ID exam 4 Flashcards

Question

Etravirine ADR

Answer 1

rash peripheral neuropathy

Answer 2

non-competitive inhibitor of reverse transcriptase

Answer 3

do not co admin with other NNRRIs CYP3A4

Answer 4

depression, insomnia, headache, rash QT prolongation

Answer 5

non-competitive inhibitor of reverse transcriptase

Answer 6

nausea, dizziness, headache, fatigue, diarrhea, ab pain, abnormal dreams

Answer 7

prvent proteolytic cleavage of HIV polypeptides and maturation of viral particles

Answer 8

high protein bound rapid absorption

Answer 9

midazolam, triazolam, fentanyl, ergot derivatives

Answer 10

GI, neurologic disorders, rash, fatigue

Answer 11

prevent proteolytic cleavage of HIV precursor polypeptides and maturation of viral particles

Answer 12

GI, insomnia, peripheral neurologic symptoms, myalgia, depression, fever

Answer 13

prevent proteolytic cleavage of HIV precursor polypeptides and maturation of viral particles

Answer 14

high protein bound

Answer 15

GI, headahce, ab pain

Answer 16

inhibit viral integrase enzyme blocking viral DNA into host genome

Answer 17

insomnia, headache, nausea, asthenia, fatigue

Answer 18

inhibit viral integrase enzyme blocking viral DNA into host genome

Answer 19

high protein bound

Answer 20

protease inhibitors ritonavir

Answer 21

inhibit integrase enzyme by binding to amino acids in active site and block strand of transfer step

Answer 22

high protein bound UGT1A1 metabolization

Answer 23

metabolic inducers 2 hours before or 6 hours after cations

Answer 24

insomnia and headache

Answer 25

targets HIV integrase and prevents strand transfer activity and integration of provirus into host genome

Answer 26

not for severe hepatic impairment

Answer 27

rifampin antacids

Answer 28

lactic acidosis, liver problems, new or worsening kidney problems

Answer 29

integrase strand transfer inhibitor

Answer 30

IM slow absorption high protein bound

Answer 31

other antiretroviral HIV meds UGT1A1 or 1A9 inducers -rifampicin, carbamazepine, oxcarbazepine, phenytoin, phenobarbital Cabenuva

Answer 32

IM: inj site rxn, headache, fever Oral: headache, hot both: depressive, insomnia, rash

Answer 33

inhibit P450 3A4

Answer 34

high protein bound

Answer 35

CYP3A4, CYP2D6

Answer 36

atazanavir causes jaundice and rash

Answer 37

interfere with essential steps in viral replication by binding between viral capsid protein subunits and hexamers

Answer 38

sub q: long absorption high protein bound

Answer 39

p-gp, UGT1A1

Answer 40

itching, swelling, redness, pain, hardened skin, small mass/lumps at injection site

Answer 41

disrupt gp41 rendering it incapable of mediating membrane fusion to allow viral entry into host cell

Answer 42

sub q inj high protein bound undergoes catabolism

Answer 43

lots of CYPs ritonavir, rifampin

Answer 44

inj site rxn pneumonia hypersensitivity rxn respiratory, nephritis, guillain-barre syndrome

Answer 45

block HIV outer envelope binding of gp120 to CCR5

Answer 46

CYP3A4 and Pgp

Answer 47

pyrexia, upper rti, rash, musculoskeletal, ab pain, dizziness

Answer 48

block HIV from binding to CCR5 and CXCR4 on CD4 cells

Answer 49

need loading dose

Answer 50

diarrhea, dizziness, nausea, rash

Answer 51

dephosphorylated product that binds directly to gp120 and inhibits viral interaction with CD4 receptors

Answer 52

hydrolysis, oxidation, and UGT

Answer 53

temsavir increase plasma concentration of grazoprevir and voxilaprevir rifampin

Answer 54

n/v/d ab pain dyspepsia fatigue sleep disturbance immune reconstitution inflammatory syndrome

Answer 55

TDF, FTC TAF, FTC (M, TGF only) Cabotegravir (IM q8w)

Answer 56

capsid inhibitor purpose-1 (cis-women) purpose-2 (MSM and trans-women) sq 6 months

Answer 57

All sexually active adults and adolescents should be informed about PrEP For sexually active adults and adolescents

Answer 58

reduce acquisition of HIV infection with resulting morbidity, mortality and cost to individuals and society

Answer 59

HIV and HIV RNA test sign/symptoms pregnancy test STI testing

Answer 60

renal toxicities STI testing

Answer 61

1: HIV, HIV RNA, signs, administer CAB 2: HIV, HIV RNA, signs, administer CAB

Answer 62

4: STI 6: STI 12: evaluate need for PrEP

Answer 63

ART to prevent HIV infection after a potential exposure medical emergency HIV - baseline, 4-6 wk, 3 months Pregnancy test for women

Answer 64

HIV-negative or HIV status unknown within the last 72 hours May have a known or known exposure to HIV through: -sex/sexual assalt -shared needles -occupational exposure

Answer 65

TDF/FTC 1 tab daily + raltegravir 400 mg twice daily TDF/FTC 1 tab daily + dolutegravir 50 daily

Answer 66

Main cause of mortality in HIV and patients Prophylaxis and HAART led to decrease incidence

Answer 67

CD4 count surrogate marker for risk PCP rare at CD4 200-250 MAC rare at CD4 >50

Answer 68

lead to immune reconstitution syndrome affect adherence or absorption of meds may hold off

Answer 69

Influenced by degree of immunosuppression and potentially environment OIs may be more likely in HIV immuno-suppressed vs. those w/ transplants, SCID

Answer 70

Pneumocystis jirovecii M. tuberculosis Mycobacterium-avium Complex (MAC) Toxoplasma gondii Cryptococcus neoformans Histoplasma capsulatum Candida

Answer 71

Varicella zoster virus Cytomegalovirus Hep B and Hep C Herpes simplex virus

Answer 72

Usually insidious and subacute presentation Fever Dyspnea Tachypnea +/- rales or rhonchi Non-productive or mildly productive cough

Answer 73

CD4 CXR (bilateral, florid, subtle infiltrates) ABG (abnormal PaO2) Culture Elevated LDH

Answer 74

may worsen before it improves If worsening after 4 days or lack of improvement after 7-10 days = reassess or change therapy

Answer 75

ADR ABG Labs

Answer 76

TMP/SMX (IV,PO) 15-20 mg/kg/d tid Alternatives -pentamidine IV -Trimethoprim PO+ dapsone PO -Atovoquone PO -Clindamycin IV/PO + primaquine PO Adjunct -Steroids IV/PO w/ PaO2 < 70 and within 72 hours

Answer 77

Pentamidine - azotemia, nephrotoxicity, glycemia, LFT Dapsone - rash, nausea Atovoquone - n/v/d, ha, rash Primaquine - methemoglobinemia, rash, anemia, LFT

Answer 78

Initiate: CD4 < 200 DC: CD4 > 200 ≥ 3 months

Answer 79

Continue after treatment DC: CD4 > 200 ≥ 3 months Restart: CD4 < 200

Answer 80

TMP/SMX 1 DS QD Alternatives: Dapsone 100 mg QD, aerosolized pentamidine 300 mg qmonth, atovaqone 1500 mg qd

Answer 81

Contract by inhalation (lung 1st infected site) Most common life-threatening fungal infection

Answer 82

Subtle presentation Fever, HA, malaise, mental status changes -Should consider in all HIV + patients w/ advanced disease or low CD4 counts and non-specific symptoms or pulmonary or CNS symptoms

Answer 83

Serum and CSF testing for cryptococcal antigen -antigen > 1:8 equals infection Fungal culture India ink exam of CSF or from culture may be used to diagnose if antigen unavailable

Answer 84

Stabilize CSF (LP if required)

Answer 85

Induction ( 2 weeks ) -Liposomal Ampho IV + 5-fluorouracil PO -Amphotericin B IV + 5-fluorouracil PO Consolidation (≥ 8 weeks) -Fluconazole 400-800 mg daily Chronic maintenance -Fluconazole 200 mg daily - ≥ 12 months w/ CD4 > 100 and asymptomatic

Answer 86

5-FC: Serum levels, renal function, bone marrow toxicity Azoles: GI, LFT, drug interactions

Answer 87

-disseminated infection -common in soil and water -oral or respiratory route

Answer 88

Advanced immunosuppression, CD4 < 50; rare in CD4 > 100 Poor long-term prognosis w/o therapy

Answer 89

fever, diarrhea, sweats, ab pain GI infections

Answer 90

Culture organism from blood Biopsy of liver, BM, lymph nodes also sensitive and specific

Answer 91

Resistant to standard TB drugs Clinical response w/i 2-8 weeks of initiation Macrolide (azi or clari) + ethambutal +/- rifabutin, ciprofloxacin or amikacin

Answer 92

usually up to 1 year if asymptomatic and CD4 > 100 x 6 months

Answer 93

macolides: GI, LFT ethambutol: eye exam, renal dose adj rifabutin: uveitis, discoloration of body fluid

Answer 94

Symptom resolution may take 2-8 weeks Monitor bacterologic eradication (follow-up blood cx at 4-8 weeks)

Answer 95

Initiate: CD4 < 50 and not starting ART DC: CD4 > 100 for ≥ 3 months

Answer 96

DC: CD4 > 100 ≥ 6 months AND completed 1 year MAC therapy and asymptomatic for MAC Restart: CD4 < 100

Answer 97

Azithromycin 1200 mg weekly

Answer 98

most common OI treat to improve quality of life overgrowth of normal flora w/ breakdown of local defenses instead of acquisition of new strain

Answer 99

mouth pain, difficulty eating mild to severe symptoms white placques on buccal surfaces

Answer 100

severe symptoms dysphagia odynophagia esophageal ulceration anorexia

Answer 101

Visually with oral plaques May need bronch for esophageal candidiasis

Answer 102

Local vs. systemic Systemic required for esophageal candidiasis

Answer 103

nystatin clotrimazole fluconazole ampho b itraconazole caspofungin

Answer 104

Use host to replicate virus

Answer 105

RNA to DNA via reverse transcriptase Primary infects CD4 T cells Also infect macrophages and dendritic cells

Answer 106

1: accounts for majority of infections 2: spread through heterosexual contact

Answer 107

MSM, heterosexual Behavior and bio factors affect transmission Could happen orally

Answer 108

IV drug use Occupational exposure

Answer 109

Whole blood, plama, Ig, albumin

Answer 110

Gestation During delivery Breast feeding Decreased with AZT treatment

Answer 111

Mouth swab OTC Home access HIV1 test system (send results in for testing)

Answer 112

CD4 cells mainly

Answer 113

Resolve symptoms of early infection, delay progression Start with low antibodies at first Can cause decrease in viremia

Answer 114

Viral: change epitopes Latent: proviral DNA, in resting cells, provide stable viral reservoir

Answer 115

HIV infected people with CD4 cells <200 or CD4 count <14%

Answer 116

Herpes, ulcers, bronchitis, pneumonia, esophagitis MAC Pneumocystis pneumonia Cryptococcus, extrapulmonary

Answer 117

Measure rate of HIV destructive potential immune system High baseline: More rapid decline in CD4 cells, more rapid disease progression, decreased survival

Answer 118

Give best prognostic estimator of clinical course Train Wreck: viral load-speed CD4-distance

Answer 119

Max and suppress of viral load (RNA) Restore and preserve immune function Reduce HIV associated morbidity and prolong duration and quality of survival Prevent transmission

Answer 120

Increase urgency: OI or AIDS Pregnancy Low CD4 (<200) Early HIV infection Co infection with HBV/HCV

Answer 121

Dolutegravir + TDF/Emtricitabine OR TAF/Emtricitabine Bictegravir/TAF/Emtricitabine (Biktarvy®) Dolutegravir/Lamivudine (Dovato®)

Answer 122

1 pill per day GI, insomnia, SCr, renal, bone DDI with Ca, Mg, Fe, take with food

Answer 123

2 pills per day GI, insomnia, SCr, renal, bone DDI with Ca, Mg, Fe, take with food

Answer 124

1 pill per day need another agent if VL <500 at baseline GI, insomnia, SCr DDI with Ca, Mg, Fe, take with food

Answer 125

DRV/c or DRV/r with TAF or TDF plus (FTC or 3TC)

Answer 126

Simplify virologic suppression Check HBV status and resistance prior to starting 1 month lead in then every 1 or 2 months IM, gluteal, 2 injections

Answer 127

HIV nephropathy CV disease Malignancies Neurocognitive decline

Answer 128

LFTs, lipids, CBC, STD VL/CD4: Decreased dramatically at 4-6 weeks <50 copies by 16-24 weeks CD4 stable Recheck q3-6 months

Answer 129

Virologic failure: inability to achieve maintain VL suppression virologic rebound: detectable VL incomplete virologic response: 2 consecutive VL>200 after 24 wks of ART virologic blip: isolated detectable VL followed by virologic suppression

Answer 130

Failure to maintain CD4 response Initial increase of 150 Causes: Nadir <200 Age Coinfection Meds

Answer 131

Activate Jak-STAT signal transduction pathway and lead to translocation of a cellular protein

Answer 132

pt w/ ESRD require dose reductions

Answer 133

CYP1A2 methadone****

Answer 134

pyrexia, myalgia

Answer 135

competes with endogenous deoxyguanosine triphosphate and inhibits the HBV polymerase interfering with reverse transcriptase

Answer 136

children over 2 and adults

Answer 137

administered on an empty stomach

Answer 138

competitively inhibits HIV1 and 2 reverse transcriptase and HBV reverse transcriptase

Answer 139

rapidly absorbed longer half life in adults than children

Answer 140

bactrim sorbitol

Answer 141

phosphorylated by cellular kinase and inhibits HBV DNA polymerase (reverse transcriptase) and causes DNA chain termination

Answer 142

hemodialysis pt need dose adj

Answer 143

INF-alpha cause peripheral neuropathy

Answer 144

compete with uridine triphosphate for incorporation into HCV RNA by NS5B polymerase

Answer 145

take with high fat meal

Answer 146

another DDA results in bradycardia P-gp inducers

Answer 147

L: inhibit HCV NS5A protein S: inhibit HCV NS5B RNA dependent RNA polymerase

Answer 148

pH dependent oral absorption highly protein bound

Answer 149

amiodarone p-gp

Answer 150

S: inhibit HCV NS5B RNA dependent RNA polymerase V: inhibit HCV NS5A protein

Answer 151

E: inhibit HCV NS5A which is essential for RNA replication and virion assembly G: viral replication

Answer 152

high protein bound wide distribution oxidative metabolism

Answer 153

G: viral replication P: inhibit RNA replication and virion assembly

Answer 154

carbamazepine, efavirenz, st. johns wort

Answer 155

S: inhibit RNA polymerase by HCV NS5B RNA Ve: inhibit HCV NS5A protein Vo: reversible inhibitor of NS3/4A protease

Answer 156

fecal-oral: contaminated food or water

Answer 157

sexual, mother-to-child, blood exposure (transdusion, IDU, tattoo)

Answer 158

blood exposure (transfusion, IDU, tattoo); sexual, mother-to-child

Answer 159

<6 months HBV > HAV > HCV increase LFT can progress to liver failure

Answer 160

>6 months HBV DNA increased ALT/AST elevations hepatocellular necrosis, inflammation, fibrosis HBV, HCV alcohol, drugs, autoimmune

Answer 161

hep b/c virus replicates in liver cells immune system responds w/ inflammation inflammation leads to fibrosis and sometimes cirrhosis

Answer 162

HBV/HCV not directly cytopathic immune response to virus-infected hepatocytes by CTL

Answer 163

asymptomatic = carriers or inactive disease severe: compensated cirrhosis: asymptom, fatigue, jaundice decomp cirrhosis: fatigue, jaundice, wt loss, ascites, edema

Answer 164

impairment of liver function cancer (hepatocellular carcinoma) blockage of portal vein blood flow though liver leading to ascites

Answer 165

Labs: increase ALT/AST, decrease bilirubin, increase INR/PT, hypersplenism Histopathology: absence of necrosis or inflammation, necrosis, fibrosis, cirrhosis

Answer 166

Provides information regarding: -degree of inflammation -stage of fibrosis or scarring -presence/absence of cirrhosis Help determine: -prognosis -cause of liver disease -need for treatment

Answer 167

transfusion (blood) fluids (blood, semen) organ and tissue transplant mother to baby contaminated needles/syringes child to child

Answer 168

HBeAG for a little than mainly anti-HBe w/ symptoms

Answer 169

HBeAG mainly than anti-HBe for a little acute 6 months, chronic years

Answer 170

HBsAg HBeAg anti-HBc IgG anti-HBc IgM HBV DNA (PCR)

Answer 171

Anti-HBs Anti-HBc IgG

Answer 172

HBsAg HBeAg Anti-HBc IgG HBV DNA (PCR)

Answer 173

liver cirrhosis hepatic cancer liver transplantation

Answer 174

antibody test (EIA): indicate past or active infection, presence of antibodies does not confer immunity (follow up with viral load) HCV RNA test (PCR): confirm active infection, RNA exist but not as useful

Answer 175

hematologic rheumatologic renal derm CNS systemic

Answer 176

generally asymptomatic fatigue, loss of appetite, nausea, right upper quadrant pain, jaundice

Answer 177

viremic after 6 months may also be asymptomatic slow progression to chronic liver morbidity/mortality

Answer 178

1-6 serotypes does not predict progression of infection can predict likelihood of treatment response

Answer 179

> 50 yo duration of infection male iron overload steatosis alcohol coinfection with HBV or HIV

Answer 180

Serum HBV DNA >20,000 persistent or intermittent elevation in ALT/AST levels liver biopsy showing chronic hepatitis with moderate or severe necroinflammation

Answer 181

increase chance of seroconversion sustained suppression of HBV replication prevent disease progression to cirrhosis and HCC minimize further injury in patients with ongoing liver damage

Answer 182

ALT >2x ULN ALT > 2x ULN HBV DNA >20,000 IU/mL

Answer 183

AST/ALT q3 months (goal=normal) HBV DNA q3-6 months (goal=undetect) monitor disease progression q1-3 months 6 months after drug disc. and q3-6 months after HBeAg q6 months if positive HBeAb q6 months if negative HBsAg annual (goal=negative)

Answer 184

counsel on prevention of disease transmission avoid alcohol

Answer 185

adults: 180 mcg subq wk x48ek neuropsychiatric disorders, autoimmune disorders, infections, ischemic disorders pregnancy category c

Answer 186

300 mg qd w/ normal reanal (>50 ml/min) pregnancy category B

Answer 187

25 mg qd (NO CrCl <15 ml/min)

Answer 188

>16 yo: 0.5 mg qd (CrCl >50 ml/min) pregnancy category C

Answer 189

baby boomers (1945-1965) IVDA long term dialysis tat in unregulated settings HCW or public safety after exposure children of HCV+ moms prior transfusion or organ recipients HIV infection or unexplained chronic liver disease

Answer 190

(+): confirm w/ sensitive RNA test (-): recheck if exposure occurred w/in 24 wks positive anti-HCV and negative HCV RNA = no active disease

Answer 191

HCV viral load >12 wks after end of therapy no SVR required retreatment

Answer 192

HCV antibody, viral load, genotype Test for progression -serologic -radiologic -biopsy

Answer 193

all patients with chronic HCV, except those w/ short life expectancy that will not benefit from treatment or transplant

Answer 194

advanced liver disease person with transplant co-infections: HIV, HBV, other liver disease extrahepatic manifestations of HCV IVDAs decrease transmission HIV-infected MSM incarcerated persons hemodialysis pts

Answer 195

Velpatasvir/sofosbuvir 1 po qd 12 wk (not for 3) glecaprevir/pibrentasvivr 3 po qd 8 wk

Answer 196

prior treatment decomp cirrhosis (child-pugh B,C), ascites, hepatic encephalopathy) ESRD HBV+ pregnancy HCC prior liver transplant

Answer 197

SVR >12 wks after end of treatment liver function tests depending on baseline fibrosis score (cirrhosis - test for HCC) check for reinfection if continued risk - HCV viral load

Answer 198

glecaprevir/pibrentasvir 3 po qd 8 wks velpatasavir/sofosbuvir 1 po qd 12 wks (ledipasvir/sofosbuvir 1 po qd 8 wk 1a/1b/4) (elbasvir/grazoprevir 1 po qd 12 wks no cirrhosis)