HIV/TB Flashcards
1
Q
- TB drugs
- isoniazid
A
* ISsy has your STANDARD (standard tx for latent) TB (#1 TB med) which made her a B(6) who drinks (stop if jaundice) to the point that she can’t feel her hands and feet, even though she shouldn’t (avoid alc)
* Resistance can occur, monitor LFTs, standard tx for latent => take PO daily for 9 months
* Other A/E: optic neuritis, dizziness
* MOA: inhibits synthesis of mycolic acid in CW
2
Q
TB drugs
* rifampin
A
- MOA: inhibits DNA dependent RNA polymerase; broad spectrum for active / semi dormant / latent TB
- Interactions: CP450, contraceptives, NNRTIs (difficult to tx HIV if have a secondary infxn)
- Edu: red-orange discoloration of all body fluids, limit alc, barrier method for birth control (decreases COC effectiveness)
- A/E: hepatotoxic, flu-like symptoms, pruritus
3
Q
TB drugs
* pyrazinamide
A
- MOA: inhibits synthesis of mycolic acid in CW
- A/E: hepatotoxic, non-gouty polyarthraligia, rash
- Contraindications: do NOT give for liver disease pts
- Interactions: CP450 (including warfarin), NNRTIs
- Edu: barrier method for birth control, manage polyarthalgias w/ NSAIDS
- Monitor: LFTs 2 weeks after starting tx
- The POLY PYRamids were built by alcoholic workers so monitor their (C) walls carefully
4
Q
TB drugs
* ethambutol
A
- MOA: inhibits synthesis of mycolic acid in CW
- For: people who have had previous therapy (where resistance might’ve formed)
- Contraindications: do NOT gvie to kids < 8
- Interactions: CP450 (including warfarin), NNRTIs
- Edu: take with food (for GI upset), report vision changes
- A/E: optic neuritis (monitor for vision changes, red-green color discrimination, blurred vision, visual field constriction
* SEE PIC
5
Q
- For HSV / V2V
* acyclovir
A
- MOA: inhibits viral replication by suppressing synthesis of viral DNA
- For: Herpes (recurrent cold sores prophylactically) and varicella (chicken pox if started within 24 hrs of onset) (shingles)
- A/E: PO has few adverse rxns
- Think acyclovir = abreva
- **acyclovir => When your LOVIR gets chickenpox, you want to bring him lots of water (nephrotoxic) and hamburger BUNs **
6
Q
- oseltamirivir (Tamiflu)
A
- Admin: PO or intranasal; give within 48 hrs of symptom onset, take with food
- For: improve S/S and duration of influenza, also used prophylactically
- Interactions: blunts response to flu vaccine (wait 2 days to give live vaccines, and 2 weeks after getting the flu vaccine to start Tamiflu)
7
Q
Influenza Vaccine
A
- Precautions: do NOT take if have a febrile illness, do NOT give live to pregnant or immunocompromised pts
- Contraindications: hypersensitivity to eggs, severe rxn in past, Guillain-Barre syndrome
- Recommendations: > 6 months oold, approved for pregnant and chronic illness patients
- A/E of inactivated vaccine: soreness, fever, Guillain-Barre syndrome (IM or intradermal)
- A/E of live vaccine: flu-like symptoms (intranasal)
- Protection begins 1-2 weeks after vaccine and lasts > 6 months
8
Q
- NRTIs (Nucleoside Reverse Transcriptase Inhibitors)
* abacavir, tenofovir, emtricitabitine (ATE)
A
- MOA: incorporates into viral DNA strand by reverse transcriptase terminating DNA synthesis
- For: HIV
- A/E: hepatic steatosis (fatty degeneration of the liver), lactic acidosis (STOP med), lipoatrophy
*
9
Q
PREP and PEP
A
- PREP: PRe-Exposure Prophylaxis => take 2-24 hrs before high risk exposure for HIV
- PEP: Post-Exposure Prophylaxis => take NO MORE than 72 hrs after exposure
10
Q
NNRTIs (Non-Nucleotide Reverse Transcriptase Inhibitors)
* efanvirez (Sustiva)
A
- MOA: binds directly and non-competitively to reverse transcriptase
- Admin: given daily d/t long half life
- For: HIV
- Contraindications: Preg Cat D (teratogenic)
- Interactions: CP450, contraceptives, St. John’s Wort
- Edu: take on empty stomach at bedtime, barrier method for contraception
- A/E: CNS effects (hallucinations), rash (STOP with severe rash, mild give antihistamines), risk for liver damage
SEE PIC
11
Q
NRTIs vs. NNRTIs
A
SEE PIC
12
Q
Protease inhibitors (Antivirals cont’d)
* lopinavir / ritonavir
A
- MOA: prevents HIV protease enzyme from assembling new viron
- ritonavir BOOSTS effects of lopinavir
- For: HIV, given with at least 2 reverse transcriptase inhibitors
- Contraindications: do NOT give to DM pts (hyperglycemia), cardiac issues (hyperlipidemia)
- A/E: lipodystrophy, hyperlipidemia, hyperglycemia, PR/QT prolongation
- LuPI + RITO like PROTein but its not good for their DM bc they may get diarrhea and that breaks their fat (hyperlipidemia / lipodsytrophy) heart (PR/QT prolongation) so they drink (refridgerate your drinks, monitor LFTs)
13
Q
Integrase inhibitor
* raltegravir
A
- MOA: inhibits integrase which prevents incorporation of viral DNA into host genome
- For: 1st line agent in combo with other antivirals
- Interactions: Double dose of raltegravir if taking with rifampin, PPIs increase drug lvls
- A/E: insomnia, liver failure, hypersensitivity rxn (stop drug if severe aka Steven Johnson syndrome and try diff. combo)
- RALT INTEGRAted Steven (SJS) into their group (1st line in combo) and they partied so hard they don’t sleep and drink (liver damage) so much they wake up with HAs
14
Q
CCR5 Antagonist
* maraviroc
A
- MOA: blocks HIV entry into T cell
- 50-60% of HIV cases are CCR5 trophic (taken in combo always, must confirm HIV strain is CCR5 trophic first)
15
Q
TB drug facts
A
- Admin: Directly observed therapy (DOT), or intermittant dosing (larger doses 2-3 times per week, still efffective)
- Tx if latent: standard tx (isoniazid daily for 9 months) or isoniazid / rifapentine combo for 3 months (not safe for everyone)
- Taking HIV meds and TB meds together can cause immune reconstitution syndrome (IRIS)- inflammatory rxn
