SH Revision 4 Flashcards
As a general rule, HIV regimens consist of [+]
What is the BHIVA recommendation drug regimens to start for HIV tx? [4]
As a general rule, regimens consist of:
Two nucleoside reverse transcriptase inhibitors (NRTIs)
A third agent, typically one of:
- Ritonavir-boosted protease inhibitor (PI/r)
- Non-nucleoside reverse transcriptase inhibitor (NNRTI)
- Integrase inhibitor (INI) - RECOMENDED
OR
- Dolutegravir + Lamivudine
This is the list of BHIVA preffered drug regimens to start
In theory; any of above can be used; but BHIVA slide is the.
Name examples for NRTIs [4] and NNRTIs [2]
NRTIs:
* Tenofovir disoproxil fumarate
* Abacavir
* Emtricitabine
* Lamivudine
NNRTIs:
- Efavirenz
- Nevirapine
As NRTIs are the backbone - don’t want to be LATE with starting treatment Lamivudine, Abacavir TDF Emtricitabine
Describe the MoA of PIs [1]
Protease inhibitors (PIs) inhibit the action of protease preventing the cleavage of Gag-Pol polyproteins.
PIs are given alongside which drug [1] as they boost the action of the drug
Name two examples of PIs
They are given alongside ritonavir - referred to as a boosted PI - which increase the action of the drug.
PIs:
* Atazanavir
* Darunavir
* Lopinavir
[] tend to have a high barrier to resistance and therefore may be preferred in patients where there are concerns regarding adherence
NRTIs
NNRTIS
PIs
II
EI
[] tend to have a high barrier to resistance and therefore may be preferred in patients where there are concerns regarding adherence
NRTIs
NNRTIS
PIs
II
EI
Post-attachment inhibitors prevent envelope protein [] engaging with co-receptors.
Name an example [1]
Post-attachment inhibitors prevent envelope protein glycoprotein-120 engaging with co-receptors.
There is currently one medication in this class, the monoclonal antibody Ibalizumab. It is given as an IV infusion once every two weeks.
Which drugs are contained in PEP? [2]
For how long is the course? [1]
Once a day of:
* Tenofovir disoproxil fumerate
* Two Raltegravir
for 28 days
State 3 side effects of protease inhibitors [3]
There are many adverse effects including lipodystrophy, hyperlipidaemia, insulin resistance and hepatotoxicity.
Which drugs are used in PrEP? [1]
Tenofovir-df/emtricitabine
How do you measure safety and toxicity of ARTs? [3]
- Renal and liver test
- Lipids and metabolic tests
- FBCs
Which ART might cause this reaction
Abacavir
Efavirenz
Tenofovir
Darunavir
Nevirapine
Which ART might cause this reaction
Abacavir - get HLAB5701 screen
Efavirenz
Tenofovir
Darunavir
Nevirapine
Which two drugs make up long-acting drugs for HIV treatment? [2]
II and NNRTI
Name two side effects of Tenofovir DF long term use [2]
Tenofovir DF:
- Tubular toxicity (prevents re-ab of certain solutes at PCT - risk of kidney failure
- Reduction in bone mineral density
Name a side effect of abacavir long term use [1]
Dyslipidaemia / atherosclerosis
Avoid in ptx with high risk CVD
Dolutegravir is which drug class? [1]
Integrase inhibitor
Which drug class is associated with Cushingoid appearances? [1]
AZT / old medications
Which drug is most likely to cause vivid dreams, and somnolence
Efavirenz
Emtricitabine
Lopinavir
Abacavir
Enfuvirtide (T-20)
Tenofovir
Atazanavir
Raltegravir
Ritonavir
Dolutegravir
Nevirapine
Which drug is most likely to cause vivid dreams, and somnolence
Efavirenz
Emtricitabine
Lopinavir
Abacavir
Enfuvirtide (T-20)
Tenofovir
Atazanavir
Raltegravir
Ritonavir
Dolutegravir
Which drug is most likely to cause diarrhoea, nausea
Hyperlipidaemia
Efavirenz
Emtricitabine
Lopinavir
Abacavir
Enfuvirtide (T-20)
Tenofovir
Atazanavir
Raltegravir
Ritonavir
Dolutegravir
Nevirapine
Which drug is most likely to cause diarrhoea, nausea
Hyperlipidaemia
Lopinavir (PI)
Which ART causes a risk of hypersensitivty? [1]
Which drug class does it belong to? [1]
Abacavir: hypersensitivity
- NRTI
Renal disease is caused by long term use of which ART? [1]
Tenofovir
Which ART causes a risk of hepatotoxicity? [1]
Which drug class does it belong to? [1]
Nevirapine NNRTI
Which ART can cause this reaction? [1]
Which drug class? [1]
Darunavir
- PI
NB: Reaction = SJS
Efavirenz can cause which side effects? [3]
Neuropsychotic / CNS side effects:
- impaired concentration
- mood swings
- sleep disturbance
Which drug is most likely to cause a severe reaction at the injection site
Efavirenz
Emtricitabine
Lopinavir
Abacavir
Enfuvirtide (T-20)
Tenofovir
Atazanavir
Raltegravir
Ritonavir
Dolutegravir
Nevirapine
Which drug is most likely to cause a severe reaction at the injection site
Efavirenz
Emtricitabine
Lopinavir
Abacavir
Enfuvirtide (T-20)
Tenofovir
Atazanavir
Raltegravir
Ritonavir
Dolutegravir
25 yo man, recently diagnosed with HIV, prominent, non-tender glands in neck and axillae. Otherwise well with CD4 of 550 and viral load of 25000 copies per ml.
Burkitts lymphoma
Chancroid
Epstein Barr virus
Genital herpes
Hodgkin’s lymphoma
Kaposi’s sarcoma
Lymphogranuloma venereum
Non Hodgkin’s lymphoma
Persistent generalised lymphadenopathy
Rubella
Sarcoidosis
Syphilis
Persistent generalised lymphadenopathy (PGL)
Does not do anything, entirely benign
Can occur anywhere where lymph nodes are
Important to document that it is there
Sometimes goes away, sometimes does not
