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Flashcards in HIV Deck (181):
0

What's HIV?

HIV is a RNA retrovirus that attacks the immune system, mainly the CD4+ T cells => progressive decrease in CD4+ T cell count.

1

Role of CD4+ count?

Major lab indicator of immune fxn in pts infected with HIV

Serves as a key factor in determining both the urgency of antiretroviral therapy (ART) initiation

Need for prophylaxis against opportunistic inf

2

What should be measured in pts who are on tx? Why?

Plasma HIV-1 RNA (viral load)

Bcuz viral load is the most important indicator of response to antiretroviral therapy

3

What does viral load quantifies?

The degree of viremia by measuring the amt of HIV RNA in the blood and used to

Assess dx progression AND possible drug resistance

4

Howz HIV transmitted?

Infected blood, serum and vaginal secretions

5

How does vertical transmission of HIV occur?

Pregnancy

At birth

Through breastfeeding

6

Effect of ART (antiretroviral therapy)?

Dramatically reduced HIV-associated morbidity and mortality

7

What are the primary goals of antiretroviral therapy (ART)?

Restore and preserve the immune system

Suppress HIV viral load to undetectable levels

Reduce HIV-associated morbidity, prolong survival and prevent transmission

8

What's recommended in ALL HIV-infected individuals?

ART is recommended

Also recommended for HIV-infected individuals for the prevention of HIV transit mission including to sexual partners

9

What needs to be done by pts for ART regimen to be effective long-term?

Adherence rate of 95% or higher in order for ART regimen to be effective

10

Whats the 1st step in HIV replication cycle? Agent(s) that work here?

Fusion of HIV to the host cell surface

Fusion inhibitor and CCR5 antagonist

11

Whats the 2nd step in HIV replication cycle? Agent(s) that work here?

HIV RNA reverse transcriptase, Integrase and other viral proteins enters the host cells

None

12

Whats the 3rd step in HIV replication cycle? Agent(s) that work here?

Viral DNA is formed by reverse transcription

NRTIs and NNRTIs

13

Whats the 4th step in HIV replication cycle? Agent(s) that work here?

Viral DNA is transported across the nucleus and integrates into the host DNA

Integrase Strand Transfer Inhibitors

14

Whats the 5th step in HIV replication cycle? Agent(s) that work here?

New viral RNA is used as genomic RNA and to make viral proteins

None

15

Whats the 6th step in HIV replication cycle? Agent(s) that work here?

New viral RNA and proteins move to the cell surface and a new, immature, HIV forms

None

16

Whats the 7th step in HIV replication cycle? Agent(s) that work here?

The virus mature by protease releasing individual HIV proteins

PIs

17

What lab parameters must be done as baseline b4 therapy starts?

CD4+ count + HIV RNA viral load (prior to ART initiation or modification, 2-8 wks post initiation, then Q3-6months thereafter)

Drug resistance testing (ART initiation and modification)

Lipid panel, blood chemistry, CBC with differential (prior to ART initiation, modification and Q6-12 months)

18

What does an increase in HIV RNA viral load indicate?

Drug resistance and/or inadequate tx response

19

What does a decrease in CD4+ count indicate?

Predictor of dx progression

20

What are some common complications of ART?

Lactic acidosis and severe hepatomegaly with steatosis

Immune reconstitution inflammatory syndrome (IRIS or IRS)

Lipodystrophy/lipoatrophy

Fat redistribution/lipohypertrophy

Diarrhea

21

How do u deal with Lactic acidosis and severe hepatomegaly with steatosis (common complications of ART)?

Suspend tx.

Most common with NRTIs

22

What's Immune reconstitution inflammatory syndrome (IRIS or IRS)?

A paradoxical worsening of a preexisting opportunistic inf when ART is initiated

23

What's the most common pathogens associated with Immune reconstitution inflammatory syndrome (IRIS or IRS)?

M. tuberculosis
M. avium
Pneumocystis jirovecii pneumonia (PCP)
Herpes simplex virus (HSV)
Herpes zooster
Cytomegalovirus (CMV)
Cryptococcus
Hepatitis B

24

How's Immune reconstitution inflammatory syndrome (IRIS or IRS) managed?

Start or continue therapy for opportunistic infection

Continue ART

Add corticosteroids (sometimes)

25

Whats Lipodystrophy/lipoatrophy?

Loss of subcutaneous fat in the face, arms, legs and buttocks


Most common with PIs and Stavudine

26

Whats Fat redistribution/lipohypertrophy?

Fat accumulation in the upper back (buffalo hump) and abdominal area and increased breast size in females and males.

Most common with PIs and Stavudine

27

Which is the most common SE of ART use?

Diarrhea

28

What was most recently approved for tx of non-infectious diarrhea in adults with HIV/AIDS on ART?

Crofelemer (Fulyzaq)

29

What's the initial combo for ART-naive HIV pts?

NNRTI-based regimen (Efavirenz/Tenofovir/Emtricitabine)

PI-based regimens
(Atazanavir+Ritonavir+Tenofovir/Emtricitabine)
(Darunavir+Ritonavir+Tenofovir/Emtricitabine)

INSTI-based regimens
(Raltegavir+Tenofovir/Emtricitabine)
(Elvitegavir/Cobicistat/Tenofovir/Emtricitabine)
(Dolutegravir+Abacavir/Lamivudine)
(Dolutegravir+Tenofovir/Emtricitabine)

30

What's the NNRTI-based regimen used in ART-naive HIV pts?

Efavirenz/ Tenofovir/ Emtricitabine

31

What's the PI-based regimen used in ART-NAIVE HIV pts?

Atazanavir+Ritonavir+Tenofovir/Emtricitabine

Darunavir+Ritonavir+Tenofovir/Emtricitabine

32

What's the INSTI-based regimen used in ART-naive HIV pts?

Raltegavir+Tenofovir/Emtricitabine

Elvitegavir/Cobicistat/Tenofovir/Emtricitabine

Dolutegravir+Abacavir/Lamivudine

Dolutegravir+Tenofovir/Emtricitabine

33

In what Grp of pts should Atazanavir be avoided?

Those using > 20mg Omeprazole

34

When should Elvitegavir/Cobicistat/Tenofovir/Emtricitabine be initiated?

In pts with CrCl >= 70mL/min

(Avoid use with other ART or with other nephrotoxic drugs)

35

What's the preferred initial combo for ART-NAIVE in HIV pregnant women?

PI-based regimen
(Lopinavir/Ritonavir + Zidovudine/Lamivudine)
(Atazanavir + Ritonavir + Zidovudine/Lamivudine)

NNRTI-based regimen
(Nevirapine + Zidovudine/Lamivudine)

36

What's the preferred PI-based regimen in pregnant HIV women that are ART-naive?

Lopinavir/Ritonavir + Zidovudine/Lamivudine

Atazanavir + Ritonavir + Zidovudine/Lamivudine

37

What's the preferred NNRTI-based regimen in pregnant HIV women that are ART-naive?

Nevirapine + Zidovudine/Lamivudine

38

What types of dosing Lopinavir/Ritonavir is used in pregnant women?

Twice daily dosing of Lopinavir/Ritonavir

NEVER use once daily dosing

39

What are the alternative regimens in ART-naive HIV pts?

NNRTI-based regimens
(Efavirenz + Abacavir/Lamivudine)
(Rilpivirine/Tenofovir/Emtricitabine)
(Rilpivirine + Abacavir/Lamivudine)

PI-based regime
(Atazanavir + Ritonavir + Abacavir/Lamivudine)
(Darunavir + Ritonavir + Abacavir/Lamivudine)
(Fosamprenavir + Ritonavir + either (Abacavir/Lamivudine or Tenofovir/Emtricitabine)
Lopinavir + Ritonavir + either (Abacavir/Lamivudine or Tenofovir/Emtricitabine)

INSTI-based regimens
(Raltegavir + Abacavir/Lamivudine)

40

What's the NNRTI-based regimen used as ALTERNATIVE regimen in ART-naive HIV pts?

Efavirenz + Abacavir/Lamivudine

Rilpivirine/Tenofovir/Emtricitabine

Rilpivirine + Abacavir/Lamivudine

41

What's the PI-based regimen used as ALTERNATIVE regimen in ART-naive HIV pts?

Atazanavir + Ritonavir + Abacavir/Lamivudine

Darunavir + Ritonavir + Abacavir/Lamivudine

Fosamprenavir + Ritonavir + either (Abacavir/Lamivudine or Tenofovir/Emtricitabine

Lopinavir + Ritonavir + either (Abacavir/Lamivudine or Tenofovir/Emtricitabine

42

What's the INSTI-based regimen used as ALTERNATIVE regimen in ART-naive HIV pts?

Raltegravir + Abacavir/Lamivudine

43

When is the use of Rilpivirine CI?

In pts with pretx HIV RNA > 100,00 copies/ml

Combo with proton pump inhibitors, is also CI

44

Is once daily Lopinavir/Ritonavir recommended in HIV positive pregnant women?

No!

Twice daily is

45

When is the use of Abacavir CI?

Pts who test positive for HLA-B*5701

46

MOA of Nucleoside/Tide Reverse Transcriptase Inhibitors (NRTIs)? What step in the HIV replication cycle does it work at?

Binds to catalytic site of reverse transcriptase, interfering with HIV viral RNA-dependent DNA polymerase and resulting in inhibition of viral replication.

Step 3

47

What's the black box warning of ALL NRTIs? Which agents are most responsible?

Lactic acidosis and Severe hepatomegaly with steatosis

Stavudine, Didanosine and Zidovudine

48

List NRTIs agents

Abacavir ABC (Ziagen)

Didanosine ddl (Videx, Videx EC)

Emtricitabine FTC (Emtriva)

Lamivudine 3TC (Epivir)

Stavudine d4T (Zerit)

Tenofovir TDF (Viread)

Zidovudine ZDV or AZT (Retrovir)

49

What's the black box warning of Abacavir, ABC (Ziagen)? - NRTIs

Hypersensitivity rxn (don't re-challenge he)

50

What screening MUST be done to pts about to start Abacavir, ABC (Ziagen)? Why? - NRTIs

HLA-B*5701 allele (if positive, don't use ABC)

Cuz of hypersensitivity rxn

51

What's the black box warning of Didanosine, ddl (Videx; EC)? - NRTIs

Pancreatitis (sometimes fatal)

52

What's the SE of Didanosine, ddl (Videx; EC)? - NRTIs

DIP

Diarrhea

Increased LFTs

Peripheral neuropathy

53

Howz Didanosine, ddl (Videx EC) taken? - NRTIs

Take on an empty stomach

54

Storage and stability of Didanosine, ddl (Videx; EC) and Stavudine, d4T (Zerit) - NRTIs?

Stable for 30 days if refrigated

55

Black box warning of Emtricitabine, FTC, (Emtriva) and Tenofovir, TDF (Viread) - NRTIs?

May exacerbate Hepatitis B once drug is d/c or HBV resistance may develop

56

SE of Emtricitabine, FTC, (Emtriva) - NRTIs?

Hyper pigmentation

57

Is there any benefit in combining Emtricitabine, FTC, (Emtriva) - NRTIs with Lamivuding, 3TC?

No!

Both are cytosine analogs: FTC and 3GC

58

What's the dose of Emtricitabine, FTC, (Emtriva) - NRTIs capsule? How often?

200mg Daily

59

What's Atripla?

Emtricitabine, FTC + Efavirenz + Tenofovir

60

Howz Atripla (Emtricitabine, FTC + Efavirenz + Tenofovir) used?

Once daily, On an empty stomach, preferably at HS (bedtime)

61

What's the black box warning of Lamivudine, 3TC (Epivir)?

Don't use Epivir-HBV for HIV tx (contains lower doses of Lamivudine)

May exacerbate Hepatitis B once drug is d/c or HBV resistance may develop

62

SEs of Stavudine, d4T (Zerit)?

Increased LFTs
Peripheral neuropathy

63

What's the dosing of Tenofovir, TDF (Viread) - NRTIs?

300mg daily

64

SEs of Tenofovir, TDF (Viread) - NRTIs?

FORR

Fanconi syndrome

Osteomalacia

Renal insufficiency

Reduced bone density

65

Black box warning of Zidovudine, ZDV or AZT (Retrovir)?

Hematologic toxicities (neutropenia and anemia), esp in advanced HIV

Symptomatic myopathy and myositis (associated with prolonged use)

66

SEs of Zidovudine, ZDV or AZT (Retrovir)?

Increased LFTs

67

Role of IV Zidovudine, ZDV or AZT (Retrovir) in therapy? Exception?

IV Zidovudine, ZDV or AZT (Retrovir) used in labor for HIV+. Women

Unless viral load is < 400 copies/m

68

List NRTIs agents that should be avoided if possible?

Didanosine, ddl (Videx, Videx EC)

Stavudine, d4T (Zerit)

Zidovudine, ZDV or AZT (Retrovir) - except in pregnancy, when it's preferred

69

Advantage of NRTIs over PIs and NNRTIs?

NRTIs don't undergo hepatic transformations via CYP metabolic pathway, t4 they have fewer significant drug interactions

70

Which med should be avoided with ALL NRTIs bcuz of increased risk of lactic acidosis?

Ribavirin

71

Why is the combo of Didanosine, ddl and Stavudine, d4T CI?

Combo increases risk of Pancreatitis, Peripheral Neuropathy and Hyperlactatemia

72

Why is the combo of Didanosine, ddl and Tenofovir, TDF CI?

Due to resistance and virologic failure as well as increased Didanosine, ddl conc

73

Whys the combo of Emtricitabine and Lamivudine; Zidovudine and Stavudine avoided?

No benefit

74

MOA of Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)? Step in HIV replication cycle?

Binds to reverse transcriptase and blocks the RNA-dependent and DNA-dependent DNA polymerase activities including HIV-1 replication

Step 3 (same as NRTIs)

75

What's the SE of all agents in NNRTIs?

Rash (SJS/TEN) -monitor erythema, facial edema, skin necrosis, blisters, tongue swelling

Hepatoxicity - monitor LFTs

76

List NNRTIs agents

NEED R

Nevirapine, NVP, (Viramune, Viramune XR)

Efavirenz, EFV, (Sustiva)

Etravine, ETR, (Intelence)

Delavirdine, DRV, (Rescriptor)

Rilpivirine, RPV, (Edurant)

77

Which NNRTIs agent is preferred? When is it not preferred?

Efavirenz, EFV (Sustiva)

Not preferred In women who are planning to be pregnant or are sexually active (except the woman is on Atripla and is already in her 1st trimester, them she may continue)

78

Which NNRTIs agent is for tx in experienced pts?

Etravirine, ETR, (Intelence)

79

What's the abbreviation of Efavirenz? Brand name?

EFV

Sustiva

80

SEs of Efavirenz, EFV, (Sustiva)?

CNS - impaired conc, drowsiness, vivid dreams, resolves btw 2-4wks

Psychiatric Sx - depression, paranoia, mania, suicide

81

Dosing of Efavirenz, EFV, (Sustiva)?

600mg daily

Take on an empty stomach, preferably at bedtime

82

Pregnancy category of Efavirenz, EFV, (Sustiva)?

D

83

Howz Etravirine, ETR, (Intelence) dosed?

200mg bid AFTER meals

84

Which NNRTI is gen avoided, except in pregnancy when it's then preferred?

Nevirapine, NVP (Viramune, Viramune XR)

85

What's unique about the use of Nevirapine, NVP (Viramune, Viramune XR)?

Needs 14 day lead-in period

86

Black box warning of Nevirapine, NVP (Viramune, Viramune XR)?

Severe hepatotoxic rxn may occur (liver failure, death)

Severe, life-threatening skin rxns (SJS/TEN)

87

Main SEs of Nevirapine, NVP (Viramune, Viramune XR)?

Increased LFTs

88

Howz Rilpivirine, RPV (Edurant) dosed?

25mg daily with a meal

89

SEs of Rilpivirine, RPV (Edurant)?

CNS - depression, mood changes, suicidal ideation, insomnia

90

What should be done b4 placing a pt on NNRTIs?

Always run a drug interaction check on ALL pts receiving NNRTIs

91

MOA of Protease Inhibitors (PIs)? What step of HIV replication cycle does PIs work on?

Inhibits HIV-1 protease and renders the enzyme incapable of cleaving the Gag-Pol polyprotein, resulting in productions of immature, no infectious virions.

Step 7 (virus matures by protease releasing individual HIV proteins)

92

Class SEs of PIs?

Hyperglycemia/ Insulin resistance/ Diabetes

Lipoatrophy, fat maldistribution, hyperlipidemia

Hepatitis and hepatic decompensation

Immune reconstitution syndrome

93

Which PIs agents have the lowest occurrence of Lipoatrophy, fat maldistribution, hyperlipidemia?

Atazanavir and Darunavir

94

Which PIs have the highest occurrence of hepatitis and hepatic decompensation?

Tipranavir

95

List the preferred PIs agents

RAD

Ritonavir, RTV (Norvir)

Atazanavir, ATV (Reyataz)

Darunavir, DRV, (Prezista)


96

What's the dosing of Atazanavir, ATV (Reyataz)?

300mg + 100mg Ritonavir daily

Take with food and water (better absorption)

97

SEs of Atazanavir, ATV (Reyataz)?

PR interval prolongation

Indirect Hyperbilirubinemia (leading to jaundice or scleral icterus - referred to as "bananavir")

Rash

Nephrolithiasis (take with 48oz (1.5L) of water may reduce risk

98

Howz Darunavir, DRV (Prezista) dosed in tx-naive?

800mg + 100mg Ritonavir daily

Take with food. Swallow whole

99

SEs of Darunavir, DRV (Prezista)?

Nausea

Diarrhea

Rash (SJS/TEN)

100

Warnings associated with Darunavir, DRV (Prezista) use?

Caution in pts with a sulfa allergy

101

What's the abbreviation and brand name of Atazanavir?

ATV

Reyataz

102

What's the abbreviation and brand name of Darunavir?

DRV

Prezista

103

What's the abbreviation and brand name of Ritonavir?

RTV

Norvir

104

Howz Ritonavir, RTV (Norvir) dosed?

100-400mg/d - booster dose

Take with food

105

Howz solutions, capsules and tablets of Ritonavir, RTV (Norvir) stored?

Ritonavir, RTV (Norvir) solution - don't refrigerate (contains 43% alcohol)

Ritonavir, RTV (Norvir) capsule - refrigerated (30days at room temp)

Ritonavir, RTV (Norvir) tablets - room temp

106

SEs of Ritonavir, RTV (Norvir)?

N/V/D

Pancreatitis

Asthenia

Altered taste

PR prolongation

107

Which PIs is/are preferred in pregnancy?

Atazanavir, ATV (Reyataz)

Lopinavir + Ritonavir, LPV/r (Kaletra)

108

Howz Lopinavir + Ritonavir, LPV/r (Kaletra) dosed in tx-naive HIV+ pts?

800mg Lopinavir/200mg Ritonavir daily or 400mg/200mg BID

Take w/o regard to food, except the oral soln needs to be taken with food

109

Whys Ritonavir used in combo with other PIs?

Ritonavir is a strong inhibitor of 3A4, t4 it's used at low doses to increase, or boost the level of other PIs.

110

MOA of fusion inhibitors? Step in HIV replication cycle?

Block attachment (or fusion) of HIV-1 virus with CD4 cells by blocking the conformational change in gp41 req for membrane fusion and entry into CD4 cells (also known as cell entry inhibitors)

Step 1

111

List agents under Fusion Inhibitors

Enfuvirtide, T20 (Fuzeon)

112

What's the place of Enfuvirtide, T20 (Fuzeon) - fusion inh in therapy?

Salvage therapy (for tx-experienced pts)

113

SEs of Enfuvirtide, T20 (Fuzeon) - Fusion Inh?

Local injection site rxns in almost 100% pts (pain, erythema, induration, nodules and cysts, pruritus, ecchymosis)

Increased risk of bacterial pneumonia

114

MOA of CCR5 antagonists? Step it acts on in HIV replication cycle?

Binds to CCR5 co-receptor on the CD4 cells and prevent the conformation change req for HIV cell entry

Step 1

115

List agents under CCR5 antagonists?

Maraviroc, MVC, (Selzentry)

116

What's the place of Maraviroc, MVC, (Selzentry) in therapy?

For tx-experienced pts

117

Black box warning of Maraviroc, MVC, (Selzentry) - CCR5 antagonist

Hepatotoxicity with allergic type features

118

SEs of Maraviroc, MVC, (Selzentry) - CCR5 antagonist?

Upper respiratory tract inf

Fever

Rash (including SJS)

Musculoskeletal sx

Dizziness

119

Monitoring for Maraviroc, MVC, (Selzentry) - CCR5 antagonist?

Prior to starting therapy, pts must undergo a screening test (Trofile).

120

Why is the screening test, Trofile recommended prior to starting Maraviroc, MVC, (Selzentry) - CCR5 antagonist?

Maraviroc, MVC, (Selzentry) - CCR5 antagonist only works for pts with CCR5-tropic dx

121

MOA of Integrase Strand Transfer Inhibitors (INSTIs)? Place in HIV replication cycle?

Integrase inhibitors block the Integrase enzyme needed for viral DNA to enter the host nucleus

Step 4

122

What's the agents under INSTIs?

RED

Raltegavir, RAL (Isentress)

Elvitegavir, EVG; Cobicistat, COB; Emtricitabine, Tenofovir, (Stribild)

Dolutegravir, DTH, (Tivicay)

123

Howz Raltegavir, RAL (Isentress) dosed?

400mg BID

124

What's the abbreviation and brand name of Raltegavir?

RAL

Isentress

125

Which INSTIs is taken with regards to food?

Elvitegavir, EVG; Cobicistat, COB; Emtricitabine, Tenofovir, (Stribild)

126

Main SE of Elvitegavir, EVG; Cobicistat, COB; Emtricitabine, Tenofovir, (Stribild)?

Proteinuria

127

Which HIV agents are boosters (inhibitors used to increase/ boost the levels of other HIV agents)?

Ritonavir

Cobicistat

128

List the 2-drugs combo HIV pdts

Emtricitabine 200mg + Tenofovir 300mg (Truvada) 1 tab daily

Lamivudine 150mg + Zidovudine 300mg (Combivir) 1 tab BID

Abacavir 600mg + Lamivudine 300mg (Epzicom) 1 tab daily

129

List the 3-drugs combo HIV pdts

Abacavir 300mg + Lamivudine 150mg (Epzicom) + Zidovudine 300mg (Trizivir) 1 tab BID

Emtricitabine 200mg + Tenofovir 300mg + Efavirenz 600mg (Atripla)
1 tab daily on empty stomach

Emtricitabine 200mg + Tenofovir 300mg + Rilpivirine 25mg (Complera)
1 tab daily with food


130

List the 4-drugs combo HIV pdts

Emtricitabine 200mg + Tenofovir 300mg + Elvitegravir 150mg + Cobicistat (Stribild) 1 tab daily with food

131

Which agents used in the 4-drug combo aren't approved as solo agents and only used in combo pdt?

Elvitegravir (INSTIs)

Cobicistat

132

What's the brand name and dosing of Emtricitabine 200mg + Tenofovir 300mg?



Truvada - 1 tab daily

133

What's the brand name and dosing of Lamivudine 150mg + Zidovudine 300mg?

Combivir - 1 tab BID

134

What's the brand name and dosing of Abacavir 600mg + Lamivudine 300mg?

Epzicom - 1 tab daily

135

What's the brand name and dosing of Abacavir 300mg + Lamivudine 150mg + Zidovudine 300mg?






Trizivir - 1 tab BID

136

What's the brand name and dosing of Emtricitabine 200mg + Tenofovir 300mg + Efavirenz 600mg?

Atripla - 1 tab daily on empty stomach

137

What's the brand name and dosing of Emtricitabine 200mg + Tenofovir 300mg + Rilpivirine 25mg?

Complera - 1 tab daily with food

138

What's the brand name and dosing of Emtricitabine 200mg + Tenofovir 300mg + Elvitegravir 150mg + Cobicistat?

Stribild - 1 tab daily with food

139

What's Pre-Exposure Prohylaxis (PrEP)?

New HIV prevention method in which people who don't have HIV take Truvada (Emtricitabine/Tenofovir) to reduce their risk of becoming infected

140

What's the med used in PrEP?

Emtricitabine/Tenofovir (Truvada) 1 tab PO daily

141

What needs to be done before initiating PrEP?

Confirm HIV negative status through HIV antibody test

Confirm CrCl >= 60mL/min

Confirm pt very high risk for acquiring HIV

Screen for Hep B and STDs

142

What needs to be done after initiating PrEP?

HIV test and document -ve result

Provide no more than 90-day supply at a time (renew rx only once HIV negative status is confirmed)

Pregnancy test

Counseling on PrEP adherence and safe sex practices

Q6 months, check SCr and calculate CrCl, and test for bacterial STDs (regardless of sx)

143

List HIV drugs used w/o food?

Atripla

Didanosine

Efavirenz (or small amt of food)

Fosamprenavir (oral suspension)

Indinavir - unboosted

Tenofovir powder (to avoid bitter taste)

144

Nonoccupational Postexposure Prophylaxis (nPEP)?

Nonoccupational exposure is the use of ART prophylaxis after sexual, injection drug use, or some other nonoccupational exposure to HIV

145

What combo is used for nPEP?

NNRTI-based regimens
Efavirenz + (Lamivudine or Emtricitabine) + (Zidovudine or Tenofovir)


PI-based regimens
Lopinavir/Ritonavir + (Lamivudine or Emtricitabine) + Zidovudine

146

What's Occupational Postexposure Prophylaxis Recommendations (PEP)?

Exposure of health care personnel to blood and body fluids that may be potentially be contaminated with HIV

147

What's the preferred tx for Occupational Postexposure Prophylaxis Recommendations (PEP)?

Raltegavir + Truvada (Tenofovir/Emtricitabine) for a 4-wk course (within 72 hrs)

148

Name OTC HIV testing?

Express HIV-1 Test System

OraQuick test

149

How soon after using OraQuick test should test be read?

After 20mins, but no later than 40mins

150

Look at strategies to improve adherence to ART?

Pg 368

151

What's primary prophylaxis of Pnuemocystis pneumonia (PCP)?

TMP/SMX 1DS tab PO daily

Or

1 SS PO daily

152

What's alternative prophylaxis of Pnuemocystis pneumonia (PCP)?

TMP/SMX 1 DS PO TIW

Or

Dapsone 100mg PO daily or 50mg PO BID

Or

Dapsone + Pyrimethamine + Leucovorin) or Aerosolized pentamidine, or Atovaquone

153

What's the indication of Pnuemocystis pneumonia (PCP)?

CD4+ count < 200 cells/mL

Or

Oropharyngeal candidiasis

154

What's criteria for d/c of primary prophylaxis of Pnuemocystis pneumonia (PCP)?

CD4+ count > 200 for 3 months on ART

155

What's indication of Toxoplasma gondii?

Toxoplasma IgG positive pts with CD4+ count < 100 cells/mL

156

What's primary prophylaxis of Toxoplasma gondii?

TMP/SMX 1 DS tab PO daily

157

What's alternative prophylaxis of Toxoplasma gondii?

TMP/SMX 1 DS PO TIW

Or

1 SS PO daily

Or

(Dapsone 50mg PO daily + Pyrimethamine 50mg PO weekly + Leucovorin 25mg PO weekly)

158

What's criteria for d/c primary prophylaxis of Toxoplasma gondii?

CD4+ count > 200 for 3montbs on ART

159

What's indication for Mycobacterium Avium complex (MAC)?

CD4+ count < 50 cells/mL after ruling out active disseminated MAC dx

160

What's primary prophylaxis for Mycobacterium Avium complex (MAC)?

Azithromycin 1,200mg PO weekly

Or

Clarithromycin 500mg PO BID

Or

Azithromycin 600mg PO twice weekly

161

What's criteria for d/c of primary prophylaxis for Mycobacterium Avium complex (MAC)?

CD4+ count >= 100 for 3 months on ART

162

What's 1st-line tx of Cryptococcal meningitis (opportunistic inf)?

Liposomal Amphotericin B + Flucytosine

163

What's alternative tx of Cryptococcal meningitis (opportunistic inf)?

Amphotericin B deoxycholate + Flucytosine/Fluconazole

164

What's secondary prophylaxis of Cryptococcal meningitis (opportunistic inf)?

Fluconazole (low dose)

165

What's 1st-line tx of Cytomegalovirus (CMV) retinitis (opportunistic inf)?

Valganciclovir or Ganciclovir

166

What's alt. tx of Cytomegalovirus (CMV) retinitis (opportunistic inf)?

Foscarnet or Cidofovir

167

What's secondary prophylaxis of Cytomegalovirus (CMV) retinitis (opportunistic inf)?

Continue same agent at reduced at reduced dose (usually Valganciclovir)

168

What's 1st-line tx of Mycobacterium Avium complex (opportunistic inf)?

Clarithromycin or Azithromycin + Ethambutol +/- Rifampicin/Rifabutin

169

What's alt. tx of Mycobacterium Avium complex (opportunistic inf)?

Replace 1 agent with Moxifloxacin

170

What's secondary prophylaxis of Mycobacterium Avium complex (opportunistic inf)?

Same agents at same doses

171

What's 1st line tx of Pneumocystis pneumonia (PCP) (opportunistic inf)?

TMP/SMX +/- corticosteroids

172

What's alt. tx of Pneumocystis pneumonia (PCP) (opportunistic inf)?

Atovaquone or (Clindamycin + Primaquine) or Pentamidine IV or (Dapsone + Trimethoprim)

173

What's secondary prophylaxis of Pneumocystis pneumonia (PCP) (opportunistic inf)?

TMP/SMX or Dapsone or (Dapsone + Pyrimethamine) or Atovaquone or Inhaled Pentamidine

174

What's 1st line tx of Toxoplasmosis meningoencephalitis (opportunistic inf)?

Pyrimethamine + Sulfadiazene

175

What's alt. tx of Toxoplasmosis meningoencephalitis (opportunistic inf)?

TMP/SMX, (Pyrimethadine + Clindamycin or Azithromycin), (Atovaquone or with Sulfadiazine or Primethamine)

176

What's secondary prophylaxis of Toxoplasmosis meningoencephalitis (opportunistic inf)?

Same agents at reduced dose

177

What's imp in all HIV meds counseling?

Don't skip any doses

178

What's imp in Tenofovir counseling?

Use only the dosing scoop to measure the oral powder

Mix oral powders with soft foods that can be swallowed w/o chewing e.g. Applesauce,

Don't mix oral powder with liquid

Give entire dose right away after mixing, to avoid bad taste

179

What's imp in Efavirenz counseling?

Take on an empty stomach, w/o food, usually once daily at bedtime

180

What's considered high risk in HTN?

Pts that have DM, CKD, known CAD
Or
CAD equivalent (carotid artery dx, PAD, abdominal aortic aneurysm)
Or
10-yr Framingham risk score > 10%

Decks in NAPLEX Class (73):