Therapeutics - HIV part 1 Flashcards
true or false
a patient who is antiretroviral naive vs experienced will receive very different therapy
TRUE
bc if experienced, most likely have a resistant virus if they are needing additional therapy
are there prophylactic meds for HIV
yes
true or false
there is no drug that cures HIV
true
just helps people to live longer lives by preventing viral growth and replication – but infection is always there
true or false
HIV meds do NOT reduce the risk of HIV transmission
FALSE - they do
HIV medications prevent HIV from advancing to….
AIDS
U=U meaning
if the patient has an undetectable viral load (<50), they cannot SEXUALLY transmit their HIV infection to another person
(undetectable = untransmittable)
blood transfers are a different story - this only applies to sexual transmission. also, you can still transmit other STI’s sexually - this just applies to HIV
true or false
HIV is diagnosed by checking for the HIV virus in the patient’s bloodstream
FALSE
diagnosed by checking for HIV antibodies
in 1996, HIV management was challenging
a total of around 20 pills (3 diff drugs) were administer, divided to be 3 times a day. how were these administered in relation to meals and hydration
1 hour before and 2 hours after meals
had to have 1.5 LITERS of water a day - bc the drugs could cause kidney stokes
TID was 8 hours apart (8am, 4pm, midnight for ex)
true or false
there are not a lot of patients who are unaware that they have an HIV infection
FALSE
a lot are unaware. this is concerning because they can potentially spread to others
we need to screen more for HIV
what population is most affected by HIV
MSM
the majority of women who have HIV get it how?
through sexual contact with men
name 2 OTC tests for testing for HIV
OraQuick (rub in cheek and gums - most common)
Home access express HIV-1 test (finger prick)
ONLY in emergency situations, what may be used to screen/diagnose HIV
give an example of this emergency situation
the viral load
too much $ to use as screening for everyone
ie - healthcare professional getting a needle stick
what is the name of the blood test to screen for HIV infection?? (not OTC)
what is done to confirm the infection??
ELISA screening test
the western blot is the test to confirm if the ELISA test (+) was true
remember - these are testing for ANTIBODIES - not the HIV virus itself
what are issues with HIV screening tests that test for HIV antibodies?
there is a window period between when you get infected and when you develop antibodies
which is more sensitive to HIV treatment:
-CD4 count
-viral load
viral load
CD4 count is a measure of……..
what is an approximate “normal value”?
the patient’s immune funcion
~1000 cells/mm cubed
define viral load
the measure of the virus in the blood. copies of virus/mL of blood
what is considered an “undetetectable” viral load in modern days
<50 copies of the virus/mL of blood
-our systems can’t detect this low
what are “nukes”
NRTI’s
nucleoside/nucleotide reverse transcriptase inhibitors
6 general class pharmacotherapy options for HIV
-NRTI’s
-NNRTI’s
-Protease inhibitors
-Entry Inhibitors
-integrase inhibitors
-capsid inhibitors
name 4 types of entry inhibitors
fusion inhibitor
CCR5 antagonist
post attachment inhibitor
attachment inhibitor
name the general, most common regimen for how we treat HIV (not specific drugs - just classes)
2 nucleosides/tides + at least 1 drug from another class
name 5 NRTI’s
zidovudine
lamuvidine
abacavir
tenofovir
emtricitabine
what are the only 2 NRTI’s that CANNOT BE USED TOGETHER and why?
lamuvidine and emtricitabine
they are very similar
abbreviations for the 2 different forms of tenofovir
TAF and TDF
what is the ONLY NRTI that is not renally eliminated and thus does not need a dose adjustment for renal failure?
how is it eliminated?
abacavir
hepatic elimination
abacavir + alcohol
increases the blood levels of abacavir
this is because abacavir is metabolized by alcohol dehydrogenase. if you drink, abacavir metabolism will thus be slowed because the alcohol is occupying the enzymes
what is the food requirement for ALL of the NRTI’s
(that are available in the US)
can be taken with or without food!
BUT remember - these are used in combination, so have to consider the drug it is used with
true or false
all of the NRTIs are renally eliminated
FALSE
all are except abacavir
therefore, all except abacavir need dosage adjustment for renal insufficiency! also, certain drugs shouldnt be used if pt is below a certain creatinine clearance
dosing of NRTI’s
QD almost all of the time
really the only exception is zidovudine - which is BID or TID
true or false
zidovudine cannot be used in pregnancy
false - it can
BLACK BOX WARNING OF NRTI’s
lactic acidosis and severe hepatomegaly with steatosis - rare, but serious
aside from the BBW, name 3 other side effects of NRTI’s
-hepatotoxicity
-NVD
-HIV/hep b coinfected pts may have severe hepatic flares when tenofovir, lamuvidine, and emtricitabine are withdrawn
ALL antiretrovirals share what 2 side effects
hepatotoxicity and GI intolerance (NVD)
3 side effects SPECIFIC to abacavir
HYPERSENSITIVITY SYNDROME (starts as rash/fever, gets hard to breathe and can be fatal - do HLAB5701 SCREENING TEST B4 ADMINISTERING!!)
hyperlipidemia, potential increased risk myocardial infarction
name the 2 NRTIS that are NOT available in the US anymore and 1 side effect
didanosine and stavudine
peripheral neuropathy
tonofovir side effects**
nephrotoxicity, asthenia, headache, GI, ostopenia
HOWEVER - TAF vs TDF
TAF is newer and has less risk of nephrotoxicity and osteoporosis!!!!***
zidovudine side effects
anemia, neutropenia, myopathy
name 5 NNRTI’s
which are considered 1st vs 2nd gen and what is the general difference between the 2?
efavirenz, nevirapine are considered 1st gen
etravirine, rilpivirine, doravirine are considered 2nd gen
their resistance profiles are very different between the 2 generations
name the NNRTI that MUST be taken on an empty stomach
efavirenz
NNRTI that should be taken:
-following a meal
-with food
etravirine
rilipivirine
2 NNRTIs that can be taken with or without food
nevirapine
doravirine
*****general DDI concern for NNRTIS
CYP450 interactions!
ALL are CYP450 substrates - and dep on the specific NNRTI, tit may inhibit and/or induce CYPs
which NNRTI has a DDI concern with PPIs
rilipivirine
which NNRTI is taken at night and why
efavirenz
bc of the side effects
particular nevirapine side effects
rash, SJS
necrosis
osteopenia
hepatotoxicity
NVD
which NNRTI can cause CNS disturbances and lead to vivid dreams
efavirenz
(also why it’s dosed at bedtime - makes you sleepy)
true or false
efavirenz is safe in pregnancy
dont really know
shown to be teratogenic in animal studies, but not in humans (yet)
which NNRTI has a BBW of hepatotoxicity
nevirapine
which NNRTI can cause depression and thus should not be given to a mentally unstable patient
rilipivirine
how to recognize protease inhibitors by looking at the name
“navir” at the end
which protease inhibitor is the “boosting protease inhibitor” and what does this mean
ritonavir - very potent CYP inhibitor!!!
at low dose (not effective vs HIV at low dose), it boosts another drug – pharmacokinetic enhancer - increases the levels of other protease inhibitors when used together
name the 6 protease inhibitors that must be taken with food
atazanavir
darunavir
nelfinavir
ritonavir
saquinavir
tipranavir
(amanda didnt need to see raisins)
is indinavir taken with or without food?
what class is it
protease inhibitor
if given with ritonavir, can be taken with or without food
without ritonavir - empty stomacg
true or false
lopinavir must be taken with food
false - with or without
which 3 protease inhibitors should not be given to people with sulfa allergies
darunavir, fosamprenavir, and tipranavir
true or false
all the protease inhibitors have a concern with CYP450 interactions
true
which protease inhibitor should not be taken with antacids because it is well absorbed in acidic medium?
atazanavir
which protease inhibitor is very important to drink a lot of fluids
indinavir
which protease inhibitor capsules should be refrigerated
ritonavir and tipranavir
aside from the DDI concern with CYP450, what is another major concern with protease inhibitors
they have a lot more side effects than previous classes
chronic long term use leads to significant side effects:
hepatotoxicity, GI intolerance
hyperglycemia - insulin resistance is type 2 diabetes
hyperlipidemia
lipodystrophy - body fat changes
bleeding episodes
ostopenia/osteoporosis
rash, sometimes kidney stones
which protease inhibitor is known to have diarrhea as a side effect
nelfinavir
which protease inhibitor has a BBW of intracranial hemorrhage
tipranavir
