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HIV/TB Flashcards

1
Q

Isoniazid MOA

A

Bactericidal against active TB

Bacteriostatic against dormant TB

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2
Q

Isoniazid Use

A

Latent TB

Active TB 1st line

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3
Q

Isoniazid A/E

A 
Peripheral neuropathy (from B6 deficiency) -MC
N/D
Dizziness
Optic neuritis 
Seizures
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4
Q

Isoniazid Pt edu

A

Take Vit B6 (pyridoxine) to prevent peripheral neuropathy
Limit alcohol intake
Can develop resistance

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5
Q

Isoniazid Toxicity

A

Hepatotoxic
-monitor for anorexia, malaise, yellowing of eye
may need to stop drug

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6
Q

Isoniazid Monitoring

A

SxS of hepatotoxicity
LFTs
Monthly

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7
Q

Direct observation therapy

A

Administration of each dose is carried out in the presence of an observer
By the Health department
Preferred

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8
Q

Intermittent Dosing

A 
Can be done at home
2-3 times a week dosing 
Larger doses but less frequently 
No additional risk for A/E
As effective as daily dosing
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9
Q

Latent TB Standard Tx

A

Isoniazid daily for 9mo - self administered

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10
Q

Latent TB Tx for allergy to Rifampin

A

Isoniazid and Rifapentine once weekly for 3 mo
DOT
Not safe for everyone

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11
Q

Active TB Induction phase

A

Eliminate actively dividing extracellular TB

Rifampin, Isoniazid, Ethambutol, Pyrazinamide x2mo

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12
Q

Active TB Continuation phase

A

Eliminate intracellular “persisters”
Rifampin and Isoniazid x4.5 mo
May last longer

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13
Q

Drug resistant TB

A

Inherent resistance, Development of resistance during tx, Inadequate drug therapy
Tx can be up to 24 mo

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14
Q

TB Tx Goal

A

Cure, prevent spread to others

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15
Q

Rifampin MOA

A

Suppresses RNA synthesis and protein synthesis

Inhibits bacterial DNA- dependent RNA polymerase

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16
Q

Rifampin Use

A

Broadspectrum abx
1st line Active Tb
Kills active and semi-dormant TB

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17
Q

Rifampin Drug interactions

A 
CYP3A4
Warfarin
PO BC
Protease inhibitors
NNRTI 
-All decrease effect of Rifampin
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18
Q

Rifampin A/E

A

Red-orange body fluids (every body fluid, wear glasses because it will stain contacts)
N/V/D
Flu-like symptoms
Pruritus

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19
Q

Rifampin Toxicity

A

Hepatotoxicity

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20
Q

Rifampin Pt edu

A

Use barrier method of sexual protection

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21
Q

Rifampin Monitoring

A

Drug resistance

LFTs

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22
Q

Pyrazinamide Use

A

1st line Active TB

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23
Q

Pyrazinamide A/E

A

Non Gouty polyarthralgias
N/V/D
Rash

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24
Q

Pyrazinamide Toxicity

A

Hepatotoxic

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25
Q

Pyrazinamide Contraindications

A

Liver disease

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26
Q

Pyrazinamide Pt edu

A

Limit alcohol

Manage polyarthralgias with NSAIDS (ibuprofen or aspirin)

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27
Q

Pyrazinamide Monitor

A

LFTs

-before and 2 weeks after

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28
Q

Ethambutol MOA

A

Bacteriostatic- stops from reproducing

Suppresses incorporation of mycolic acid in the cell wall

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29
Q

Ethambutol Use

A

1st line active TB
Previously treated with other drugs
Resistant to Isoniazid and/or Rifampin

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30
Q

Ethambutol A/E

A 
Optic neuritis (blurred vision, constriction of visual field, disturbance of color)
-especially in children
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31
Q

Ethambutol Contraindications

A

Children under 8 - due to optic neuritis

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32
Q

Ethambutol Pt edu

A

Monitor vision changes

Take food if GI upset

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33
Q

Ethambutol Monitoring

A

Monthly
Blurred vision
Color discrimination
Visual field disturbances

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34
Q

TB and HIV considerations

A

May require longer durations of treatment
At risk for developing immune reconstitution syndrome (IRIS) - exaggerated inflammatory response (another infection)
Drug interactions

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35
Q

TB Vaccine

A

BCG: only given in countries with high rates of TB and only given to children, once given, they will always test positive on a PPD

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36
Q

Efavirenz interaction with Rif

A

Least interactions

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37
Q

Protease inhibitors interaction with Rif

A

Replace Rif with Rifabutin

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38
Q

Raltegravir interaction with Rif

A

Increase dose of Raltegravir

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39
Q

Dolutegravir interaction with Rif

A

Increase Dolutegravir frequency

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40
Q

Maraviroc interaction with Rif

A

Increase Maraviroc dose

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41
Q

Acyclovir MOA

A

Inhibits viral replication by suppressing synthesis of viral DNA
Activation of acyclovir to acycloguanosine monophosphate (GMP) by thymidine kinase (GTP), the compound directly responsible for inhibiting DNA synthesis

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42
Q

Acyclovir Use

A

1st line for HSV, VZV
HSV type 2
Prophylaxis in immunocompromised pts
Not a cure, only treatment of symptoms as they happen

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43
Q

Acyclovir A/E IV

A

Phlebitis

Inflammation

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44
Q

Acyclovir A/E PO

A

N/V/D
HA
Vertigo

45
Q

Acyclovir A/E Topical

A

Local burning/stinging

46
Q

Acyclovir Toxicity

A 
Nephrotoxicity 
Neurotoxicity (agitation, tremors, delirium, hallucinations, myoclonus, delirium, coma
47
Q

Influenza Vax Types

A

Inactive- most common
Recombinant- not made with egg
Live attenuated- nose spray

48
Q

Influenza Vax Protection

A

Begins 1-2 weeks after vax

Last 6 mo

49
Q

Influenza Vax Use

A

Anyone greater than 6 mo old
Pregnant- only inactivated
Children 2-8 need to get it 2 times to be effective

50
Q

Influenza Vax A/E Inactivated

A 
Soreness at site
Fever
Myalgia
Malaise
Guillain-barre syndrome
51
Q

Influenza Vax A/E Live

A 
Runny nose
Congestion
Sore throat/ cough 
HA
Fever
Myalgia
52
Q

Influenza Vax precautions

A

Do not vaccinate person who is acutely ill (fever greater than 100)
Can vaccinate person who is minor illness (fever less than 100)

53
Q

Influenza Vax Contraindications

A

Hypersensitivity to eggs - inactivated
Severe reaction to influenza vax in the past
Guillain-barre syndrome

54
Q

Oseltamivir Use

A

Can improve symptoms and duration of flu A/B
Not for sx past 48hr
Can be prophylaxis

55
Q

Oseltamivir A/E

A 
N/V
Hypersensitivity reaction
Anaphylaxis 
Rash
Neuropsychiatric effects (hallucinations in children)
56
Q

Oseltamivir Drug interaction

A

Blunts vax response

D/C: 2 days before live vax and for 2 weeks after vax

57
Q

Oseltamivir Pt edu

A

Take with food for N/V

58
Q

Nucleoside Reverse Transcriptase Inhibitors (NRTI) Drugs

A

Abacavir
Tenofovir
Emtricitabine

59
Q

NRTI MOA

A

Incorporates into viral DNA strands by reverse transcriptase terminating DNA synthesis
Blocks enzyme of HIV it needs to make copies of itself
Prevents DNA strands from growing

60
Q

NRTI

61
Q

NRTI A/E

A 
Hepatosteatosis (mitochondrial breakdown of fatty acids and deposited onto the liver) 
Lactic acidosis (mitochondrial breakdown- Vs, and ABG monitoring, Nausea, fatigue, respiratory acidosis) 
Lipoatrophy (redistribution of fat in the shoulder blades, face and neck)
62
Q

Abacavir A/E

A

Hypersensitivity reaction

63
Q

Abacavir Drug interaction

A

Ganciclovir/Valganciclovir

64
Q

Abacavir Testing done before treatment

A

HLA-B*5701 genetic testing

65
Q

NRTI Monitoring

66
Q

Tenofovir A/E

A

Osteomalacia
Renal insufficiency
N/V

67
Q

Tenofovir Drug interactions

A

Didanosine

68
Q

Tenofovir Nursing considerations

A

Adjust dose for renal impairment

Already has a phosphate group attached

69
Q

Tenofovir Monitoring

A

Cr clearance

70
Q

Emtricitabine A/E

A

Hyperpigmentation of hands and soles of feet

71
Q

Emtricitabine Drug interaction

A

Lamivudine

72
Q

Emtricitabine Nursing considerations

A

Adjust dose for renal impairment

73
Q

Emtricitabine Monitoring

A

Cr clearance

74
Q

Test for HIV pt before starting Tx

A 
CD4 count 
Plasma HIV RNA (viral load)
Genotype resistant test 
Hep A, B, C
STIs
75
Q

Initial phase of HIV

A

High rate of replication

Experience flu-like acute retroviral symptoms

76
Q

Middle phase of HIV

A

Can be up to 10 years
Prolonged clinical latency
Low HIV blood levels
Asymptomatic

77
Q

Latent phase of HIV

A

CD4 levels typically fall below 200
AIDS and opportunistic infections more likely to occur
Peripheral neuropathy
CNS problems

78
Q

HIV Goals

A 
Reduce HIV associated morbidity 
Prolong the duration and quality of life 
Suppress HIV viral load
Restore and maintain immune function
Prevent transmission 
No cure
79
Q

Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI) Drug

80
Q

Efavirenz MOA

A

Binds directly and non-competitively to reverse transcriptase, blocking DNA polymerase activity
Blocks DNA as it activates
Prevents DNA strand altogether

81
Q

Efavirenz Use

A

1st line therapy for HIV

82
Q

Efavirenz A/E

A

Rash
Increased liver enzymes
CNS effects (vivid dreams/ nightmare)
Dizziness/drowsiness with food

83
Q

Efavirenz Toxicity

A

Hepatotoxicity

84
Q

Efavirenz Drug interactions

A

CYP3A4
BC
St. John Wort

85
Q

Efavirenz Contraindication

86
Q

Efavirenz Pt edu

A

Take on empty stomach at bedtime

Use barrier method of protection of contraception

87
Q

Efavirenz Monitoring

88
Q

NNRTIs

A

Not structurally related to nucleoside
Active when administered
Take on empty stomach
X preggo

89
Q

NRTIs

A 
Chemically related to nucleoside and nucleotide 
Intracellular conversion
Fewer drug interactions
W/wo food 
✔︎ preggo
90
Q

Protease inhibitor Drug

A

Lopinavir/Ritonavir

91
Q

Protease inhibitor MOA

A

Prevents HIV protease enzyme from cleaving polyprotein into individual proteins responsible for assembling new viron
Prevents budding off and infeeting new cells

92
Q

Protease inhibitor A/E

A

GI effects N/V/D
Increased bleeding with hemophilia
Lipodystrophy
Hyperlipidemia
Hyperglycemia- new onset DM ~ 2 mo after start of tx
Increased serum transaminases - liver injury

93
Q

Protease inhibitor Drug interactions

A

CYP3A4
-Statins: use something else to control HLD
Usually given with 2 reverse transcriptase inhibitors which is part of antiretroviral management

94
Q

Protease inhibitor Use

95
Q

Lopinavir/Ritonavir MOA

A

Lopinavir is active

Ritonavir boosts effects of lopinavir

96
Q

Lopinavir/Ritonavir A/E

A

Diarrhea

PR/QT prolongation (AV block/ Torsades de Pointes)

97
Q

Lopinavir/Ritonavir Drug interactions

A

BC
Disulfiram
Metronidazole

98
Q

Lopinavir/Ritonavir Contraindication

A

Those who have a HST of heart problems and or take drugs that cause heart problems (zofran)

99
Q

Lopinavir/Ritonavir Pt edu

A

Take with food

Refrigerate

100
Q

CCR5 Antagonist Drug

101
Q

Maraviroc MOA

A

Blocks entry into the cell

102
Q

Maraviroc Use

A

Must have genotype testing done for CCR5 trophic (HIV strain must have CCR5 trophic before initiation)
Must be combined
BID
Mostly used when other resistance

103
Q

Integrase inhibitor Drug

A

Raltegravir

104
Q

Raltegravir MOA

A

Inhibits integrase, preventing incorporation of viral DNA into hose genome
Metabolized by uridine diphosphate glucuronosyltransferase

105
Q

Raltegravir Use

A

1st line in combo for HIV

Resistant strains

106
Q

Raltegravir A/E

A

Insomnia
HA
Hypersensitivity reaction (SJS)

107
Q

Raltegravir Drug interactions

A

PPI: Increase plasma drug level
Rifampin: Would have to double dose of Rifampin

108
Q

Raltegravir Toxicity

A

Hepatotoxicity

109
Q

Raltegravir Monitoring

Final HIV/TB (1 decks)

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