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NAPLEX Review > ID Opportunistic and HIV > Flashcards

ID Opportunistic and HIV Flashcards

1
Q

What CD4+ T lymphocyte count is considered immunocompromised?

A

<200

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2
Q

Use of systemic steroids for ____ days or longer at a prednisone dose of ____mg/d or _____mg/kg/d can cause an immunocompromised state

A

14 days or longere
Dose of 20mg/d or more
2mg/kg/d or more

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3
Q

Lack of what organ can cause an immunocompromised state?

A

Spleen (asplenia)

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4
Q

Use of what medications can cause an immunocompromised state

A

Immunosuppressants

Cancer chemo

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5
Q

What is chemoprophylaxis?

A

Prophylaxis of opportunistic infections

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6
Q

What are common opportunistic infections that require primary prophylaxis?

A

Pneumocystitis pneumonia (PCP or PJP)
Toxoplasmosis gondii encephalitis
Mycobacterium avium complex (MAC)

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7
Q

Is prophylaxis recommended for candida infections in immunocompromised people?

A

Immunocompromised patients are at a higher risk but prophylaxis is not recommended

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8
Q

What ANC level is considered severe neutropenia?

A

ANC < 500 cells/mm3

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9
Q

What primary prophylaxis medications are good to use in the setting of sulfa allergy

A

atovaquone
dapsone
pentamidine

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10
Q

What primary prophylaxis medications are good to use in the setting of G6PD deficiency?

A

atovaquone

pentamidine

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11
Q

What medication is added to all pyrimethamine-containing regimens as rescue therapy to reduce the risk of pyrimethamine-induced myelosuppression?

A

Leucovorin

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12
Q

When to initiate and discontinue primary prophylaxis for Pneumocystitis pneumonia (PCP or PJP) in HIV

A

Initiate when CD4 count <200 cells, oropharyngeal candidiasis, or other AIDS-defining illness
D/C when CD4 >200 cells for 3 or more months on ART

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13
Q

Primary prophylaxis regimen for Pneumocystitis pneumonia (PCP or PJP) in HIV

A

Preferred: bactrim DS or SS daily
Alternative: bactrim DS 3x/wk OR dapsone +/- (pyrimethamine + leucovorin) OR atovaquone

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14
Q

When to initiate and discontinue primary prophylaxis for toxoplasma gondii encephalitis

A

Initiate when CD4 count < 100

D/c when CD4 >200 for >3 months on ART

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15
Q

Primary prophylaxis regimen for Toxoplasma gondii encephalitis

A

Preferred: bactrim DS daily
Alternative: bactrim DS 3x/wk OR dapsone + pyrimethamine + leucovorin OR atovaquone OR atovaquone + pyrimethamine + leucovorin

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16
Q

When to initiate and discontinue primary prophylaxis for Mycobacterium avium complex (MAC) infection

A

Initiate when NOT taking ART and CD4 <50 (if on ART - not recommended)
D/c when taking fully suppressive ART

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17
Q

Primary prophylaxis regimen for mycobacterium avium complex (MAC)

A

Preferred: azithromycin 1200mg weekly
Alternative: Azithromycin 600 twice weekly OR clarithromycin 500mg BID

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18
Q

When treating thrush in someone with HIV is systemic or topical treatment preferred?

A

Systemic

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19
Q

Preferred, alternative, and secondary prophylaxis regiment for
Candida (thrush)

A

Preferred: fluconazole
Alternative: itraconazole, posaconazole
Secondary prophylaxis: None

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20
Q

Preferred, alternative, and secondary prophylaxis regiment for
Cryptococcal menintigis

A

Preferred: Amphotericin B + flucytosine
Alternative: fluconazole +/- flucytosine
Secondary prophylaxis: Fluconazole (low dose)

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21
Q

Preferred, alternative, and secondary prophylaxis regiment for
Cytomegalovirus (CMV)

A

Preferred: Valganciclovir or ganciclovir
Alternative: Foscarnet, cidofovir
Secondary prophylaxis: None; maintain CD4 > 100 cells

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22
Q

Preferred, alternative, and secondary prophylaxis regiment for
Mycobacterium avium complex (MAC)

A

Preferred: (Clarithromycin or azithromycin) + ethambutol
Alternative: preferred PLUS rifabutin, amikacin or streptomycin, moxifloxacin, or levofloxacin
Secondary prophylaxis: Same as treatment regimen

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23
Q 
Preferred, alternative, and secondary prophylaxis regiment for 
Pneumocystitis pneumonia (PCP)
A

Preferred: Bactrim +/- prednisone or methylprednisolone x 21 days
Alternative: Atovaquone OR pentamidine IV
Secondary prophylaxis: same as primary prophylaxis

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24
Q

Preferred, alternative, and secondary prophylaxis regiment for
Toxoplasmosis gondii encephalitis

A

Preferred: Pyrimethamine + leucovorin + sulfadiazine
Alternative: Bactrim OR (clinda or azithormycin) +/- pyrimethamine + leucovorin OR atovaquone +/- (atovaquone + sulfadiazine)
Secondary prophylaxis: Same as treatment; reduced dose

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25
Q

What cells does HIV use to replicate?

A

CD4+ T cells

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26
Q

When is AIDS diagnosed?

A

When a patient’s CD4 count falls below 200 cells/mm3 or the presence of an AIDS defining condition

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27
Q

Who should be tested for HIV?

A

Everyone at least once
Everyone ages 13-64 at high risk - annually
- Sharing drug equipment needles
- High-risk sexual behaviors
- History of a sexually transmitted infection

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28
Q

What are the 3 stages of HIV?

A

Acute infection
Chronic infection
AIDS

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29
Q

What happens during the acute infection stage of HIV?

A

Lasts 2-4 weeks
HIV multiplies rapidly
S/sx are flu-like
Highly infectious

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30
Q

What happens during the chronic infection stage of HIV?

A

ART suppresses the viral load OR the virus is replicating causing the viral load to increase and CD4 count to decrease

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31
Q

What happens during the AIDS stage of HIV?

A

Patient has AIDS-defining condition or CD4 count <200

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32
Q

How is HIV diagnosed?

A

Positive HIV-1/HIV-2 antigen/Antibody immunoassay THEN positive confirmatory testing with HIV-1/HIV-2 antibody differentiation immunoassay

33
Q

What is an OTC in-home HIV test? How does it work?

A

Oraquick
Detects presence of HIV Ab
Positive test requires f/u testing
Should be done >3 months from exposure

34
Q

What are the 7 stages of HIV replication?

A 
1 - binding/attachment to CD4 cell
2 - fusion
3 - reverse transcription 
4 - integration
5 - transcription and transplantation
6 - assembly
7 - budding and maturation
35
Q

What stage of HIV replication does Maraviroc (Selzentry) and Ibalizumab-uiyk (Trogarzo) inhibit?

A

Stage 1 - binding/attachment to CD4 cell

36
Q

What stage of HIV replication does Enfuvirtide (Fuzeon) inhibit?

A

Stage 2 - fusion

37
Q

What stage of HIV replication do non-nucleoside and nucleoside reverse transcriptase inhibitors (NNRTIs and NRTIs) inhibit?

A

Stage 3 - reverse transcription

38
Q

What stage of HIV replication do integrase strand transfer inhibitors (INSTIs) inhibit?

A

Stage 4 - integration

39
Q

What stage of HIV replication do protease inhibitors inhibit?

A

Stage 7 - budding and maturation

40
Q

What is a normal CD4 count?

A

800-1200 cells/mm3

41
Q

What testing should HIV patients undergo during initial evaluation?

A 
CD4 count
HIV viral load
Drug resistance genotype testing
CMP
Hepatitis B and C testing
Pregnancy (women)
Drug-specific screening
42
Q

How high must adherence be to HIV medications to prevent resistance?

43
Q

What are the recommended regiments for initial ART in most treatment-naive adults that are 1 pill once daily?

A

1 INSTI + 1 or 2 NRTIs
Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide)
Triumeq (dolutegravir/abacavir/lamivudine)
Dovato (dolutegravir/lamivudine)

44
Q

What are the recommended regimens for initial ART in most treatment-naive adults that are 2 pills?

A

[Tivicay (dolutegravir) OR Isentress (Ralegravir)]
PLUS
[Truvada (emtricitabine/tenofovir disoproxil) OR Descovy (Emtricitabine/Tenofovir alafenamide)]

45
Q 
Tenofovir DF (TDF) vs tenofovir AF (TAF)
Which has more renal and bone issues?
A

TDF

Do not use if renal impairment or high fracture risk

46
Q

Which medication requires HLA-B*5701 allele testing?

What does the allele indicate?

A

Abacavir

Allele indicates higher risk of severe hypersensitivity reaction

47
Q

When should dovato not be initiated?

A

When HIV RNA > 500,000 copies/mL

Hepatitis B co-infection

48
Q

Nucleoside(tide) reverse transcriptase inhibitor (NRTI) MOA

A

Competitively block reverse transcriptase enzyme

49
Q

What medications are NRTIs?

A 
Tenofovir disoproxil fumarate
Tenofovir alafenamide
Lamivudine
Emtricitabine
Abacavir
Zidovudine
50
Q

Which NRTI is given during delivery when the viral load is >1000 to protect the baby

A

Zidovudine (Retrovir)

51
Q

Which NRTIs have a higher risk of adverse effects?

A

Stavudine, didanosine, and zidovudine - older

Lactic acidosis and hepatomegaly with steatosis

52
Q

NRTI SE

A

N/D, increased LFTs

53
Q

What is PEP and PrEP?

A

PEP - post-exposure prophylaxis

PrEP - pre-exposure prophylaxis

54
Q

Integrase strand stransfer inhibitors (INSTIs) MOA

A

Block the integrase enzyme, preventing viral DNA from integrating into the host cell DNA

55
Q

What drugs are integrase strand transfer inhibitors (INSTIs)

A

Bictegravir (BIC)
Elvitegravir (EVG)
Dolutegravir (Tivicay)
Raltegravir (RAL)

56
Q

INSTIs SE

A

HA, insomnia, diarrhea, weight gain, depression, CKP/myositis/rhabdomyolysis

57
Q

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) MOA

A

Bind to the enzyme non-competitively causign a conformational change that inhibits the enzyme

58
Q

What medications should not be taken with integrase strand transfer inhibitors

A

Cations

Take INSTI 2 hours before and 6 hours after aluminum and mg containing products

59
Q

NNRTIs BBW and CI

A

BBW: hepatotoxicity, severe rash
CI: Rilpivarine - do not use with PPIs; Rilpivirine and doravirine - do not use with strong CYP inducers

60
Q

Protease inhibitor medications

A

Atazanavir (reyataz)

Darunavir (Prezista)

61
Q

Protease inhibitor MOA

A

Inhibits protease enzyme which prevents protein strands from being cut into the smaller pieces needed for assembly of new virions
HIV continues to replicate but produces immature virions that are not infectious

62
Q

Protease inhibitors and drug interactions

A

CYP3A4 inducers decrease concentration of PIs

63
Q

What medications are boosters?

A

Ritonavir

Cobicistat

64
Q

Boosters MOA

A

Ritonavir and cobicistat are inhibitors of CYP3A4

Inhibit ART metabolism, increasing ART effect

65
Q

What medicationsare CCR5 atagonists

A

Maravioric

66
Q

Maravioric MOA

A

Blocks HIV from binding to the CCR5 co-receptor on the CD4+ cell, preventing HIV from entering the cell

67
Q

What test needs to be done before giving maravioric?

A

Tropism assay to reveal co-receptor

Only works with CCR5 tropic disease and is NOT useful if CXCR4 or mixed

68
Q

Maravioric BBW, CI, and SE

A

BBW: hepatotoxicity
CI: Severe renal impairment (CrCl<30); potent CYP3A4 inhibitors/inducers
SE: N/D, LFTs, URTIs

69
Q

What medication is a fusion inhibitor

A

Enfuvirtie (T20)

70
Q

Enfuviritide MOA

A

Prevents HIV from fusing to CD4 cell membrane, preventing entry into the cell

71
Q

Enfuviritide warnings and SE

A

Warnings: bacterial pneumonia, hypersensitivity reaction
SE: local injection site reaction

72
Q

What medication is a CD4 directed post-attachment HIV-1 inhibitor

A

Ibalizumab-uiyk (Trogarzo)

73
Q

Ibalizumab-uiyk MOA

A

Monoclonal antibodies that bind to CD4+ cell to block HIV entry

74
Q

What are AIDS defining conditions?

A

Opportunistic infections
Kaposi’s sarcoma
HIV wasting syndrome

75
Q

What is immune reconstitution inflammatory syndrome (IRIS)?

A

Paradoxical worsening of either a new or known condition that has been supressed, but becomes unmasked after ART is started

76
Q

Which HIV medication can cause neural tube defects in pregnancy?

A

Dolutegravir - small risk

Continue if this medication is effective

77
Q

Recommended HIV treatment in treatment-naive pregnant women

A

Two NRTIs (Abacavir/lamivudine OR TDF/emtricitabine)
PLUS
Boosted PI: (Atazanavir or darunavir+ritonavir)
OR
Raltegravir or dolutegravir

78
Q

PrEP - when to take medication and what medication to take

A

Before high-risk activity then daily

1 tablet with 2 drugs (Truvada or descovy)

79
Q

PEP - when to take medication and what medication to take

A

After HIV-exposure, within 72 hours, take for 28 days

Truvada (If CrCl>60) + dolutegravir (Tivicay) OR Raltegravir (Isentress)

NAPLEX Review (79 decks)

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