HIV treatments Flashcards
Zidovudine
Give to a woman who is pregnant if she is HIV positive
How often do you test a healthcare worker exposed to needlestick
test at baseline, 6 weeks, 3 months, and 6 months.
This is in contrast to a patient who is tested before therapy and then every 3 to 6 months.
What tx to give to an exposed healthcare worker
Tenofovir + emtricitabine + dolutegravir OR raltegravir
(triple therapy)
ralte = rally or Dolute = dilute,
Teno = Tense, + Emtric = Trick2G
Tense Trick2G rally or Tense Trick2G dilute
What to give HIV positive if they test positive for TB?
Check CXR, start on isoniazid and pyridoxine 9-12 months
If CXR is pos for infiltrates, start four drug therapy under ID specialist
isoniazid = ice on a
Pyridoxine = Fire
Fire and Ice
What is HAART?
combination therapy with at least three meds from two different classes to avoid resistance
NRTI
abacavir, emtricitabine, lamivudine, zidovudine (retrovir)*, tenofovir
memorize abcavir, zidovudine (preg), tenofovir (PReP), emtricitabine
NNRTI
Efavirenz, etravirine, nevirapine, rilpivirine, doravirine
-Rine, pine, renz
PI (protease inhibitor)
fosamprenavir, lopinavir, nelfinavir, ritonavir, saquinavir, atazanavir, atazanavir/cobisctat, darunavir/ritonavir, darunavir/cobicistat, tipranavir/ritonavir
-NAVIR, with the exception of abcdavir, fostavir.
Don’t mistake this for integrase inhibitors which end in -Gravir
-last step of the HIV growth cycle. right before it gets clipeed. PI is like NAAAw
characteristics of protease inhibitors
administered as combo therapy to boost other regimens. metabolized by P450. suppress HIV replication.
Entry/fusion inhibitors
enfuvirtide (fusion inhibitors)
maraviroc (CCR5 antagonist)
Entry into “maraudon” like in WoW. Fuver = furvor, like passionate about entering maraudon
entry fusion inhib characteristics
addon therapy
Integrase strand transfer inhibitors
raltegravir, cabotegravir, dolutegravir
Dilute, rally, caboose
Gravir = Gravity pull you in. Like being pulled into a double helix DNA
-or like gratitude for being the quickest acting agent
Characteristic of integrase inhibitors
allows for more rapid decrease in viral load versus other regimens
New therapies HIV
fostemsavir- GP120 prevents entery
ibalizumab-uiyk- block CD4 receptors
capsid inhibior- interfere with HIV capsid
pharmokinetic enhancer- boosts others
fostemsavior = a foster parent that blocks the entrance of the bad guy into the house
iBall= block CD4 like in a soccer game, they get in front of the ball
When to do labs for someone after changing their therapy?
Lab 1-2 months after change, and then once they stabilize, 3-6 months.
Mucocutaneaous candidiasis oral
clotrimazole
fluconazole
Clothe, Fluke
The lucky clothing shopper who wins the free gift from the recipt, and wins white tic tacs
Mucocutanous candidiasis - fungal rash
topical clotrimazole 1%
topical ketoconazole 2%
Trim Clothes, keto diet
Think of getting new, smaller clothes from the keto diet.
A girl shopping in the mall, on a keto diet, with a rash.
Oral Hairy Leukoplakia
caused by EBV
no specific treatment, it resolves with ART
Genital herpes tx
acyclovir
famciclovir
valacyclovir
Valhala, Famsick, Ace
The valhala warrior who comes and goes. Is fame sick. Famous. And she “aced’ because she slept with someone to boot.
Herpes zoster shingles
famiciclovir
valacyclovir
consider live attenuated zoster vaccine Zostavax or inactivated Shingrix only for patients 51+ with CD4 count less than 200
Fame sick, Valhala
Singles is so painful, its as painful as being a famous warrior from valhala
Herpes is like the valhala warrior, going into valhala and coming back out
molluscum contagiosum
treated topically with liquid nitrogen
imiquimod topical
Imitate = imiqui
It imitates molluscs, look alike
Pneumocystis Jiroveci Pneumonia - everything
most opportunistic infectio
fungal
AIDS defining
perihilar infiltrates
Wright Giemsa stain or direct fluorescence antibody testing
Rx - trimethoprim sulfamethoxazole DS (Bactrim DS) + prednisone
prophylaxis for CD4 count less than 200
Back/Trim Prednisone (Red Nose)
A gardener (trimming) w/ a red nose
The bushes are the perihilar infiltrates
esophageal candidiasis (C. albicans)
fluconazole
fluke is luck or a rare occurance. imagine a “fluke” popping up in your esophagus, by suprise when they do the EGD.
Kaposi’s Sarcoma
Resolves with ART
caused by HHV8
Wasting syndrome
ART, megestrol acetate, dronabinol, medical cannabis, anabolic steroids (testosterone).
Megastore, Drone-able
Wasting like a machine employed store that is commericialized and wasteful
Mycobacterium avium
-causes fevers and weight loss, affects multiple organs
clarithromycin + ethambutol (combo due to emerging resistance)
prophylaxis offered less than 50
treated for 12 months at least. may be discontinued if CD4 count exceeds 100 for 6 months.
Clear + Ethane - think of breathing it in and it makes you sick
makes you very very sick to breath in ethane fumes
Cryptococcal Meningitis
Cryptococcus neoformans, encapsulated budding yeast found in pidgeon and soil
Dx gram positive of CNS fluid for budding, encapsulated fungi
IV liposomal amphoetericin B with PO flucytosine
PO fluconazole one year
IV loposomal amphoetericin - am poetic like coldplay fly on + flucytosine flew sight or scene, flew with blue
Cryptococcal comes from pidgeons so A pidgeon flying in the sky is poetic, and the other flying on w/ blue.
Cytomegalovirus Retinitis
Ganciclovir + Valganciclovir
Gandolf (too old and can’t see) + Valley (a valley that he cannot see)
Toxoplasmosis
Parasite
pyrimethamine + sulfadiazine + leucovorin
Prophylaxis when CD4 count less than 100 (Bactrim)
Prophylaxsis is back in cat poop
meth on fire + sulfur + Corvin (werewolf) so cat poop smells like sulfur and meth on fire plus a dog
Tuberculosis
Annual TB and prophylaxis HIV treatment for a person with a latent TB infection
Coccidiomycosis
Annual IgG and IgM serologic screening
Prophylactic fluconazole if positive, until **250 for 6 months
Fluconazole = flying in the sky, with no one to hide
Pneumocystitis
CD4 200
TMP SMX in all patients for prophylaxis, discontinue when greater than **200
Back/Trim Prednisone (Red Nose)
A gardener (trimming) w/ a red nose
The bushes are the perihilar infiltrates
Histoplasmosis
CD4 less than 150
Limited data to support itraconazole prophylaxis
consider hyperendemic areas
discontinue when CD4 is more than **150 for 6 months
Toxoplasmosis
CD4 100
TMP-SMX prophy if less than 100 and positive IgG serology
Discontinue when above **200 for 3 months
Bactrim + cat - Back in cat poop
Cryptococcus
When CD4 less than 100
prophylaxis not recommended due to side effects and resistance to therapy
Mycobacterium avium complex
50 or less
check blood cultures first, then prophy w/ azithromycin if cultures neg.
discontinue when CD4 is greater than **100 for three months
