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D&D Infectious Disease FINAL > Therapeutics - HIV part 1 > Flashcards

Therapeutics - HIV part 1 Flashcards

1
Q

true or false

a patient who is antiretroviral naive vs experienced will receive very different therapy

A

TRUE

bc if experienced, most likely have a resistant virus

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2
Q

are there prophylactic meds for HIV

A

yes

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3
Q

true or false

there is no drug that cures HIV

A

true

just helps people to live longer lives by preventing viral growth and replication – but infection is always there

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4
Q

true or false

HIV meds do NOT reduce the risk of HIV transmission

A

FALSE - they do

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5
Q

HIV medications prevent HIV from advancing to….

A

AIDS

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6
Q

U=U meaning

A

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

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7
Q

true or false

HIV is diagnosed by checking for the HIV virus in the patient’s bloodstream

A

FALSE

diagnosed by checking for HIV antibodies

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8
Q

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

A

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)

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9
Q

true or false

there are not a lot of patients who are unaware that they have an HIV infection

A

FALSE

a lot are unaware. this is concerning because they can potentially spread to others

we need to screen more for HIV

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10
Q

what population is most affected by HIV

A

MSM

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11
Q

the majority of women who have HIV get it how?

A

through sexual contact with men

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12
Q

name 2 OTC tests for testing for HIV

A

OraQuick (rub in cheek and gums - most common)
Home access express HIV-1 test (finger prick)

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13
Q

ONLY in emergency situations, what may be used to screen/diagnose HIV

give an example of this emergency situation

A

the viral load

too much $ to use as screening for everyone

ie - healthcare professional getting a needle stick

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14
Q

what is the name of the blood test to screen for HIV infection?? (not OTC)
what is done to confirm the infection??

A

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

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15
Q

what are issues with HIV screening tests that test for HIV antibodies?

A

there is a window period between when you get infected and when you develop antibodies

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16
Q

which is more sensitive to HIV treatment:

-CD4 count
-viral load

A

viral load

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17
Q

CD4 count is a measure of……..

what is an approximate “normal value”?

A

the patient’s immune funcion

~1000 cells/mm cubed

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18
Q

define viral load

A

the measure of the virus in the blood. copies of virus/mL of blood

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19
Q

what is considered an “undetetectable” viral load in modern days

A

<50 copies of the virus/mL of blood

-our systems can’t detect this low

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20
Q

what are “nukes”

A

NRTI’s

nucleoside/nucleotide reverse transcriptase inhibitors

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21
Q

6 general class pharmacotherapy options for HIV

A

-NRTI’s
-NNRTI’s
-Protease inhibitors
-Entry Inhibitors
-integrase inhibitors
-capsid inhibitors

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22
Q

name 4 types of entry inhibitors

A

fusion inhibitor
CCR5 antagonist
post attachment inhibitor
attachment inhibitor

23
Q

name the general, most common regimen for how we treat HIV (not specific drugs - just classes)

A

2 nucleosides/tides + at least 1 drug from another class

24
Q

name 5 NRTI’s

A

zidovudine
lamuvidine
abacavir
tenofovir
emtricitabine

25
Q

what are the only 2 NRTI’s that CANNOT BE USED TOGETHER and why?

A

lamuvidine and emtricitabine

they are very similar

26
Q

abbreviations for the 2 different forms of tenofovir

A

TAF and TDF

27
Q

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?

A

abacavir

hepatic elimination

28
Q

abacavir + alcohol

A

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

29
Q

what is the food requirement for ALL of the NRTI’s
(that are available in the US)

A

can be taken with or without food!

BUT remember - these are used in combination, so have to consider the drug it is used with

30
Q

true or false

all of the NRTIs are renally eliminated

A

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

31
Q

dosing of NRTI’s

A

QD almost all of the time

really the only exception is zidovudine - which is BID or TID

32
Q

true or false

zidovudine cannot be used in pregnancy

A

false - it can

33
Q

BLACK BOX WARNING OF NRTI’s

A

lactic acidosis and severe hepatomegaly with steatosis - rare, but serious

34
Q

aside from the BBW, name 3 other side effects of NRTI’s

A

-hepatotoxicity
-NVD
-HIV/hep b coinfected pts may have severe hepatic flares when tenofovir, lamuvidine, and emtricitabine are withdrawn

35
Q

ALL antiretrovirals share what 2 side effects

A

hepatotoxicity and GI intolerance (NVD)

36
Q

3 side effects SPECIFIC to abacavir

A

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

37
Q

name the 2 NRTIS that are NOT available in the US anymore and 1 side effect

A

didanosine and stavudine
peripheral neuropathy

38
Q

tonofovir side effects**

A

nephrotoxicity, asthenia, headache, GI, ostopenia

HOWEVER - TAF vs TDF

TAF is newer and has less risk of nephrotoxicity and osteoporosis!!!!***

39
Q

zidovudine side effects

A

anemia, neutropenia, myopathy

40
Q

name 5 NNRTI’s

which are considered 1st vs 2nd gen and what is the general difference between the 2?

A

efavirenz, nevirapine are considered 1st gen

etravirine, rilpivirine, doravirine are considered 2nd gen

their resistance profiles are very different between the 2 generations

41
Q

name the NNRTI that MUST be taken on an empty stomach

A

efavirenz

42
Q

NNRTI that should be taken:

-following a meal
-with food

A

etravirine

rilipivirine

43
Q

2 NNRTIs that can be taken with or without food

A

nevirapine
doravirine

44
Q

*****general DDI concern for NNRTIS

A

CYP450 interactions!

ALL are CYP450 substrates - and dep on the specific NNRTI, tit may inhibit and/or induce CYPs

45
Q

which NNRTI has a DDI concern with PPIs

A

rilipivirine

46
Q

which NNRTI is taken at night and why

A

efavirenz

bc of the side effects

47
Q

particular nevirapine side effects

A

rash, SJS
necrosis
osteopenia
hepatotoxicity
NVD

48
Q

which NNRTI can cause CNS disturbances and lead to vivid dreams

A

efavirenz

(also why it’s dosed at bedtime - makes you sleepy)

49
Q

true or false

efavirenz is safe in pregnancy

A

dont really know

shown to be teratogenic in animal studies, but not in humans (yet)

50
Q

which NNRTI has a BBW of hepatotoxicity

A

nevirapine

51
Q

which NNRTI can cause depression and thus should not be given to a mentally unstable patient

A

rilipivirine

52
Q

how to recognize protease inhibitors by looking at the name

A

“navir” at the end

53
Q

which protease inhibitor is the “boosting protease inhibitor” and what does this mean

A

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

54
Q
A

D&D Infectious Disease FINAL (21 decks)

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