Exam 5 - HIV/AIDS Flashcards Preview

Therapeutics V Spring 2019 (P3 Spring) > Exam 5 - HIV/AIDS > Flashcards

Flashcards in Exam 5 - HIV/AIDS Deck (112):
1

General Rule of treatment:
need at least __#__ active agents from at least __#___ classes

3 active agents;
from 2 classes

2

HIV expresses receptor proteins _____ which preferentially binds to ______ receptors T cells, macrophages, dendritic cells

gp120;
CD4 receptors

3

T or F: HIV is spread through breastmilk

true
(hepatitis B NOT spread via breastmilk though)

4

3 stages of HIV infection?

1. Acute retroviral syndrome
2. Chronic HIV infection (asymptomatic)
3. AIDS (acquired immunodeficiency syndrome) symptomatic

5

3 main routes of transmission for HIV/AIDs

-Exposure of mucous membrane/damaged tissue to infected body fluids
-Blood stream exposure to infected body fluids
-Mother to child

6

When CD4 cells are infected with HIV/AIDs the cell is not able to do ______ production or secrete _______

antibody;
secrete cytokines

7

At CD4 counts below ________ is kinda start of opportunistic infections

500 cells/mm3

8

Sequence of appearance of laboratory markers for HIV infection:
1st seen:
2nd seen:
3rd seen:

1st seen: HIV RNA
2nd seen: HIV p24 antigen
3rd seen: HIV antibody

9

HIV RNA is first lab marker detectable --- approx how long after infection?

10 days

10

A diagnosis of HIV an be made from either of the following:
-Positive result from __________
Positive ______ test (ex: _________)

-multitest algorithm (initial and supplemental tests MUST be differnet)
- virologic (ex: viral load or qualitative HIV NAT)

11

OraQuick Test:
Used to detect ________
uses ________ to test

detect HIV
use ORAL FLUID (not saliva tho)

12

OraQuick Test:
results seen how?

like pregnancy test
(2 lines = positive)

13

what is a seroconversion window?

a time THAT VARIES BETWEEN DIAGNOSTIC TESTS;
at end of window it will show a positive test/when antibodies will be seen...

14

OraQuick Test:
how long is the seroconversion for this test?

3 months

15

two main surrogate markers for HIV?

CD4 T lymphocyte cell count
HIV RNA (viral load)

16

CD4 count or HIV RNA?
which one is used to assess a patients overall immunocopetence

CD4 T lymphocyte cell count

17

CD4 count or HIV RNA?
used to assess the effectiveness of therapy

HIV RNA (Viral load)

18

CD4 count or HIV RNA?
more useful BEFORE initiation of therapy

CD4

19

CD4 count or HIV RNA?
more useful AFTER initiation of therapy

Viral RNA

20

CD4 count is a calculated value based on __________ and can fluctuate depending on _________

based on total WBC count
may fluctuate with bone marrow suppressing medication/acute infections

21

Staging of HIV infection is split into __#___ of classifications and is based primarily on _______

into 4 classifications
based on CD4 count

22

two ways you can be in stage 3/AIDS?

CD4 count < 200
OR
any AIDS defining opportunistic infection

23

what drugs are the backbone of initial antiretroviral therapy in treatment naive patients?

NRTIs "nukes"

24

what NRTIs are adenosine analogues

Tenofovir
Didanosine

25

what NRTIs are cytidine analogues

lamivudine and emtricitabine

26

what NRTIs are thymidine analogues

stavudine and zidovudine

27

what NRTIs are guanosine analogue

abacavir

28

Prior to initiation of _______ pts must undergo screening for HLA-B5701 genotype

Abacavir

29

Class effects/ADEs of NRTIs?

mitochondrial toxicity
lactic acidosis (w/ or w/out hepatomegaly and hepatic steatosis)

30

what are examples of mitochondrial toxicity

anemia
granulocytopenia
myopathy
peripheral neuropathy
pancreatitis

31

Some agents have low affinity for mitochondrial DNA polymerase gamma ---- these agents are (1st or last line) and are what specific agents

they are 1st line! if low affinity for mitochondrial = better ADE profile
Specific agents are TEAL!!!
Tenofovir, Emtricitabine, Abacavir, Lamivudine

32

TDF (tenofovir disoproxil fumarate) has been assoc. with new onset/worsening _________ and decreases in ________

renal impairment
decrease in BMD (bone mineral density)

33

most NRTIs are eliminated via ________

renal excretion

34

the only NRTIs that are hepatic glucuronidated are _________ and __________\

zidovudine
abacavir

35

All NRTIs (except _______) need dose adjusted in renal insufficiency

abacavir

36

NRTIs:
few or lots of drug interactions?

few

37

Due to inhibition of intracellular phosphorylation and minimal additive antiviral activity _______ and _______ should not be used as NRTI backbone therapy

emtricitabine
+
lamivudine

38

class effect ADE with NNRTIs

rash (usually happens within the first 4 weeks of therapy)
SJS is a potential issue

39

NNRTIs:
few or a lot of drug interactions?

lots of drug interactions

40

NNRTIs:
eliminated renally or hepatically?

hepatically
(use in caution with hepatic impairment)

41

Class effects/ADEs of Protease Inhibitors:

GI intolerance-N/V/D
Insulin resistance
lipodystrophy

42

PIs:
few or a lot of drug interactions?

SO MANY --- because they get metabolized by CYP3A4

43

what drug class can have "boosting"

protease inhibitors (bc of CYP3A4 metabolism)

also elvitegravir in INSTIs

44

INSTIs is what drug class?

integrase strand transfer inhibitors

45

class effect/ADE for INSTIs

weight gain

46

INSTIs are mainly eliminated via __________
and also subject to _______

UGT1A1 glucuronidation;
cationic chelation

47

which INSTI needs boosting to be allowed to dose once a day

elvitegravir

48

what does bPI stand for

boosted PI

49

what drug is a chemokine coreceptor antagonist

maraviroc

50

what drug is a fusion inhibitor

enfuviritide

51

HIV Goals of Therapy:
Suppress plasma HIV RNA to below detecable levels (aka < _______)

20 copies/mL

52

Persistent viremia results in immune activation/inflammation:
will cause what issues?

CV and thromboembolic events
cancer
neurocognitive dysfunction and frailty

53

do ART therapy for how long?

indefinitely (lifelong)

54

you can or not eradicate HIV infections with current treatments

can not (duh we have not cured AIDS)

55

ART is recommended for who?

ALL PTS!! regardless of CD4 count

56

what trial showed that it is best to start ART ASAP rather than wait for CD4 count to get below a certain #

START trial...

57

_____________ and ___________ are NOT recommended for 1st line therapy since they have not demonstrated potent/sustained antiviral activity

monotherapy and dual therapy ART
(triple drug regimen is best)

58

in general antiretroviral regimens for a treatment naive pt consist of what drugs?

TWO NRTIs in combo with a 3rd active antitetroviral agent from one of the following 3 drug classes:
INSTI, NNRTI, or PI boosted

59

______ is the "backbone" of therapy

2 NRTIs

60

what are the two common drug combos for NRTI backbone in ARV(antiretroviral) therapy

abacavir(ABC) + lamivudine (3TC)
or
TDF/TAF + emtricitabine (FTC)

61

4 main recommended initial regimens for people with HIV?

-ABC + 3TC + DTG
- DTG + TDF/FTC OR TAF/FTC
- BIC + TAF + FTC
- RAL + TDF/FTC OR TAF/FTC

62

what is abacavir's abbreviation

ABC

63

what is lamivudine's abbreviation

3TC

64

what is emtricitabine's abbreviation

FTC

65

what is dolutegravir's abbreviation

DTG

66

what is bictegravir's abbreviation

BIC

67

what is Raltegravir's abbreviation

RAL

68

Clinical Scenarios + Considerations:
if HLA-B5701 is + or unknown

AVOID ABC regimens!

69

Clinical Scenarios + Considerations:
if we must start antiretroviral therapy before we have the drug resistance results available -- what drugs should we DEFINITELY AVOID

ABC regimens
and NNRTI based regimens

70

Clinical Scenarios + Considerations:
if we must start antiretroviral therapy before we have the drug resistance results available -- what drug regimens should we do and why??

Tenofovir/FTC +
DRV/r or DRV/c or DTG

DRV and DTG have slow resistance to develop--- so safe bet about low resistance!!

71

Clinical Scenarios + Considerations:
what regimen should be taken on an empty stomach?

EFV based regimens

72

what is ritonavir's abbreviation?

RTV

73

Clinical Scenarios + Considerations:
what regimens SHOULD be taken with food

ATV based
DRV based
EVG based
RPV based

74

Clinical Scenarios + Considerations:
what drug should be avoided in CKD
and
which one should be considered as avoided

avoid TDF
consider avoiding ATV

75

what is atazanavir's abbreviation

ATV

76

Clinical Scenarios + Considerations:
which drug should be avoided in osteoporosis?

and what 2 specific ones can be used

AVOID TDF!!

TAF and ABC are ok

77

Clinical Scenarios + Considerations:
avoid what drug based regimens if psychiatric illnesses are present

EFV and RPV based

78

what is ritonavir's abbreviation

RTV

79

avoid what antivirals if high cardiac risk

ABC or LPV regimens

80

which antiviral may cause opioid withdrawal if initiated in patients who are on a stable dose of methadone

EFV

81

______ and ______ are not recommended with any rifamycin containing regimen

TAF and BIC

82

Antiviral Drug Interactions:
Boosted-PIs are CYP3A4 ______

inhibitors

83

Antiviral Drug Interactions:
NNRTIs are CYP3A4 ______

inducers

84

Antiviral Drug Interactions:
_______ are UGT1A1 substrates

INSTIs

85

Antiviral Drug Interactions:
Statins and __________ interact (will need to decrease dose)

Statins also interact with _______ (will need to increase dose maybe)

Protease inhibitors/cobicstat

NNRTIs

(CYP interactions)

86

Antiviral Drug Interactions:
_________ will increase metformin

dolutegravir

87

Antiviral Drug Interactions:
PDE5 inhibitors and ______ interact

protease inhibitors/cobcistat

88

Antiviral Drug Interactions:
Corticosteroids and _________ interact

protease inhibitors/cobcistat

89

Antiviral Drug Interactions:
BZDs and ________ interact

protease inhibitors/cobcistat

90

Antiviral Drug Interactions:
________ is contraindicated with PPIs

Rilpivirine

91

Antiviral Drug Interactions:
antacids should be separated from _______ by 6 hrs because of chelation

INSTIs

92

Antiviral Drug Interactions:
Never give _______ with Al or Mg

Raltegravir

93

what does RAM stand for

resistance associated mutation

94

to do resistance testing:
need a viral load of at least _______ copies/mL

1000

95

clinical scenarios where resistance testing is warranted?

at entry to care
and
if virologic failure

96

if a pregnant woman with HIV is near delivery:
if viral load is > 1000 copies/mL or unknown --- do what?

schedule caesarian section at 38 weeks!!
and give IV zidovudine to mother during labor

97

when can pregnant lady do vaginal birth?

when viral load is less than 50 copies/mL

98

Postpartum considerations with HIV:
all newborns should get ARVs within ______ of life

6 - 12 hours of life

99

ARV prophylaxis for newborns born to HIV + moms?

4 weeks of PO zidovudine

100

PrEP vs PEP?

pre-expsoure phophylaxis
or
post exposure prophylaxis

101

what is currently only approved PrEP regimen

TDF/emtricitabine

102

who gets PrEP?

HIV NEGATIVE pts at high risk for HIV acquisition aka

-men who sex with men in not in monogamous with neg. partner
-heterosexual men or women in not in monogamous with neg. partner
- infrequent condom user w/ 1 or more high risk partner
- any bacterial STI in past 6 mos
- or if known HIV + partner
- ppl who inject drugs (sharing within past 6 mos)

103

Testing needed PRIOR to PrEP initiation

-documented negative HIV antibody or antigen test within 7 days
- any Sxs of acute HIV retroviral syndrome
- Hep B or Hep C serology
- CrCl gotta be above 60 mL/min
- pregnancy test

104

monitoring for PrEP?
do not have the prescription exceed _______ in length

90 days

105

If pt is on PrEP and at a return visit becomes HIV infected: do what?

stop PrEP therapy because only 2 drugs -- need to bump up to 3 drug therapy options!

106

who is PEP recommended for

pts that have had an accidental exposure to HIV
(healthcare needlesticks, sexual assualt victims, or accidental condom break)

107

for PEP therapy:
how long to do it?

x 28 days;
OR
if source patient is found to be NEGATIVE -- can just stop PEP therapy

108

for PEP therapy:
Should start ASAP and needs to be started within _______ or little benefit will be obtained

within 72 hours

109

PEP therapy option?

Emtrictabine/TDF +
(RAL or DTG) x 28 days

110

for PEP therapy: if pt is women of childbearing potential/are pregnant --- avoid what drug in the PEP therapy?

avoid DTG!

111

Monitoring with PEP:
Rapid testing at baseline --- if positive do not do PEP;
Repeat testing at ______ and ______

4 - 6 weeks;
and 3 months

112

PEP Counseling:
Patient should use precaution to prevent __________

secondary transmission (esp first 6 - 12 weeks)
(use barrier to contraception/avoid blood/tissue donation, avoid pregnancy or breastfeeding)