initial treatment for HAART (backbone)? not drugs list

A

Recommended Initial Regimens for Most People with HIV:

2 NRTIs + 1 INSTI (“Backbone”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

5 Recommended Initial Regimens for Most People with HIV

A 
Triumeq
Tivicay + Truvada or Descovy
Stribild
Isentress + Truvada or Descovy
Genvoya
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Genvoya QD

A

elvitegravir, cobicistat, tenofovir AF, emtricitabine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Stribild QD

A

elvitegravir, cobicistat, tenofovir DF, emtricitabine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Triumeq QD

A

dolutegravir, abacavir, lamivudine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Follow-up for HIV patients

A

Follow-up in 2-4 weeks from starting HAART

  • Adherence
  • Side effects, tolerability, ADRs
  • Transmission prevention
  • Lab work

Routine follow-up every 3 months
Possibly every 6 months for patients with suppressed viral load and stable immunologic status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Efavirenz-Associated CNS Adverse Effects

A 
Primary ADRs are related to CNS:
Dizziness
Confusion
Impaired concentration
Insomnia
Abnormal dreams
Irritability
Depression

Taken QHS so as to sleep off CNS side effects

Empty stomach to reduce CNS side effects

High fat meal will significantly increase drug absorption and therefore increase side effects

Alcohol can potentiate CNS side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Genotypic Resistance Testing

A

Mutations within genes that code for proteins (enzymes) that are target of antiretroviral drugs

Valid ONLY for meds being given at the time of test

Resistant strains become “minority species” when drug pressure removed

Ideally test while ON medication

Archived resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Ritonavir (Norvir®, RTV)

A

The “Booster”

Boosting dose: 100 mg with PI with food

MANY drug interactions

Hepatotoxicity

Lipid abnormalities:
Elevated triglycerides and LDL
Monitor frequently
Pre-existing abnormality may not be a reason to avoid

26
Q

Metabolic Complications of HAART

A 
Associated with long-term antiretroviral use:
Lipid abnormalities
Lipodystrophy
Hyperglycemia
Decreased bone mineral density
27
Q

Drug Interaction (Ex: lipid-lowering agent)

A

Ritoravir - Rosuvastatin and Atorvastatin

Simvastatin level increase significantly with PI use

28
Q

Pneumocystis jiroveci pneumonia or Pneumocystis carinii pneumonia (PCP)

A

Gradual onset
Fever (Temp >38.1°)

Tachypnea

Chest exam may be normal (50%) if ↓air movement
Ronchi
Crackles

Radiologic manifestations differ from CAP or HAP

29
Q

Toxoplasmosis and 3 clinical syndrome associate

A

Parasite: Toxoplasma gondii

Encephalitis/cerebral abscess
Headache
Fever
Mental status changes

Pneumonitis
Fever
Dyspnea
Cough

Chorioretinitis
Eye pain
Decreased visual acuity

30
Q

Mycobacterium avium complex (MAC)

A 
Disseminated Infection
Fever
Night sweats
Abdominal pain
Diarrhea
Weight loss
Elevated alkaline phosphase, LDH

Localized infection
Lymphadenopathy
Fever

31
Q

Treatment for PCP for HIV patient

A

Bactrim DS QD or Dapsone 100mg QD

G6PD Deficiency

32
Q

Treatment for Toxoplasmosis for HIV patient

A

Bactrim DS QD

33
Q

Treatment for MAC for HIV patient

A

Azithromycin 1200mg Qweek

34
Q

Opportunistic Infections in the HIV-Immunocompromised Host

A

PCP
MAC
Toxoplasmosis
Oral (thrush), oropharyngeal, & vaginal candidiasis

Disseminated infection:
Cryptococcal meningitis
Histoplasmosis
Blastomycosis

35
Q

Cervical Abnormality in HIV patients

A

Increased risk of invasive cervical cancer

Screening
PAP testing Q 6 months during first year of diagnosis
PAP testing yearly if stable
PAP testing Q 6 months if CD4 <200

36
Q

Menstruation and birth control in HIV patient

A

Earlier onset of menopause
Osteoporosis increase
Heart disease increase

Interruption in menstrual cycle
Hormone production

Oral contraceptives
Interaction with ethinyl estradiol; PI may decrease EE
Depo-Provera OK

37
Q

TAF, TFV and TDF

A

TAF is an oral prodrug of tenofovir
TAF converted to TFV, and then to TFV-diphosphate intracellularly
TFV: nephrotoxic
TDF: readily converts to TFV in plasma after absorption
TAF remains stable in plasma resulting in lower plasma and higher intracellular concentrations

TAF MOA in ppt

38
Q

Hepatitis C in HIV patients

A

HIV increases HCV replication and progression
Hepatotoxicity & antiretrovirals

Test for HCV initially and Q year

HCV viral load & LFTs to monitor progression in patients that are co-infected

39
Q

Rilpivirine (in Complera®) & Acid-Reducing Agents

A

Antacids
Give antacid at least 2 hours before or at least 4 hours after RPV

H2RAs
Give H2RA at least 12 hours before or at least 4 hours after RPV

PPIs
CONTRAINDICATED: Do no co-administer

40
Q

Primary prophylaxis for PCP for HIV patients

A

Must confirm G6PD Deficiency
If G6PD deficient:
THEN
Atovaquone suspension 1500mg QD

If G6DP is not deficient:
THEN
Dapsone 100mg QD (or 50mg BID)

41
Q

Primary Prophylaxis for Toxoplasmosis for HIV patient

A

Dapsone alone does not cover Toxo

Dapsone 50mg QD + pyrimethamine 50mg Q week + leucovorin 25mg PO weekly
OR
Dapsone 200mg + pyrimethamine 75mg + leucovorin 25mg PO Q week
OR
Atovaquone 1500mg PO QD

42
Q

Atazanavir (Reyataz) & ARAs

A

Antacids
Give ATV at least 2 hours before or 1 hour after antacids

H2RAs
Do not exceed famotidine 40mg BID in naïve pts
Give ATV 300mg + RTV 100mg simultaneously with and/or ≥ 10 hours after H2RA

PPIs
Do not exceed omeprazole 20mg QD in naïve pts
Should be given at least 12 hours before ATV/r

43
Q

FYI: Precautions for Atazanavir

A 
Transient hyperbilirubinemia
Increase in indirect (unconjugated) bilirubin (avg: 0.3-0.5 mg/dL)
Reversible upon discontinuation
Inhibition of UDP glucuronyl transferase
Liver unable to conjugate
Scleral icterus
Jaundice
Typically resolves within 2 months

Nephrolithiasis and cholelithiasis have been reported
Consider temporary interruption or discontinuation
Hydration

Possible PR interval prolongation

44
Q

FYI: Precautions for Darunavir

A 
Has a sulfa moiety
Use in caution in patients with a known sulfonamide allergy
NOT a contraindication for use
Drug-induced hepatitis
Monitor LFTs before and during therapy
Skin reactions
Stevens-Johnson Syndrome
Toxic Epidermal Necrolysis
Discontinue use if severe reaction develops
45
Q

Cobicistat precautions

A

Cobicistat is a pharmacokinetic booster with NO antiretroviral activity

It is a potent CYP3A4 inhibitor

Inhibits renal tubular secretion of creatinine

SCr will return to baseline after cobicistat discontinuation

DO NOT initiate COBI if Est CrCl < 70 mg/dL

DISCONTINUE COBI if Est CrCl < 50 mg/dL
Separate STRIBILD and antacids by 2 hours (due to elvitegravir)

46
Q

Tivicay® (dolutegravir) and Triumeq®

A

Tivicay (dolutegravir) may be taken with or without food

Tivicay should be taken 2 hours before or 6 hours after taking cation-dontaining antacids or laxatives, sucralfate, oral supplements containing iron or calcium, or buffered medications.

ALTERNATIVELY: Tivicay and supplements containing calcium or iron can be taken together with food.

47
Q

CD4 at which to initiate prophylaxis for PCP

A

<200 cells/mm^3

48
Q

CD4 at which to initiate prophylaxis for Toxoplasmosis

A

<100 cells/mm^3

49
Q

CD4 at which to initiate prophylaxis MAC

A

<50 cells/mm^3

50
Q

CD4 at which to discontinue prophylaxis for PCP

A

> 200 cells/mm^3 for 3 months or longer

51
Q

CD4 at which to discontinue prophylaxis for Toxoplasmosis

A

> 200 cells/mm^3 for 3 months or longer

52
Q

CD4 at which to discontinue prophylaxis for MAC

A

> 100 cells/mm^3 for 3 months or longer

53
Q

Diarrhea and HIV antivirals

A

“Break-in” period
Almost all medications

Concern for dehydration, weight loss
Calcium supplements (Tums)

Pharmacologic therapies
Loperamide (Immodium®)
Diphenoxylate/atropine (Lomotil®)

Tips for patients
Eat foods high in soluble fiber (oatmeal, bananas, bread)
Avoid milk products
Avoid greasy foods
Plenty of fluids
54
Q

Patterson’s Diarrhea Treatment Plan

A

Tums (calcium carbonate) regular or extra-strength
Take 2 tablets every 6 hours as needed
(Skip Step 1 if you are taking Reyataz® (atazanavir) or Viracept® (nelfinavir))

IF THAT DOESN’T WORK add…
Fibercon (calcium polycarbophil)
Take 1 tablet twice daily

IF THAT DOESN’T WORK add…
Imodium A-D (loperamide 2mg)
Take 2 capsules (4mg) now, then 1 every 4-6 hours as needed
(16 mg/day max)

55
Q

Antihypertensives & Protease Inhibitors

A

Verapamil, diltiazem
PIs increase drug levels, cautious use
->Increased antihypertensive effect

Peripherally acting CCBs okay to use
Amlodipine

56
Q

How to handle a missed dose for HIV drugs

A

Once daily and Twice daily:
If you miss a dose by less than 6/12 hours, take your missed dose right away. Then take your next dose at your regularly scheduled time.
If you miss a dose by more than 6/12 hours, wait and then take the next dose at your regularly scheduled time.
Do not take two doses at the same time to make up for a missed dose.

57
Q

FYI: HIV Resistance Differs By Drug Class

A

NNRTIs & NRTIs:

  • Efavirenz and several NRTIs have low barrier for resistance
  • K103N mutation: all it takes to render efavirenz and nevirapine useless
  • M184V mutation: all it takes to render emtricitabine or lamivudine useless
  • Cross resistance possible

Protease Inhibitors:
-Unboosted protease inhibitors have resistance similar to NNRTIs and NRTIs
-Boosted protease inhibitors have high degree of forgiveness1
-May take several major mutations to confer resistance
-May take combination of major and minor mutations to confer resistance
Selective non-adherence to ritonavir is common2

58
Q

Abacavir (Ziagen®, ABC)

A

300mg BID or 600mg QD with or without food

Hypersensitivity Reaction
Fever
N/V
Malaise
Myalgia/arthralgia
Rash

First 2 months of therapy, gradual worsening of symptoms with each dose –>Do NOT re-challenge, next reaction could be FATAL
HLA-B*5701 allele test

59
Q

HIV Pre-Exposure Prophylaxis (PrEP)

A

A biomedical intervention to prevent HIV infection in HIV-negative people.

1 tablet of Truvada taken every day
Truvada approved for PrEP in 2012

PrEP guideline in ppt

60
Q

Truvada Medication Information

A

Dosing: one tablet by mouth once daily

Contraindications: unknown or positive HIV-1 status, monotherapy for HIV-1 infection

Precautions: hepatitis B virus co-infection, lactic acidosis, autoimmune disorders, osteomalacia

Mechanism of action: blocks virus from establishing infection
Inhibition of HIV-1 reverse transcriptase

Pregnancy category: B

Safe in pregnant patients if benefit outweighs risk

Breast Feeding: Infant risk cannot be ruled out

Dietary modifications: none, take with or without food

Side Effects: upset stomach, headache, vomiting, loss of appetite

Initial lab work:
HIV test, CMP, Hepatitis B & C serology, STI screening
Routine monitoring every 3 months
Rapid HIV test (ELISA)
Antibodies can take 3 to 6 months to develop
Kidney function (BMP)

PrEP affordability in ppt

Pharmacotherapy (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions