Diabetes, HIV, Asthma, Pediatrics, Drugs in Pregnancy & Lactation Flashcards
(102 cards)
1
Q
HIV
What is the main indicator of immune function in HIV that determines the need for prophylaxis therapy against opportunistic infections?
A
CD4 count
2
Q
HIV
What is the most important indicator of response to antiretroviral therapy & should be measured at baseline and regularly throughout therapy?
A
HIV-1 RNA
“Viral load”
3
Q
HIV
Transmission
A
Semen
Blood
Body secretions
“Some Big Bullshit”
4
Q
HIV
Define Horizontal transmission
A
Sex or needle sharing
5
Q
HIV
Define Vertical transmission
A
Mother to baby (pregnancy), birth or breastfeeding
6
Q
HIV
What is the gold standard HIV test called?
A
HIV ELISA
test for HIV antibody in the blood
7
Q
HIV
What must a patient have to be diagnosed as HIV positive?
A
Positive HIV ELISA test + positive supplemental tests
8
Q
HIV
What are the stages of HIV replication cycle & where does each drug work?
A
Stage 1: Attachment (CCR5 antagonists)
Stage 2: Fusion (Fusion inhibitors)
Stage 3: Reverse transcription (NRTIs & NNRTIs)
Stage 4: Integration (INSTIs)
Stage 5: Transcription & Translation (none)
Stage 6: Assembly (none)
Stage 7: Maturation/Budding (PIs)
9
Q
HIV drug classes
CCR5 Antagonist
A
Maraviroc (Selzentry)
10
Q
HIV drug classes
Fusion Inhibitor
A
Enfuvirtide (Fuzeon)
11
Q
HIV drug classes
NRTIs
A
Lamivudine (Epivir)
Abacavir (Ziagen)
Tenofovir (Viread)
Emtricitabine (Emtriva)
12
Q
HIV drug classes
NNRTIs
A
Efavirenz (Sustiva)
Rilpivirine (Edurant)
“virenz”
13
Q
HIV drug classes
INSTIs
A
Raltegravir (Isentress)
Elvitegravir (Vitekta)
Dolutegravir (Tivicay)
“gravir”
14
Q
HIV drug classes
PIs
A
Ritonavir (Norvir)
Atazanavir (Reyataz)
Darunavir (Prezista)
“navir”
15
Q
HIV
What are antiretrovirals (ARTs) goals?
A
- Preserve immune function
- Suppress viral load to undetectable levels
- Prevent transmission
- Reduce morbidity
16
Q
HIV
What is the adherence rate for ART to be effective long-term?
A
95%
17
Q
HIV
What is the recommended regimen for pregnant women?
A
2 NRTIs + PI (w/ ritonavir boost)
or
NNRTI + INSTI
18
Q
HIV
All NRTIs have a boxed warning for what?
A
Lactic acidosis & hepatomegaly with steatosis
19
Q
HIV
What is Emtricitabine (Emtriva) boxed warning?
A
severe exacerbation of HBV
if drug is stopped –> may also cause hyperpigmentation
20
Q
HIV
Truvada generic
A
Tenofovir + Emtricitabine
21
Q
HIV
Atripla generic
A
Tenofovir + Emtricitabine + Efavirenz
22
Q
HIV
What is the boxed warning for Tenofovir (Viread)?
A
Severe Exacerbation of HBV
if drug is stopped may also cause ARF & osteomalacia
23
Q
HIV
All NNRTIs can cause:
A
Hepatotoxicity & severe rash (SJS/TEN)
24
Q
HIV
What ART has a warning for suicidal ideations, fetal toxicity (category D), & convulsions?
A
Efavirenz (Sustiva)
NNRTI
CNS symptoms usually resolve in 2-4 wks
25
HIV
What ART may decrease levels of oral contraception & methadone?
Efavirenz (Sustiva)
26
HIV
Complications of ARTs
1. Lactic acidosis w/ hepatomegaly
2. Immune reconstitution inflammatory syndrome (IRIS)
3. Lipodystrophy: fat redistribution
4. Lipoatrophy: loss of fate in face, arm, legs (occurs mostly w/ NRTIs)
5. Lipohypertrophy: fat accumulation in back & neck (mostly PIs)
6. Diarrhea (mainly PIs)
27
HIV
What ART is recommended for PrEP?
Truvada
28
HIV
For PEP, treatment should be initiated when?
Within 72 hours & includes a 3-drug regimen of Truvada + raltegravir (Isentress) for 4 weeks
29
Asthma
What is 1st line for maintenance therapy?
ICS
30
Asthma
What is the 1st line for rescue therapy
SABA
31
Asthma
Stepwise approach for asthma
```
Step 1: SABA PRN
Step 2: Low-dose ICS
Step 3: Low-dose ICS + LABA or Medium-dose ICS
Step 4: Medium-dose ICS + LABA
Step 5: High-dose ICS + LABA
Step 6: High-dose ICS + LABA + Oral CCS
```
32
Asthma
Patient should only step down if symptoms have been controlled for how long?
3 months
33
Asthma
If patient is using their SABA for > 2 days/wk then:
Step up maintenance therapy
34
Asthma
What is the injectable that can be considered for patients with allergies & positive skin test called?
Omalizumab (Xolair)
35
Asthma
Omalizumab (Xolair) MOA & boxed warning
MOA: IgG monoclonal antibody that inhibits IgE binding
Boxed warning: anaphylaxis (given in office)
36
Asthma - Drug Class
Name the SABAs
Albuterol (ProAir, Ventolin, Proventil)
| Levalbuterol (Xopenex)
37
Asthma - Drug Class
LABAs
Salmeterol (Serevent)
Formoterol (Foradil)
*never used alone due to boxed warning for asthma related deaths*
38
Asthma - Drug Class
ICSs
Beclomethasone (QVAR)
Fluticasone (Flovent, Arnuity)
Budesonide (Pulmicort)
39
Asthma - Drug Class Combos
Advair generic
Fluticasone + Salmeterol
40
Asthma - Drug Class Combos
Breo generic
Fluticasone + Vilanterol
41
Asthma - Drug Class Combos
Symbicort
Budesonide + Formoterol
42
Asthma - Drug Class Combos
Dulera
Mometasone + Formoterol
43
Asthma
Counseling for ICS
Rinse and spit after use to prevent oral candidiasis (thrush)
44
Asthma
What may be used as add-on therapy to improve bronchodilation?
Theophylline
45
Asthma
About Theophylline
1. Active metabolites include caffeine & methylxanthine
2. Therapeutic peak 5-15 mcg/mL
3. IBW dosing
4. Theophylline dose = aminophylline x 0.8
5. Theophylline levels can be decreased by carbamazepine & high protein diet
46
Asthma
What drug is approved as add-on therapy for patients with severe asthma & an eosinophilic phenotype?
Mepolizumab (Nucala)
47
Asthma
What drug is approved for asthma treatment ages 12 years and older?
Spiriva Respimat
48
Asthma
Mepolizumab (Nucala) MOA
IL-5 antagonist that inhibits IgE binding
49
Asthma
Recommended treatment for asthma in pregnancy
Albuterol + Budesonide
50
Asthma
What drug class can worsen asthma symptoms?
NSAIDs
51
Asthma
Which type of inhaler should be shaken, requires slow, deep breaths and can be used with spacers?
MDIs (HFA or Respimat)
52
Asthma
Which type of inhaler should NOT be shaken, require quick, forceful breaths, and no spacers?
DPIs (Ellipta, Diskus, -Haler)
53
Asthma - Zones based on personal best (PB)
Green
80-100% of PB = good control
54
Asthma - Zones based on personal best (PB)
Yellow
50-80% of PB = worsening lung function, alter regimen
55
Asthma - Zones based on personal best (PB)
Red
<50% of PB = use SABA & go to ER
56
Asthma
A patient's peak expiratory flow rate (PEFR) is known as the patient's what & is determined by what test?
Patient's personal best (PB)
Determined by a spirometry test
57
Diabetes - Primary mechanism
increase/replace insulin secretions
Insulin
Sulfonylureas
Meglitinides
58
Diabetes - Primary mechanism
decrease hepatic glucose output
Metformin
59
Diabetes - Primary mechanism
decrease glucagon which decrease glucose production (liver)
GLP-1 agonists
DDP-4 inhibitors
Pramlintide
60
Diabetes - Primary mechanism
decrease glucose absorption
Alpha-glucosidase inhibitors
61
Diabetes - Primary mechanism
increase glucose excretion
SGLT2 inhibitors
62
Diabetes - Primary mechanism
increase insulin sensitivity
Thiazolidinediones (TZDs)
63
Diabetes - SE
Metformin
1. Lactic acidosis
2. Renal adjustments: CrCl < 45 mL/min - reduce dose; CrCl < 30 mL/min - CI
3. Weight neutral/loss
4. Hold prior to contract use & wait 48 hours after before restarting
64
Diabetes - Drugs & SE
Sulfonylureas
Glipizide (Glucotrol)
Glyburide (Diabeta)
Glimepiride (Amaryl)
SE: Hypoglycemia & weight gain
65
Diabetes - Drugs & SE
Thiazolidinediones
Pioglitazone (Actos)
Rosiglitazone (Avandia)
SE: Weight gain; may cause HF & bladder cancer
MOA: PPARy agonists that cause peripheral insulin sensitivity
66
Diabetes - Drugs, MOA SE, CP
Alpha-glucosidase inhibitors
Acarbose (Precose)
MOA: inhibit metabolism of sucrose (must use sucrose if hypoglycemic)
SE: flatulence & other GI effects
CP: take with 1st bite of each main meal
67
Diabetes - Drugs, SE, & Warning
SGLT2 inhibitors
Canagliflozin (Invokana)
Empagliflozin (Jardiance)
Dapagliflozin (Farxiga)
SE: Mycotic infections, UTIs, hypoglycemia, & weight loss
Warning: Ketoacidosis
68
Diabetes - Drugs & SE
DDP-4 inhibitors
Sitagliptin (Januvia)
Sitagliptin + Metformin (Janumet)
Linagliptin (Trajenta)
SE: URT infections, UTIs, & nasopharyngitis
69
Diabetes - Drugs, SE & Warning
GLP-1 agonists
Exenatide (Byetta) - not recommended in CrCl <30
Exenatide ER (Bydureon)
Liraglutide (Victoza)
Dulaglutide (Trulicity)
SE: Weight loss
Warning: Pancreatitis
70
Diabetes - Brand, Indication, Administration, & SE
Pramlintide
Brand: Symlin
Indicated for both Type 1 & 2 DM
Admin: SQ in abdomen prior to EACH MEAL
SE: hypoglycemia, weight loss & anorexia
71
Diabetes - Insulins, Onset, Peak & Duration
Rapid-acting insulin
Aspart (Novolog)
Glulisine (Apidra)
Lispro (Humalog)
Inhaled insulin (Afrezza)
Onset: 10-30 minutes
Peak: 0.5-2.5 hours
Duration: 3-5 hours
72
Diabetes - Insulins, Onset, Peak & Duration
Short-acting insulin
Regular (Humulin R, Novolin R)
Onset: 30-60 minutes
Peak: 1-3.5 hours
Duration: 6-10 hours
73
Diabetes - Insulins, Onset, Peak & Duration
Intermediate-acting insulin
NPH (Humulin N, Novolin N) - Onset: 1-2 hours; Peak: 4-8 hours
NPH/Regular (Humulin 70/30, Novolin 70/30) - Onset: 30 minutes; Peak: 2-12 hours
Duration: 14-24 hours
74
Diabetes - Insulins, Onset, Peak & Duration
Long-acting insulin
Detemir (Levemir) - Duration: 14-24 hours
Glargine (Lantus, Basaglar) - Duration: 24 hours
Degludec (Tresiba) - Duration - 42 hours
Onset: 1-2 hours
75
Pediatric Conditions
IM injection recommended for prevention of RSV in infants born before 29 weeks gestation and for infants with chronic illnesses
Palivizumab (Synagis)
76
Pediatric Conditions
Synagis generic, dosage, injection site
1. Generic: Palivizumab
2. Dose: Monthly injection during RSV season and should NOT EXCEED 5 months/doses
3. Site: Thigh
77
Pediatric Conditions
Nebulized racemic epinephrine is used for treatment of
Difficulty breathing in children along with steroids
78
Pediatric Conditions
ONLY drug treatment recommended for enuresis (bedwetting)
Desmopressin (DDAVP)
MOA: synthetic analogue of ADH
79
Pediatric Conditions
OTC cough & cold medicine should NOT be given to children under what age?
1. FDA: <2yo
| 2. AAP: <6yo
80
Pediatric Conditions
Treatment recommended for intestinal gas
Simethicone gas
81
Pediatric Conditions
Treatment recommended for prevention of constipation
PEG (Miralax)***
-Glycerin suppositories can be used for stat removal in constipation
82
Pediatric Conditions
Ibuprofen dosing for pain/fever
5-10 mg/kg/dose Q 6-8H
83
Pediatric Conditions
Acetaminophen dosing for pain/fever
10-15 mg/kg/dose Q 4-6H
84
Drug Use in Pregnancy & Lactation
What is the first line for smoking cessation in pregnant patients?
Behavioral intervention
85
Drug Use in Pregnancy & Lactation
Women of childbearing age should consume adequate:
1. Folic acid: 400-800 mcg/day
2. Calcium: 1000 mg/day
3. Vitamin D: 600 IU/day
86
Drug Use in Pregnancy & Lactation
When should folic acid (folate) be started in pregnancy to prevent neural tube defects?
1 month prior to pregnancy & continued for at least 2-3 months
87
Drug Use in Pregnancy & Lactation
Vaccine Recommended
1. Inactivated flu vaccine
2. Tdap between 27-36 weeks of EACH pregnancy
**NO live vaccines (MMR, Varicella, Nasal flu)**
88
Drug Use in Pregnancy & Lactation
Important pregnancy classes
1. C: studies in humans and animals are not available
2. D: positive evidence of fetal risk, but benefit may outweigh risks
3. X: contraindicated in pregnancy
89
Drug Use in Pregnancy & Lactation
Common teratogens
Alcohol, ACEIs/ARBs, BZDs, Lithium, Ergots, MTX, NSAIDs, etc
90
Drug Use in Pregnancy & Lactation
Treatment recommendations for morning sickness
Pyridoxine (vitamin B6) or ginger
91
Drug Use in Pregnancy & Lactation
Treatment recommendations for GERD
Tums (calcium carbonate)
92
Drug Use in Pregnancy & Lactation
Treatment recommendations for Flatulence
Simethicone
93
Drug Use in Pregnancy & Lactation
Treatment recommendations for Constipation
Fiber (psyllium)
94
Drug Use in Pregnancy & Lactation
Treatment recommendations for Cough, Cough, or Allergies
1st generation antihistamines (chlorpheniramine), Cromolyn
Zyrtec & Claritin can be used in 2nd or 3rd trimesters
95
Drug Use in Pregnancy & Lactation
Treatment recommendations for Pain
APAP
96
Drug Use in Pregnancy & Lactation
Treatment recommendations for Infections
PCNs, cephs, erythromycin & azithromycin
97
Drug Use in Pregnancy & Lactation
Treatment recommendations for asthma
budesonide (maintenance) PLUS albuterol (rescue)
98
Drug Use in Pregnancy & Lactation
Treatment recommendations for VTE
LMWH
99
Drug Use in Pregnancy & Lactation
Treatment recommendations for Hypothyroidism
Levothyroxine
100
Drug Use in Pregnancy & Lactation
Treatment recommendations for Hyperthyroidism
1st trimester: Propylthiouracil
2nd & 3rd trimesters: Methimazole
101
Drug Use in Pregnancy & Lactation
Treatment recommendations for Diabetes
Insulin & metformin
102
Drug Use in Pregnancy & Lactation
Pregnant patients with bacteriuria, even when asymptomatic with negative urinalysis
should be TREATED anyways
