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A - NAPLEX > Chapter 26: HIV > Flashcards

Chapter 26: HIV Flashcards

1
Q

HIV treatment is called

A

Antiretroviral therapy (ART)

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2
Q

When HIV continues to replicate, the viral load (increases or decreases) and the CD4+ count (increases or decreases)

A

increases

decreases

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3
Q

AIDS is diagnosed when the CD4+ count falls below ___ cells/mm3

A

200

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4
Q

What is it called when a woman with HIV spreads it to her child through pregnancy, childbirth or breastfeeding

A

mother-to-child or vertical transmission

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5
Q

What are the high-risk indicators for becoming infected with HIV

A
  • Sharing drug-injection equipment
  • High-risk sexual behaviors
  • History of STI, hepatitis or TB infection
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6
Q

In about ___ weeks post-infection, the viral load is high enough for HIV RNA and HIV p24 antigens to be detected, with an initial HIV-1/HIV-2 Antigen/Antibody screening test

A

2 weeks

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7
Q

Positive HIV results should be confirmed with

A

Antibody Differentiation Immunoassay

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8
Q

What does the Antibody Differentiation Immunoassay differentiate between

A

differentiates if the antibodies are HIV-1 or HIV-2

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9
Q

Nearly all HIV infection in the US is from which HIV subtype

A

HIV-1

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10
Q

Antibodies can be detected from most people by - weeks

A

4-6

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11
Q

What is the OTC HIV test kit called

A

OraQuick

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12
Q

OraQuick detects the presence of

A

HIV Ab

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13
Q

Individuals with a positive HIV result from the OraQuick test must

A

follow up with a confirmatory HIV lab test

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14
Q

The OraQuick test should be use >/= __ months from the exposure due to the lag in Ab production; testing sooner can cause a false negative result

A

3

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15
Q

What is stage 1 of the HIV life cycle & which drugs work here

A

Binding/attachment

  • Maraviroc
  • Trogarzo
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16
Q

What is stage 2 of the HIV life cycle & which drugs work here

A

Fusion

-Fuzeon

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17
Q

What is stage 3 of the HIV life cycle & which drugs work here

A

Reverse transcription

-NNRTIs, NRTIs

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18
Q

What is stage 4 of the HIV life cycle & which drugs work here

A

Integration
-INSTIs

(both start with I)

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19
Q

What is stage 5 of the HIV life cycle

A

Transcription & Translation

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20
Q

What is stage 6 of the HIV life cycle

A

Assembly

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21
Q

What is stage 7 of the HIV life cycle & which drugs work here

A

Budding

Protease inhibitors

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22
Q

What is the major lab indicator for immune function

A

CD4+ count

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23
Q

What is the most important indicator of response to ART

A

HIV viral load

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24
Q

A high viral load can be due to

A

medication non-adherence or drug resistance

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25
Q

What is the treatment goal in HIV

A

undetectable HIV viral load

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26
Q

What drug-specific testing should be performed if considering using abacavir

A

HLA-B*5701 allele

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27
Q

What drug-specific testing should be performed if considering using maraviroc

A

Tropism assay

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28
Q

ART is recommended in all HIV-infected individuals to:

A

reduce progression and prevent transmission to partners

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29
Q

Adherence must be >/= __% to prevent resistance

A

95% (i.e., missing no more than 1 dose/month with a once-daily regimen)

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30
Q

What are the names of the HIV combo tablets that contain 2 NRTIs

A

Truvada

Descovy

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31
Q

The 2 tablet regimens contain which two drug classes

A

An INSTI by itself + 2 NRTIs in a combo tablet

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32
Q

When should Tenofovir DF (or TDF) be avoided

A

Renal impairment or high fracture risk

-If using, consider a DEXA and calcium & vitamin D supplementation

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33
Q

Which 1 tablet once a day regimen contains abacavir

A

Triumeq

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34
Q

The presence of the HLA-B*5701 allele with abacavir indicates a higher risk of

A

hypersensitivity reaction

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35
Q

Dovato should not be started if the HIV RNA is > ____ copies/mL or if there is a _____ co-infection

A

500,000

hepatitis B virus

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36
Q

What are the first line ART regimens if treatment-naïve

A

1 INSTI + 1 or 2 NRTIs (tenofovir/emtricitabine or abacavir/lamivudine)

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37
Q

Why are NRTIs the backbone of HIV therapy

A
  • Good tolerability
  • Few drug interactions
  • Lack of resistance in ART-naïve patients
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38
Q

older NRTIs have a higher risk of ____ and ____ with ____

A

lactic acidosis & hepatomegaly with steatosis

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39
Q

Tenofovir disoproxil fumarate brand name

A

Viread

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40
Q

Lamivudine brand name

A

Epivir

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41
Q

Zidovudine brand name

A

Retrovir

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42
Q

NRTI MOA

A

competitively inhibit reverse transcriptase enzyme (works at stage 3)

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43
Q

All NRTIs except ___ must be dose adjusted in renal impairment

A

abacavir

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44
Q

Which NRTI is still given IV during labor and delivery to protect the baby

A

Zidovudine

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45
Q

NRTI boxed warnings

A
  • Lactic acidosis (mainly with older NRTIs)
  • Hepatomegaly with steatosis (mainly with older NRTIs)
  • NRTIs treat HIV and some treat HBV. Do not d/c NRTIs if HBV-positive without adequate HBV treatment; discontinuation can cause acute HBV exacerbation
  • Do not use abacavir if treating both HIV/HBV
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46
Q

Abacavir is CI with

A

HLA-B*5701 allele or with a history of HSR

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47
Q

Which NRTI requires the patient to carry a medical card

A

abacavir

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48
Q

Stavudine and didanosine have a BW for

A

pancreatitis and severe hepatomegaly with steatosis

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49
Q

Zidovudine has a BW for

A

anemia (treat with EPO), must have ferritin & TSAT above certain levels for EPO to be effective

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50
Q

Tenofovir DF has a warning for renal toxicity, including

A

Fanconi syndrome

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51
Q

Which NRTIs can cause lipodystrophy (body fat redistribution)

A

Stavudine, didanosine, zidovudine

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52
Q

Which NRTIs can cause peripheral neuropathy

A

Stavudine, diadinosine

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53
Q

Which NRTI can cause hyperbilirubinemia

A

Stavudine

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54
Q

SE of ALL NRTIs

A

Nausea, diarrhea

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55
Q

Lamivudine & emcitritabine SE

A

HA

56
Q

In preferred treatment regimens, which two NRTIs can be replaced with each other, but should not be used together

A

emcitritabine can be replaced with Lamivudine

57
Q

Do not use any tenofovir formulation with which HBV drug

A

adefovir

58
Q

Which formulation of tenofovir has less bone and renal effects

A

Tenofovir AF (TAF)

59
Q

INSTIs end in

A

-tegravir

60
Q

MOA of INSTIs

A

block the integrase enzyme, preventing viral DNA from integrating into the host cell DNA (stage 4)

61
Q

INSTIs should be separated from which other meds and by how long

A

Take INSTIs 2 hours before or 6 hours after aluminum & Mg-containing products

62
Q

Bictegravir in combo is called

A

Biktarvy

63
Q

Elvitegravir in combos is called (2 names)

A

Genvoya, Stribild

64
Q

Dolutegravir brand name

A

Tivicay

65
Q

Raltegravir brand names

A

Isentress, Isentress HD

66
Q

Dolutegravir (Tivicay) has a small risk of

A

neural tube defects in pregnancy

HSR with severe rash

and hepatotoxicity

67
Q

Raltegravir has a warning for

A

myopathy/↑ CPK

68
Q

INSTI side effects

A

HA, insomnia, diarrhea, weight gain

69
Q

Bictegravir and dolutegravir can ↑ which lab value, but has no effect on ___

A

SCr

no effect on GFR

70
Q

NNRTI MOA

A

Inhibit the reverse transcriptase enzyme (same as NRTIs), but NNRTIs bind to the enzyme non-competitively while NRTIs compete for the binding site (stage 3)

71
Q

Which drugs are NNRTIs

A

Efavirenz, Rilpivirine

72
Q

How should Rilpivirine be taken

A

with water and a MEAL (do not substitute with protein drink)

73
Q

Rilpivirine should not be used with which drug classes

A

Do not use with PPIs and separate from H2RAs and antacids. Rilpivirine requires acidic environment for absorption

74
Q

How should efavirenz be taken

A

Empty stomach QHS (to decrease CNS effects)

75
Q

NNRTI BW

A

hepatotoxicity, severe rash (Nevirapine is worse for hepatotoxicity and rash)

76
Q

Rilpivirine should not be used with strong CYP ____

A

inducers

77
Q

Efavirenz SE

A

Psych symptoms (suicidality), CNS effects, generally resolve in 2-4 weeks, ↑ TC, TGs

78
Q

Rilpivirine SE

A

depression

79
Q

Rilpivirine should not be used if viral load > ____ copies/mL and or CD4+ counts < ___ cells/mm3 due to higher failure rate

A

> 100,000

< 200

80
Q

Protease inhibitors end in

A

-navir

81
Q

Ataznavir brand name

A

Reyataz

82
Q

Darunavir brand name

A

Prezista

83
Q

Protease inhibitor MOA

A

Inhibits protease enzyme, which prevents protein strands from being cut into the smaller pieces needed for assembly of new virions. (stage 7)

84
Q

PIs are no longer used first line due to

A

More metabolic problems (hyperglycemia/insulin resistance, dyslipidemia with ↑ LDL and TG), lipodystrophy

85
Q

Atazanavir should not be used with which types of meds

A

acid-lowering

Take 2 hours before or 1 hour after antacids

86
Q

Tipranavir BW

A

hepatitis, intracranial hemorrhage

87
Q

Ataznavir & Darunavir must be given with

A

a booster (like ritonavir or cobicistat)

88
Q

PIs should be taken with

A

food

89
Q

Which PI solutions have high alcohol content and should be avoided with metronidazole, tinidazole and disulfuram

A

Kaletra and ritonavir

90
Q

All PIs have a warning for

A

hepatic effects and hypersensitivity reaction

91
Q

Atazanavir has warnings for

A

hyperbilirubinemia

PR interval prolongation

severe skin reactions

92
Q

Darunavir, fosamprenavir, and tipranavir should be used with caution in

A

sulfa allergy

93
Q

Indinavir warning

A

nephrolithiasis

94
Q

PIs should be used with caution in 3A4 ___

A

inducers (will ↓ PI)

95
Q

Which drugs should not be used with PIs

A

alfuzosin, colchicine, apixaban, edoxaban, rivaroxaban, dronedarone, amiodarone, direct-acting antivirals, hormonal contraceptives, lovastatin, simvastatin (use atorva or rosuvastatin instead)

96
Q

Which drugs are used as boosters in HIV

A

ritonavir and cobicistat

97
Q

Ritonavir brand name

A

Norvir

98
Q

Cobicistat brand name

A

Tybost

99
Q

How should ritonavir be taken

A

with food

100
Q

How should cobicistat be taken

A

With the boosted drug (e.g., darunavir, atazanavir & elvitegravir) & with food

101
Q

T/F: ritonavir and cobicistat can be interchanged

A

false

102
Q

ritonavir and cobicistat drug interactions

A

Do not use with dronedarone, lovastatin, simvastatin, phenobarbital, phenytoin, rifampin, and St. John’s wort

103
Q

ritonavir and cobicistat inhibit

A

3A4, 2D6 and P-gp

104
Q

Which drugs should not be used with cobicistat

A

colchicine & voriconazole

105
Q

Which drugs should not be used with ritonavir

A

Alprazolam, amiodarone, dronedarone, itraconazole

106
Q

Boosters are used to

A

increase the level of an ART (they are inhibitors, so they also increase the level of many other drugs)

107
Q

Stribild should not be used in CrCl < __

A

50

108
Q

Genvoya should not be used in CrCl < __

A

30

109
Q

CCR5 antagonists work at which stage

A

Stage 1

110
Q

Fusion inhibitors work at which stage

A

2

111
Q

CD4+ Directed Post-attachment HIV-1 inhibitors work at which stage

A

Stage 1

112
Q

Maraviroc (CCR5 antagonist) must have ___ assay prior to use

A

Tropism

-It is not useful if CXCR4 or mixed (CXCR4/CCR5)

113
Q

Enfuvirtide SE

A

injection site reaction (given SC)

114
Q

What are AIDS-defining conditions

A

-Opportunistic infections
-Kaposi’s sarcoma
HIV Wasting Syndrome

115
Q

What drugs can be used to increase appetite in patients with HIV Wasting Syndrome

A

Dronabinol and nabilone and megestrol (Megace ES) a progestin that stimulates appetite

116
Q

A paradoxical worsening of either a new or known condition that has been suppressed, but becomes unmasked after ART is started or treatment is changed to a more effective regimen is known as

A

Immune Reconstitution Inflammatory Syndrome (IRIS)

117
Q

What should be done if IRIS occurs

A

ART should be continued and the unmasked condition should be treated

118
Q

If a pregnant patient is not already on ART, which regimens could be started

A
  • Abacavir/lamivudine + atazanavir or daranuvir with ritonavir OR raltegravir or dolutegravir
  • TDF/emtricitabine (or lamivudine) + atazanavir or daranuvir with ritonavir OR raltegravir or dolutegravir
119
Q

What is PrEP

A

Taking a 2-drug combination to prevent infection from a high-risk behavior
Taken daily before high-risk activity

120
Q

What must be done prior to starting PrEP

A

Confirm that the patient is HIV-negative with Ab test

121
Q

Which drugs are used in PrEP

A

Truvada or Descovy

122
Q

Treatment with PrEP must include follow-up every __ months

A

3

123
Q

When is PEP used

A

After HIV-exposure, within 72 hours & taken for 28 days

124
Q

Which drugs are used in PEP

A

Truvada (if CrCl >/= 60) + Dolutegravir (Tivicay) OR Raltegravir (Isentress)

125
Q

When can nonoccupational PEP be used

A

after sex without a condom or after injection drug use

126
Q

When can occupational PEP be used

A

After needlestick

127
Q

Which 3 drugs are 1 tablet daily for HIV

A

Remember TBD

Triumeq, Biktarvy, Dovato

128
Q

Dovto contains which 2 drugs

A

Dolutegravir/Lamivudine

think of Demi Lovato

129
Q

Which two HIV drugs contain cobicistat

A

Genvoya and Stribild

130
Q

Atripla contains which drugs

A

Efavirenz/TDF/Emtricitabine

131
Q

Biktarvy contains which drugs

A

Bictegravir/Emtricitabine/TAF

132
Q

Complera contains which drugs

A

Rilpivirine/TDF/Emtricitabine

133
Q

Genvoya contains which drugs

A

Elvitegravir/Cobicistat/TAF/Emtricitabine

134
Q

Odefsey contains which drugs

A

Rilpivirine/Emtricitabine/TAF

135
Q

Stribild contains which drugs

A

Elvitegravir/Cobicistat/TDF/Emtricitabine

136
Q

Triumeq contains which drugs

A

Dolutegravir/Abacavir/Lamivudine

137
Q

Emtricitabine can cause ____ on palms of hands and on soles of feet

A

darkening of skin color

A - NAPLEX (83 decks)

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