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HIV Flashcards

1
Q

HIV pts susceptible to opportunistic infections (OIs) when CD4 counts are below < ______

A

200

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2
Q

HIV infections mainly attack _______ cells

A

CD4+ helper T cells

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3
Q

HIV can be transmitted via

A

blood, semen, and vaginal secretions (unprotected sex and needle sharing)

or pregnancy, breastfeeding, or birth

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4
Q

The anti-HIV antibodies take about _____ to become positive and ______ to be detected/aka to get diagnosed

A

positive: 4 - 8 weeks after

3 - 6 months to be detected

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5
Q

what are the OTC HIV tests available?

counseling point for patients ?

A

blood test — sends envelope to get results
oral swab test (takes 20-40 mins)

have to wait 3 months after exposure for it to even show up also need another confirmatory lab test for diagnosis

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6
Q

_______ is an indicator of immune function
and
_____ is an indicator of response to ART (antiretroviral therapy)

A

CD4+ count

HIV Viral load

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7
Q

Treatment goals:
CD4+ count want value ____
HIV Viral load want value ______

A

CD4: normal ~ 800 - 1200

HIV viral: undetectable

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8
Q

HIV patients need an adherence rate of ____ or higher to be effective long term

A

95%

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9
Q

____ based regimens with a _______ backbone are recommended as initial therapy for most patients

A

INSTI; NRTI backbone

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10
Q

________ requires testing for HLA-B 5701 allele

A

abacavir

do NOT use this drug if positive for the allele! it is contraindicated

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11
Q

which HIV drug should be used with caution if renal insufficiency?

A

tenofovir disoproxil fumarate

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12
Q

Key Features of NRTIs:

All NRTIs have a boxed warning for ___________ and severe _____________

A
  • lactic acidosis

- severe hepatomegaly with steatosis

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13
Q

Key Features of NRTIs:

T or F: need renal dose adjustment?

A

true – all need it except abacavir

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14
Q

Key Features of NRTIs:

T or F: No CYP450 drug intreactions

A

true

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15
Q

Key Features of NRTIs:

_______ has the hypersensitivity reactions (test for HLA-B 5701)

A

abacavir

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16
Q

Key Features of NRTIs:
Tenofovir toxicities include what 3 things?

– which tenofovir is thought to have less toxicities: disoproxil fumarate or alafenamide

A

nephrotoxicity
osteoporosis
fanconi syndrome

alafenamide is “safer”

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17
Q 
The following drugs are what class of HIV drugs?
abacavir
tenofovir
emtricitabine
lamivudine
zidovudine
didanosine
A

NRTIs

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18
Q

Brand/Generic:

Lamivudine

A

Epivir

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19
Q

Boxed warning for Epivir/lamivudine:

Do not use the ______ formulation for HIV

A

Epivir-HB (aka the hepatitis B formulation…)

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20
Q

Boxed warning for Epivir/lamivudine:

severe/acute exacerbations of _______ can occur

A

hep B

also with emtricitabine, and tenofovir derivatives

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21
Q

these two NRTIs,Lamivudine and Emtricitabine, should not be used together why?

A

they are BOTH cytosine analogs…..

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22
Q

Key Features of NRTIs:

T or F: take without regard to meals

A

true

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23
Q

Truvada for PrEP (pre exposure prophylaxis):

patients must be confirmed as HIV negative prior to use and every ______ during use

A

every 3 months

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24
Q

which NRTI is used as IV option when HIV + mothers are in labor

A

zidovudine

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25
Stavudine and Didanosine come in oral solutions --- stability notes about them?
stable in fridge for 30 days
26
Key features of NNRTIs: | T or F: needs renal adjustment
false (they do not but majority NRTIs do)
27
Key features of NNRTIs: | T or F: no CYP 450 interactions
false (majority are cyp450 substrates and some are inducers)
28
Key features of NNRTIs: | Most common ADEs include: _______ and ______
hepatotoxicity and rash (SJS/TEN)
29
Key features of NNRTIs: | Because of rash issues: monitor fro what?
erythema, facial edema, skin necrosis, blisters, and tongue swelling
30
Key features of NNRTIs: | which two are required to be taken with food
etravirine, rilpivirine
31
Key features of NNRTIs: | which one is required to NOT be taken with food
efavirenz
32
Efavirenz warnings and how to decrease incidence?
CNS effects (impaired concentrations, abnormal dreams, confusion, dizziness --- resolve in 2 - 4 weeks) --- TAKE AT BEDTIME another warning: serious psychiatric symptoms
33
``` Which antiviral drug class are the following drugs from? Efavirenz Rilpivirine Nevirapine Etravirine ```
NNRTIs
34
Rilpivirine requires _______ environment for absorption
acidic (THUS TAKE WITH FOOD and avoid concurrent use of PPIs and separate from H2RAs and antacids)
35
which NNRTI needs a 14 day lead in period to prevent the SJS/TEN/rash and hepatoxicity ADEs?
nevirapine
36
Boxed warnings of nevirapine
hepatoxicity | SJS/TEN
37
Do not initiate nevirapine if ____ counts above 250 (female) or above 400 (men) because of hepatoxicity risk
CD4 counts
38
For rilpivirine: higher rates of failure if viral load > _________
100,000 copies/mL
39
_______ levels can be decreased by efavirenz and nevirapine --- monitor for withdrawl symptoms also _____ levels can be decreased
methadone; hormonal contrapceptive counsel for alt or or additional methods
40
what antiviral drugs are "boosting agents"
ritonavir | cobicistat
41
Key Features of Protease inhibitors: | all generic names end in -____
-navir
42
Key Features of Protease inhibitors: | T or F: There are CYP interactions
true- they are CYP INHIBITORS
43
Key Features of Protease inhibitors: | T or F: they need renal adjustment
false --- they do not
44
Key Features of Protease inhibitors: | Some common side effects include?
- hepatoxicity - metabolic abnormalities (hyperlipidemia, lipohypertrophy, hyperglycemia, insulin resistance) - increased CVD risk - GI upset (N/V/D) - bleeding events (mainly hemophilia patients) - ECG changes - Rash
45
``` Which antiviral drug class do the following drugs belong to? atazanavir darunavir lopinavir nelfinavir saquinavir ```
PIs (protease inhibitors)
46
Darunavir warnings: drug induced _____ serious _______ caution for patients with _____ allergy
hepatitis; serious skin reactions; sulfa allergy
47
T or F: Darunavir MUST be given with ritonavir or cobicistat
true
48
Contaminant RitonavirL which of the following MUST have it and which one is it not recommended to be used with? Nelfinavir, Saquinavir, Tipranavir
Nelfin: NOT recommended | Saquin and Tipra MUST be given with it
49
Drug Interactions for PIs: | Avoid with CYP3A4 inducers (ex:_____ or ______)
rifampin or st johns wort
50
Drug Interactions for PIs: | what are some drug classes should be AVOIDED with PIs?
- antiarrhythmics - anticoagulants/antiplatelets - direct acting antivirals
51
what is the effect of PIs and hormonal contraceptives?
ritonavir may decrease levels -- use back up or alternative
52
what is the effect of PIs and methadone?
ritonavir will decrease levels -- monitor for methadone withdrawl
53
what is the effect of PIs and PDE-5 inhibitors?
can increase PDE-5 levels -- increase toxicity
54
what is the effect of PIs and statins? | which two are completely contraindicated
increase statin levels: lovastatin and simvastatin are CONTRAINDICATED (atorvastatin and rosuvastatin are preferred)
55
Which PI has to have caution with acid suppressing agents?
atazanavir
56
out of the two pk boosters (ritonavir or cobicistat) for PIs which one has antiviral properties
ritonavir
57
out of the two pk boosters (ritonavir or cobicistat) for PIs: take with food?
both
58
which of the preferred initial regimens contain cobicistat (aka watch out for drug interactions)
Genvoya and Stirbild
59
A ritonavir solution as a high content of what?
alcohol (43%)
60
For both of the two pk boosters (ritonavir or cobicistat) what drugs are contraindicated
``` alfuzosin(an alpha blocker) amiodarone/dronedarone carbamazepine lovastatin/simvastatin rifampin St. Johns wort Phenytoin/phenobarbital ```
61
out of the two pk boosters (ritonavir or cobicistat) for PIs: which one can be coformulated with other antivirals?
cobicistat can be | ritonavir is difficult to coformulate with
62
Key features of INSTIs | generic names end with " ______"
-tegravir
63
Key features of INSTIs: | Any major CYP450 interactions?
no
64
Key features of INSTIs: | most common side effects?
increased CPK | headache/insomnia
65
Key features of INSTIs: No renal adjustment needed...but for the drug ______ do not start if CrCl < 70 mL/min and Do not start ______ or ______ if CrCl < 30 mL/min
Stirbild | Genvoya/Biktarvy
66
Key features of INSTIs: | Drug interaction with _______ - must separate
polyvalent cations
67
INSTIs should be taken how in relation to cation containing products?
2 hours prior or 6 hours after
68
INSTIs: | T or F: they need to be avoided with H2RAs and PPIs
False!! only the polyvalent items affect the absorption
69
which drug is a CCR5 antagonist and what does this MOA mean?
maraviroc; there is a CCR5 receptor on some CD4+ cells -- that receptor normally allows/helps HIV get into cells --- blocking CCR5 when present in patients helps prevent HIV from entering cells
70
what kind of test must be done before starting maraviroc?
a tropism test (to see if CCR5 receptor is present)
71
Enfuviritide works via a MOA of _______ and is given by what route?
fusion inhibitor; | given SQ --- 98% of people have local site inj reactions
72
what is IRIS
IRIS = immune reconstruction inflammatory syndrome paradoxical worsening of a PREEXISTING opportunistic infection or malignancy (bc immune system is being stimulated) after ART is started; -can happen 1 -3 months after starting -worse when pt has low CD4+ and high viral load
73
if a patient has an Opportunistic infection -- do you stop or continue ART?
continue it (should be started within at least 2 weeks of OI treatment)
74
difference between lipodystrophy, lipoatrophy, lipohypertrophy
dys: changes in fat distribution atro: loss of SQ fat hyper: fat accumulation in neck/back = buffalo hump
75
what drug class causes lipoatrophy the most
NRTIs (esp stavudine)
76
All ARTs tend to cause ______ but protease inhibitors are typically worse
diarrhea
77
what drug is used for PrEP (pre exporsure prophylaxis)
Truvada 1 tablet daily
78
what drug options are there for non ocupational post exposure prophylaxis (nPEP)
Truvada 1 tablet daily PLUS raltegravir or dolutegravir | aka a 3 drug regimen total -- for 4 weeks
79
to get non ocupational post exposure prophylaxis (nPEP) you have to get it ASAP (but at least within ______)
72 hours
80
what drugs make up Atripla?
``` NNRTI based efavirenz entricitabine tenofovir disoproxil fumurate (aka a complete regimen because it has 3 drug combo) ```
81
what drugs make up Genvoya?
INSTI based elvitegravir + cobicistat + emtricitabine + tenofovir ALAFENAMIDE (aka a complete regimen because it has 3 drug combo)
82
what drugs make up Truvada
NRTI combo products Emtricitabine + tenofovir disoproxil fumurate (aka will need another tablet to be a full regimen)
83
what drugs make up Complera?
NNRTI based Rilpivirine + emtricitabine + tenofovir disoproxil fumurate (aka a complete regimen because it has 3 drug combo)
84
what drugs make up Stribild?
NSTI based elvitegravir + cobicistat + emtricitabine + tenofovir disoproxil fumurate (aka a complete regimen because it has 3 drug combo)
85
what drugs make up Triumeq?
dolutegravir + abacavir + lamivudine | aka a complete regimen because it has 3 drug combo
86
what drugs make up Epzicom?
Abacavir + lamivudine | aka will need another tablet to be a full regimen
87
class effect ADE of NRTIs
lactic acidosis
88
class effect ADE of NNRTIs
rash
89
class effect ADE of PI's
metabolic abnormalities (hyperlipidemia/ hyperglycemia/ lipohypertrophy)

NAPLEX Prep (19 decks)

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