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NAPLEX '22 Main Points > Opportunistic Infections & HIV + Drugs (Class/Brand/Generic) > Flashcards

Opportunistic Infections & HIV + Drugs (Class/Brand/Generic) Flashcards

1
Q

Name the 5 immunocompromised states.

A

1) HIV with a CD4 T-lymphocyte count < 200
2) Use of systemic steroids for 14 days or longer at a prednisone dose >20mg/d or > 2mg/kg/d
3) Asplenia
4) Use of immunosuppressants
5) Use of cancer chemotherapy agents esp. with severe neutropenia (ANC < 500)

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2
Q

Common opportunistic infections requiring primary prophylaxis include:

A

1) Pneumocystis jirovecii pneumonia (PJP or PCP)
2) Toxoplasmosis gondii encephalitis
3) Mycobacterium avium complex (MAC)

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3
Q

Common opportunistic infection that occurs in patients at a higher risk but prophylaxis is NOT recommended:

A

Candida infections in the mouth/esophagus “thrush”

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4
Q

Primary Prophylaxis Regimens in HIV:

Pneumocystis jirovecii pneumonia (PJP or PCP)

A

Criteria for Starting: CD4 < 200 cells/mm^3
Criteria for Discontinuing: CD4 >200 x > 3 months on ART

DOC: SMX/TMP DS or SS daily

Alternatives:

1) Dapsone or
2) Dapsone + Pyrimethamine + Leucovorin or
3) Atovaquone

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5
Q

Primary Prophylaxis Regimens in HIV:

Toxoplasmosis gondii encephalitis

A

Criteria for Starting: CD4 < 100 cells/mm^3
Criteria for Discontinuing: CD4 >200 x > 3 months on ART

DOC: SMX/TMP DS PO daily

Alternatives:

1) Dapsone + Pyrimethamine + Leucovorin or
2) Atovaquone

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6
Q

Primary Prophylaxis Regimens in HIV:

Mycobacterium avium complex (MAC)

A

Criteria for Starting:

1) Not recommended if ART is started STAT
2) If not taking ART and CD4 < 50 cells/mm^3

Criteria for Discontinuing: Taking fully suppressive ART

DOC: Azithromycin 1,200 mg PO weekly

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7
Q

Selection of alternative regimens in HIV (prophylaxis or treatment) depends on patient-specific factors:

A
  • —options for PCP in the setting of a sulfa allergy—
  • atovaquone *dapsone *pentamidine
  • —options for G6PD deficiency—–
  • atovaquone and *pentamidine

—-Leucovorin is added to all pyrimethamine-containing regimens as rescue therapy to reduce the risk of drug-induced myelosuppression—–

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8
Q

Secondary prophylaxis is initiated after initial treatment for what purpose?

A

Given to prevent recurrent of the infection regardless of the cause of immunosuppression

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9
Q

Treatment of OIs: Candidiasis

A

Appearance: white film in mouth/throat

DOC: Fluconazole

Alternative: Itraconazole

2ndary: NOT recommended

**thrush in HIV is treated with systemic steroids not local (nystatin, clotrimazole or miconazole)

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10
Q

Treatment of OIs: Cryptococcal meningitis

A

DOC: Amphotericin B (deoxycholate or liposomal) + flucytosine

Alt: Fluconazole +/- flucytosine

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11
Q

Treatment of OIs: Cytomegalovirus (CMV)

A

DOC: Valganciclovir or Ganciclovir

Alt: foscarnet or cidofovir (if toxicities to ganciclovir or resistant strains)

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12
Q

Treatment of OIs: Mycobacterium avium complex (MAC)

A

DOC: (Clarithromycin or azithromycin) + ethambutol

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13
Q

Treatment of OIs: PCP/PJP

A

DOC: Bactrim x 21 days +/ prednisone or methylpred

Alt: Atovaquone or Pentamidine IV

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14
Q

Treatment of OIs: Toxoplasmosis gondii encephalitis

A

DOC: Pyrimethamine + Leucovorin + sulfadiazine

Alt: Bactrim

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15
Q

All of the following diease-treatment pairs are correct EXCEPT:

  1. Mycobacterium avium complex - clarithromycin + ethambutol
  2. Oropharyngeal candidiasis - itraconazole
  3. Cytomegalovirus - ganciclovir
  4. Cryptococcal meningitis - liposomal amphotericin B + foscarnet
  5. Pneumocystis pneumonia - IV pentamidine
A

4

Cryptococcal meningitis - amphotericin (liposomal or conventional) + flucytosine

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16
Q

What is the DOC for PCP & Toxoplasma prophylaxis?

A

Bactrim DS daily

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17
Q

What drug is used for MAC prophylaxis?

A

Azithromycin 1200 mg weekly

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18
Q

When should Bactrim DS for primary prophylaxis of PCP be discontinued?

A

When CD4 > 200 for > 3 months on ART

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19
Q

DOC when CD4 < 50; indicates that patient needs prophylaxis due to which OI?

A

DOC: Azithromycin 1200mg PO weekly

OI: Mycobacterium avium complex (MAC)

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20
Q

An HIV-positive patient with a history of a poor medication adherence has a CD4 Count < 50. He develops CMV. What drug is used as first-line therapy for CMV?

A

Valganciclovir (Valcyte)

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21
Q

What is the preferred treatment of Toxoplasma gondii encephalitis?

A

Pyrimethamine + Leucovorin + Sulfadiazine

TGE - PLS (To go extra please!)

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22
Q

A patient has a CD4 count of 93 and a positive toxoplasma IgG. What OIs should he receive prophylaxis for at this time?

A

PCP (<200) and Toxoplasma (<100)

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23
Q

PS is an immunocompromised transplant patient who requires a medication to prevent PCP. She reports an itchy rash when taking Bactrim. What is an alternative?

A

Dapsone or atovaquone

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24
Q

CV is a 39 yoM with HIV and CMV. His response was poor and additional viral testing shows the development of resistance to valganciclovir. What alternatives would be expected to have activity in this case?

A

Foscarnet or cidofovir

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25
Q

What ART agent has a boxed warning for the risk of serious HSR?

A

Abacavir

*genomic testing - HLA-B *5701

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26
Q

A phlebotomist had an accidental needle stick from an HIV-positive patient. What drug combination is the preferred regimen for PEP?

A

raltegravir (Isentress) PLUS
emtricitabine + TDF (Truvada)

x28 days for PEP

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27
Q

All NRTIs have these warnings

A

Lactic acidosis and hepatomegaly with steatosis

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28
Q

Descovy

A

emtricitabine + TAF

29
Q

What ART is available as an IV formulation used to prevent perinatal transmission of HIV?

A

Zidovudine

30
Q

Major benefit of TAF vs TDF

A

Lower risk of nephrotoxicity

31
Q

Labs needed prior to PrEP

A

Pregnancy test
HIV negative test
Hepatitis B test
STI test

32
Q

What medication requires screening to determine the HIV tropism before starting treatment?

A

Maraviroc

33
Q

What ART class should be administered separately from antacids?

A

INSTIs

2 hours b4 or 6 hours after antacids

34
Q

Complera

A

TDF + emtricitabine + rilpivirine

35
Q

Odesfey

A

TAF + emtricitabine + rilpivirine

36
Q

emtricitabine + TDF

A

Truvada

37
Q

lamivudine + abacavir

A

Epzicom

38
Q

What drug causes the skin and sclera to yellow?

A

atazanavir (Reyataz)

Class: Protease Inhibitors

39
Q

Drug recommendations for loss of appetite and help increase muscle mass.

A

Megace ES
Dronabinol
Nabilone

40
Q

Stribild contraindicated in what condition?

A

Nephropathy

Avoid use if CrCl < 50 mL/min

Generic: TDF + emtricitabine + elvitegravir + cobicistat

41
Q

emtricitabine drug class

A

NRTIs

42
Q

zidovudine side effect

A

Anemia

Brand: Retrovir

43
Q

LA is a 31 yoF who started on ART 2 months ago when she was diagnosed as HIV-positive. She now presents with IRIS. What is an appropriate course of action?

A

Continue current ART

*treating IRIS includes treating underlying pathogen, continue current ART, and in some cases add corticosteroids to ART

44
Q

What is the INSTI component to Triumeq?

A

dolutegravir (Tivicay)

45
Q

HIV transmission

A

Via blood, semen, breast milk, & vaginal fluid

46
Q

Cobicistat is used in ART regimen as a

A

CYP450 3A4 inhibitor “PK booster”

47
Q

What HIV medications should be taken with food?

A

Genvoya
Complera
Rilpivirine

48
Q

What HIV medications should be taken on an empty stomach?

A

Efavirenz

Atripla (contains efavirenz)

49
Q

Prezista

A

darunavir

50
Q

Which of the following drugs on the Medication List interacts with one another:

Prezista
Ritonavir 
Truvada
Simvastatin 
Lovaza
HCTZ
A

Simvastatin with ritonavir & Prezista (darunavir)

*Simvastatin & Lovastatin DDI w/ PIs

51
Q

Describe how HIV lab parameters would be expected to change if ART is not started?

A

Decrease CD4 and increase viral load

*Tx goal: incr. CD4 & decr. viral load

52
Q

Viread

A

TDF

53
Q

oPEP treatment duration

A

28 days (4 weeks)

*started ASAP within 72 hours

54
Q

First-line ART regimens

A

Biktarvy
Triumeq
Dovato

55
Q

Which ART class is associated with dyslipidemia, abnormal fat deposits and high blood sugar?

A

Protease inhibitors

56
Q

How should efavirenz be administered to decrease CNS effects?

A

OES HS

57
Q

Isentress

A

Generic: raltegravir

Dosing:
Isentress - BID
Isentress HD - 2 tabs daily

58
Q

Primary goals of ARTs

A

Suppress viral load
Reduce the progression of HIV
Prevent transmission of HIV
Decrease the incidence of OIs

59
Q

Atripla

A

TDF + emtricitabine + efavirenz

60
Q

What is the minimum amount of time to wait after an HIV exposure before using OraQuick in-Home HIV test?

A

3 months

61
Q

What drug(s) has a boxed warning of pancreatitis?

A

didanosine & stavudine

62
Q

PrEP regimens

A

Truvada (emtricitabine + TDF)

Descovy (emtricitabine + TAF)

63
Q

Single tablet drugs with the complete ART regimen

A

Complera
Odesfey
Stribild
Atripla

64
Q

What ART drug class causes SJS/TEN?

A

NNRTIs

65
Q

What ART drug is administered via SC injection?

A

enfuvirtide (Fuzeon)

Class: Fusion Inhibitor - Stage 2

66
Q

Caution use in patients with sulfa allergy

A

darunavir (Prezista)

67
Q

Patient is on Complera. What is a safe recommendation for the treatment of acid reflux?

A

Tums

*Complera contains rilpivirine, rilpivirine requires an acidic gut for drug absorption and should be avoided with PPIs.

68
Q

Side effects of rilpivirine

A

CNS effects: depression, mood changes, insomnia and suicidal ideation

NAPLEX '22 Main Points (11 decks)

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