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Hematology-Oncology Exam 2 > Ortoski: High-yield Stuff > Flashcards

Ortoski: High-yield Stuff Flashcards

1
Q

Geography associated with HIV?

A

Subsaharan Africa

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2
Q

More men or women, which race?

A

Men more than women, African American predominance

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3
Q

Top 3 modes of acquisition of HIV?

A
  1. M to M sexual contact
  2. Heterosexual
  3. IVDA
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4
Q

Around what time was there more treatment, so fewer cases of HIV?

A

93-94

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5
Q

Since HIV causes inflammation, what are 2 areas of issue?

A

Cardiac and cancer

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6
Q

HIV is the BLANK leading cause of death currently

A

6th- Used to be leading in early 90s in the 25-45 age group

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7
Q

Reducing viral load reduces what?

A

Transmission

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8
Q

NRTI

A

Nucleoside reverse transcriptase inhibitor

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9
Q

NNRTI

A

Non-nucleoside reverse transcriptase inhibitor

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10
Q

PI

A

Protease inhibitor

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11
Q

D Drugs

A

d4t, ddl, ddc, AZT

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12
Q

Does AZT have a lot of SE?

A

YES

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13
Q

Nadir CD4

A

Lowest CD4 count ever

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14
Q

Naive

A

No prior drug exposure

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15
Q

Sequestered mutations

A

Found in minority- not detectable

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16
Q

BLD

A

Below level of detection- less than 20

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17
Q

Where is HIV 1 found?

A

Worldwide

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18
Q

Where is HIV 2 found?

A

Africa- Less easily transmitted

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19
Q

Group M

A

Major group worldwide

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20
Q

Group O

A

Other

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21
Q

How many subgroups or clades?

A

11

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22
Q

Group M Subgroup B

A

Americas, Japan, Austrailia, Carribean, Europe

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23
Q

Group M Subgroup C

A

S. Africa, India

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24
Q

Typical transmission modes?

A
  1. Sexual
  2. Vertical (mother to child)
  3. Transfusion
  4. IV drug use
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25
Q

If mother’s viral load is undetectable, is it less likely to transfer to fetus?

A

YES

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26
Q

Risk factors?

A
  1. 3+ nights in prison
  2. Prostitution
  3. Other STD
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27
Q

What should be emphasize?

A

Routine voluntary testing

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28
Q

What test is the best and confidental?

A

Serology

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29
Q

What is needed for a + result?

A

2 ELISA screening followed by 1 Western Blot for CONFIRMATION

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30
Q

What test is done for infants?

A

DNA test (newborns have positive antibodies no matter what from mom)

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31
Q

When is DNA test done?

A

After 1 month and after 4 months

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32
Q

What does the 4th generation ELISA have?

A

p24 antigen

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33
Q

What is required for an AIDS diagnosis?

A

Positive serology and a CD count under 200 and/or AIDS defining illness

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34
Q

CD4+ Under 200

A

Prevent PCP pneumonia

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35
Q

CD4+ Under 100?

A

Prevent Toxoplasmosis

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36
Q

CD4+ Under 50?

A

Prevent MAC

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37
Q

What is used to test kidney and liver function?

A

CMP

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38
Q

Live Vaccines?

A

NOOOOOO

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39
Q

Dosing for Hep B vaccine?

A

Give HIV pt. 40mcg (normal is 20mcg)

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40
Q

When can you give MMR?

A

Is CD4 is over 200

41
Q

Phase 1:

A

Greater than 500 CD4 cells, asymptomatic, acute phase, PHI

42
Q

Phase 2:

A

CD4- 200-500, Early symptomatic

43
Q

Phase 3:

A

CD4- 50-200, Late symptomatic, full blown AIDS

44
Q

Phase 4

A

Fewer than 50 CD4 cells- Advanced AIDS

45
Q

What measures extent of immune system damage?

A

CD4 count

46
Q

What does viral load measure?

A

Plasma HIV RNA level…higher means more CD4 destruction

47
Q

What is most popular viral RNA assay?

A

PCR

48
Q

What test does everyone infected get immediately?

A

Resistance

49
Q

What % of infections are resistant to at least 1 drug because the index patient was resistant to the drug?

A

15%

50
Q

What is best bang for buck?

A

Genotyping (can also use trophile/trophism test)

51
Q

R5 Viruses, CCR5 CoReceptor, Macrophages, Early

A

M TROPIC

52
Q

X4 Viruses, CXCR4 CoReceptor, T-cells, Late, Faster to AIDS?

A

T TROPIC

53
Q

M184V mutation

A

M: AA found in wild tpye
184: AA (codon) position
V: AA substitution/variant

54
Q

We only have drugs that kill what trophism?

A

R5

55
Q

M184V mutation, what drugs won’t work?

A

Lamivudine and Emtricitabine

56
Q

K103N mutation, what drugs will work?

A

All of the 1st generation NNRTIs

57
Q

4 types of Anti-retroviral treatment?

A
  1. Reverse Transcriptase Inhibitors: Nucleoside RTI (NRTI), non-Nucleoside RTI (NNRTI), Nucleotides
  2. Protease Inhibitors: PI
  3. Entry Inhibitors: Attachement inhibitors, chemokine receptor inhibitors, fusion inhibitorsa
  4. Integrase inhibitors
58
Q

True or False: ART is recommended for ALL HIV infected persons regardless of CD4 count

A

TRUE

59
Q

Is monotherapy okay?

A

NO

60
Q

1 exception to monotherapy?

A

Pregnant woman that normally will accept no treatment, but is willing to take AZT at the time to prevent the baby from contracting the virus

61
Q

Can you piece drugs together?>

A

NO…ALL OR NONE

-Start all drugs or stop all drugs at the same time

62
Q

Diagnosis of AIDS?

A

AIDS defining illness and/or CD4 count below 200

63
Q

All protease inhibitors are taken with what?

A

Ritonavir

64
Q

What is ritonavir?

A

A boosting agent for P450… not a viral killer anymore and helps with one-a-day dosing of others

65
Q

HS/HLAB*5701, CAD risk, Danger with Rechallenging?

A

Ziagen or ABACAVIR

66
Q

Less use with AE, hyperchromic macrocytic anemia

A

AZT (retrovir)

67
Q

If virus has M184V mutation, what won’t work?

A

Lamivudine and emtricitabine

68
Q

Neurological AE short lived, depression issues, low genetic barrier?

A

EFAVIRENZ (sustiva)

69
Q

Associated with CAD

A

Protease Inhibitors

70
Q

RENAL STONES

A

Reyataz and Crixivan

71
Q

Renal Issues

A

Viread

72
Q

Entry inhibitors (CCR5)?

A

Fuzeon

Selzentry

73
Q

Injection SC only, painful, cellulitis?

A

Fuzeon

74
Q

Use with R5 virus only?

A

Selzentry

75
Q

Work in nucleus?

A

Integrase inhibitors

76
Q

Now indicated first line with low AE?

A

Isentres (integrase inhibitor)

77
Q

Are there dietary restrictions with these drugs?

A

YES

78
Q

Does adjustments to avoid AE in?

A
  1. ED Medication
  2. PPI
  3. Statins
  4. CCBs
79
Q

Can you use Simvastatin?

A

NO

80
Q

What 3 combos can be used to initiate?

A
  1. NNRTI and 2 NRTI
  2. PI (preferably boosted with ritonavir) and 2 NRTI
  3. INSTI and 2 NRTI

(non nuc or PI pr INSTI PLUS 2 NUCs)???

81
Q

What are 2 components of lypodystrophy?

A
  1. Lipohypertropy

2. Lipoatrophy

82
Q

Ring-Enhanced Lesion

A

Toxoplasmosis brain scan related to an HIV case

-CD4 count under 100 and positive antibodies for Toxo

83
Q

Palmar or plantar rash?

A

SYPHILLIS

84
Q

What do newborns born to an HIV+ Mom get the first 6 weeks of life?

A

AZT (zidovudine)

-This is started 8-12 hours after birth and discontinued at 6 weeks (DNA BLD)

85
Q

When is PCP prophylaxis initiated for a baby born to HIV + mom?

A

At 6 weeks

86
Q

Breast feeding?

A

NO

87
Q

What is given for pre-exposure prophylaxis for dischordant couples that have an accident?

A

PrEP- Tanofovir

88
Q

Do all states require pretest counseling or signed release?

A

NO

89
Q

Anemia?

A

AZT (Zidovudine)

90
Q

HS

A

Abacavir (Ziagen)

91
Q

Nightmares

A

Efavirenz (Sustiva- CNS effects)

92
Q

Kidney Stones

A

2 protease inhibitors- Reyataz and Crixivan

93
Q

Undetectable mean irradicated

A

NO

94
Q

What is used to assess efficacy of therapy?

A

Viral loads

95
Q

Best efficacy is how many drugs?

A

3

96
Q

Pregnant women should at least take what?

A

AZT

97
Q

Combo therapy should be started and stopped…

A

ALL OR NONE

98
Q

Can you prescribe simvastatin?

A

JUST DON’T DO IT

Hematology-Oncology Exam 2 (15 decks)

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