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PHRM 865 Personal > Exam 5 > Flashcards

Exam 5 Flashcards

(101 cards)

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1
Q

NRTI: Renal

A

Require dose adjustment besides (Abacavir)

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2
Q

Empiric Therapy for Febrile Neutropenia

A

Cefepime
Zosyn
Ceftazidime (no gram+)
Imipenem
Meropenem

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3
Q

PIs: MOA

A

Inhibt the action of viral protease.
-Navir

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4
Q

Antifungal Drugs: Azole Drugs

A

-azole
Selective for fungal enzymes
Metabolised by P450s

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5
Q

Febrile Neutropenia Pathogen Directed Therapies

A

MRSA- Vanco
VRE- Dapto or Linezolid
ESBL- Carbapenem
KPC- Meropenem
NDM/IMP/VIM- Cefiderocol

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6
Q

Drugs to avoid in first trimester and CI

A

Fluconazole, itraconazole,posaconazole and isavuconazole. first

CI: Voriconazole, flucytosine, and griseofulvin

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7
Q

Ibalizumab Dosing Consideration
(Post-Attachment Inhibitor)

A

IV Loading dose then 2 weeks of IV maintance

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8
Q

Antifungal Drug: Echinocandins SOA

A

Broad Spectrum: Synergistic with Voriconazole and Amp B
-fungin
Not metabolized by liver CYPs

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9
Q

ANC level for Neutropenia for risk of infeciton

A

ANC <500 cells

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10
Q

Prefered Pregnancy Regimen

A

Dolutegravir plus (TDF or TAF) plus (emtricitabine or lamivudine)

or
Dolutegravir/abacavir/lamivudine
Only for HLAB negative and without HEPB

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11
Q

PrEP Injection Regimen

A

Cabotegravir IM 600 mg
Residual concentration

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12
Q

HIV Diagnosis

A

Positive virologic tests NAT

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13
Q

Polyvalent cations Drug interactions

A

IGIs 6 hours apart

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14
Q

AntiFungal Therapy for Febrile Neutropenia/Diagnosis

A

4-7 days of broad spectrum, Autopsy

Tx: Amp B
Azoles
Echinocandins(fungin)

Continue for 2 weeks in absense of s/sx of IFI

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15
Q

Febrile Neutropenia Prophylaxis

A

Cipro or Levo
DO NOT reuse for breakthrought infecitons

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16
Q

NNRTI: Renal

A

no.
only caution in hepatic
Virenz..

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17
Q

TMP/SMX Prophylaxis reduces which 2 infections

A

PJP and Toxoplasm

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18
Q

Histoplasmosis Treatment

A

Itraconazole 200 mg PO TID x 3 then 200 mg PO BID for 12months

Severe: Amp B plus itraconazole

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19
Q

NNRTI: Class adverse Effect

A

Rash

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20
Q

OI- Thrush Treatment

A

Fluconazole 200mg Loading dose, then 100-200 mg PO once daily for 7 days

Can also use Nystatin and Clotrimazole

Monitor LFTs and QTC

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21
Q

OI- Vulvovaginal Candidiasis TX

A

Uncomplicated: Fluconazole 150 mg PO
or Topicals

Severe: Fluconazole 100-200 mg PO daily for >7daus or topical azoles for >7 days

Recurrent (acute+long term):
Otesceconazole
or Flucanzole 150 PO q72 hours then ibrexafungerp

Azole- Boric Acid

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22
Q

Cryptococcal men Prophylaxis

A

Not recommended;
Secondary after completion of therapy
Drug: Flucanzole 200 mg for 12 months

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23
Q

If you are considering pregnancy HIV. what do you need to do.

A

Max-suppressive ARV regimen
Account for PK changes

If already on pregancay, continue same regimen.
If not- Obtain genotype.

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24
Q

MAC Treatment

A

Clarithromycin + Ethambutal

Azithromycin + Ethambutol

if Severe: add Rifabutin
If super Severe add: Levo, or moxi, or Amikacin or Streptomycin

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25
PDE5-I drug interactions
With protease inhibitors use low does
26
Benzodiazepine Drug Interactions
With PIs and Cobicistat, Preferred benzos are lorazepam, oxazepam, and temazepam.
27
Antifungal Drug that is once-weekly novel. IV
Rezafungin (Echinocandin)
28
Up-to-date HIV website
Clinicalinfo.hiv.gov for updates
29
Capsid Inhibitor: MOA
Binds to interface b/w capsid protein p24 Uprake of proviral DNA interferes For failing ART
30
Toxoplasma Prophylaxis
IgG 100. Required : TMP-SMX Stop if >200 Primary: TMP-SMX Secondary: Pyrimethamine+ Sulfadiazine + Leucovorin or TMP BID
31
Biguanide Drug interactions
Dolutegravir increases metformin, decrease dose
32
Toxoplasmosis Treatment
Pyrimethamine 200 mg x1 then weight based dosing <60: Pyrimethamine 50 mg PO + Sulfadiazine + Leucovorin >60: Pyrimethamine 75 mg+ 1500 Sulfadiazine + 10-15 leucovorin OR TMP-SMX 6 weeks
33
Prefered Benzos with what class/drugs
PIs prefere lorazepam, oxazepam, temazepam.
34
Antifungal Toxicities
Hepatic- Azole, AmpB, 5-FC, Echino Renal Toxicity- Amp B CNS- Voriconazole Photopsia- Voriconazole GI- Itraconazole, 5-FC Cardia- Itra QTC- Azole
35
Antifungal Drugs: Polyenes MOA
Amphotericin B Amphotericin B binds to ergosterol Creates leakage of intracellular cations and proteins
36
Elvitegravir Dosing Considerations (INSTIs)
Take with food
37
PJP Treatment
TMP-SMX 15-20 mg/kg/day for 21 days Alts: Primaquine plus clinda Pentamidine Add CS for O2 <70 mmJg
38
HIV Route of Transmission
1) Mucous membrane exposure 2) Blood Stream Exposure 3) Mother-Child
39
Lab screening prior to PrEP
HIV test within 1 week before prep HIV RNA STI testing Creatinine HBV
40
RIsk factors for Invasive fungal
Prolonged neutropenia + Broad spectrum antibiotics/steroids
41
Nevirapine Dosing Considerations (NNRTIs)
Titrate dose over 14 days
42
Antifungal Drugs: Flucytosine AE
Intestinal flora can metabolize to 5-FU- anti-cancer Monitor levels when combined with amp B
43
What is a polymorphic mutation major and minor?
Naturally occurring variants in the absence of therapy Major- amino acid substitution Minor- Accessory mutation little effect
44
Attachment Inhibitor: MOA
Binds gp120 on surfance of HIV, blocking attachement to CD4 -savir CYP3A4
45
PrEP Regimens On-Demand
Emtricitabine/TDF- for people who have sex with men
46
Corticosteroids Drug interactions
With PIs and cobicistat= beclomethasome is preferred.
47
Antifungal Drugs: Flucytosine MOA converases
Cytosine deaminase, then PRT then Ribonucleotide reductase. This inhibits thymidylate which stops dUMP to dTMP. Nearly always with AMP B or Fluconazole. Narrow window. Cryptococcus candida
48
HIV Rapid Testing
OraQuick OTC- + go to medical provider Negative- counsel on seroconversion window. retest
49
Antifungal Drugs: Polyenes PK and AE
Poor GI. IV for systemtic AE: Infusion related reactions. Renal Damage.
50
INSTIs: Class Adverse Effect
Weight Gain
51
Which PI requires a "boosting drug"
Ritonavir and Cobicistat- inhibitors of CYP3A4
52
Statins drug interacitons.
With PIs and Cobicistat. Must do a low dose of atorvastatin, rosuvastatin, pitavastatin or pravastatin preffered. with NNRTIs= increase dose
53
MAC Prophylaxis
Primary: CD4<50 and not recieving ART: Not recommended ART Secondary: duration 12 months Drugs: Azithro 1200 mg PO once weekkly Alt: Clithr, Azithro Secondary: Clarithro + Ethambutol + Rifabutin
54
NNRTI: MOA
Binds to allosteric site of reverse transcriptase
55
Immune System- B-lymphocyte defect
Reduce ability against EXTRACELLULAR
56
HIV treatment Recommendations
Two NRTIs in combo with a third active ARV from one of three classes: INSTI, NNRTI, or PI Data: Dolutegravir plus lamivudine for initial treatment
57
Acid Reducers Drug Interactions
Seperate antacids from po INSTIs by 6 hours. Never give raltegravir with Al or Mg.
58
OI- Esophageal Candidiasis TX
Fluconazole 200 mg loading dose,follwed by 100-200 mg up to 400 po or IV for 14-21 days
59
PDE5 Inhibitors drug interactions.
With PIs and Cobicistat, use very low dose
60
Febrile Neutropenia Oral low risk
Oral FQ + Augmentin Cipro+Aug Levo Cipro+Clinda
61
What to seperate acid reducers with
Avoid Antacids with INSTIs by 6. Atazanavir and Rilpivirine reducded by acid reducers. Rilpivirine CI with PPIs
62
Antifungal Drugs: Azoles MOA
Large 5 membered ring MOA: Inhibits 14-a-demethylase Inhibits conversion of lanosterol to ergosterol.
63
Cabotegravir Dosing Considerations (INSTIs)
30 day lead in with the oral before IM injection
64
Intrapartum HIV Considerations
If VL>1000 or unknown = C-section IV Zidovudine during labor if <50; no zidovudine VL 50-1000 can consider IV Zidovudine
65
Polyvalent cation supplements Drug interactions.
with IgIs splace apart by 6 hours. Coadmin of Ca/Fe with dolutegraviro or bictegraviir ok with food.
66
Histoplasma Prophylaxis
150 CD4 maintance for 12 months drugs: priamary: Itraconazole Secondary: Itraconazole 200 mg PO daily Stop if CD4>150
67
Etravirine Dosing consideration (NNRTIs)
Take with food
68
Antiviral Febrile Neutropenia TX
Acyclovir, Valcyclovir for HSV/VZV CMV: Ganciclovir, valganciclovir
69
HIV Stages
Acute, Chronic HIV (Asymptomatic), Aquired Immuno (AIDS)
70
INSTIs: MOA
Inhibits HIB Integrase, preventing the proviral DNA integration
71
Antifungal Drugs: Flucytosine MOA
Antimetabolite- Inhibits thymidylate synthase, interfers with protein synthesis. synergizes with Amp B
72
Target cells for HIV
gp120 binds to CD4 on T Cells destroyed by cytolytic effect
73
Febrile Neutropenia Penicillin allergy Regimen
Ciprto+Aztreonam+Vanco
74
NRTI MOA:
Synthetic purine and pyrimide analogues which result in termination of elongation of growing proviral DNA chain
75
Thrush Prophylaxis
Not recommened Fluconazole 100 or 200 mg PO
76
post-attachment: MOA
Binds to domain D2 of the Cd4 T-cell co-receptor and interrupts the post-attachment
77
Lenacapavir Dosing Consideration (Capsid Inhibitor)
SubQ every 6 months
78
Antifungal Drugs: Allylamines MOA
Disrupts ergosterol synthesis; Inhibits squalene epoxidase
79
Empiric Therapy for Febrile Neutropenia High Risk
Cefepime Zosyn Ceftazidime (no gram+) Imipenem Meropenem Add IV Vanco for sepsis, shock, gram + , pneumonia, cellulitis. IV catheter For Septic Shock gram - or pneumonia: Add AG or Ciproro or Levo
80
Immune System - T-lymphons defect
Reduce ability of host of defend against INTRACELLULAR
81
Statin Drug intreactions
PI must do low doses of atorvastatin, rosuvastatin, pitastatin. With NNRTIs dose may need increased.
82
CCR5 Antagonist:MOA
Binds to CCR5 on Cd4 blocks gp120 and orevents entry of HIV into host Consider tropism assay. CYP3A4!!
83
PrEP Regimens
Oral Daily: Emtricitabine/TDF- PO daily for all risks Emtricitabine/TAF- PO daily for men and transgender women
84
CI for PrEP
HIV Infection <77 pounds CrCL<60 - TDF/FTC CrCL<30 - TAF Possible HIV exposure within 72 hours
85
PIs: Class adverse effects
GI Intolerance, Insulin Resistance, lipodystrophy
86
Resistance- Stahlin
Candida Krusei- Fluconazole; and flucytosine and amp B Candida glab- Multiazole,echinocandin and MDR Asper- Amp B
87
PEP Regimen
Emtricitabine/TDF + (Raltegraviro or Dolutegravir)
88
Antifungal Drugs: Griseofulvin MOA
Discrupts microtubules- Fungistatic Oral used dermatophytes
89
HIV Markers
Cd4 and HIB RNA PCR(viral load)
90
NRTI: Class Adverse Effect
Mitochondrial toxicity adn lactic acidosis w/wo hepatomegaly and hepatic steatosis cavir...
91
Biguanide Drug Interactions
Dolutegravir increases metformin.
92
Treatment of choice antifungal prego-
Amp B. and topical
93
Cryptococcal Meningitis Treatment
Liposomal AmpB + Flucytosine Consoloation: Fluconazole 800 mh PO 8 weeks Maintance Fluconazole 200 mg 1 year
94
rilpivirine Dosing considration (NNRTIs)
take with low protien meal
95
PJP Prophylaxis
CD4 100-200 Must be given after completion of therapy DrugsL Bactrim
96
Tavaborole MOA
Inhibits leucyl transfer RNA (LeuRS)- Inhibits protein synthesis. Boron needed Topical for nail fungus
97
CSF in Febrile Neutropenia
ANC<500, uncontrolled, IFI, hypotension, sepsis. Prolonged infections
98
Antifungal Drugs: Allylamines Drugs
Terbinafine, Naftifine, Butenafine Tolnafatate
99
Low vs High Risk Febrile Neutropenia
Low: Neutropenia <7days, Clinically stable, Inpatient or outpatient, IV or oraL High Risk: ANC <100, Clincally unstable, inpatient, IV therapy
100
Efavirenz Dosing Consideration (NNRTIs)
empty stomach at bed time
101
Antifungal Drugs: Echinocandins MOA
long cyclic hexapeptides with fatty acid side chains. inhibit 1-3 glucoan well wall component.

PHRM 865 Personal (7 decks)

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