HIV

Question 1

What does NRTIs stand for?

Answer 1

Nucleoside Reverse Transcriptase Inhibitors

Question 2

components of basic ART

Answer 2

2 NRTIs + integrase inhibitor

Question 3

NRTIs MOA

Answer 3

prohibits transfer of ssRNA to dsDNA

Question 4

NRTIs examples

Answer 4

1. Truvada (tenofovir DF + emtricitabine)
2. Descovy (tenofovir AF + emtricitabine) - fewer kidney and bone issues than Truvada
3. Epzicom (abacivir + lamivudine) - better for kidney disease

Question 5

NRTIs SE

Answer 5

1. osteoporosis

2. kidney disease

Question 6

special consideration with Epzicom and ziagen

Answer 6

need to do HLA-B701 assay test before starting therapy b/c risk of hypersensitivity reaction

Question 7

What does NNRTIs stand for?

Answer 7

Non-nucleoside Reverse Transcriptase Inhibitors

Question 8

NNRTIs examples

Answer 8

1. Atripla

2. Complera

Question 9

NNRTIs usage

Answer 9

no used as much now b/c lot of resistance! 
MC class for transmitted resistance

Question 10

NNRTIs MOA

Answer 10

prevent RNA –> DNA

Question 11

NNRTIs SE

Answer 11

1. depression
2. abnormal dreams
3. insomnia

Question 12

integrase inhibitors example

Answer 12

Biktarvy (combo of Descovy + integrase inhibitor)
Dolutegravir (DTG)
Bictegravir (BIC)

Question 13

integrase inhibitors MOA

Answer 13

block HIV from being integrated into cell DNA

Question 14

benefits of integrase inhibitors

Answer 14

least resistance, very well tolerated

Question 15

integrase inhibitors SE

Answer 15

neuropsychiatric problems (rare)

Question 16

protease inhibitor historical significance

Answer 16

1. first drug that was shown to prolong life in HIV patients

2. class of drug that showed need for 3 different drugs for HIV

Question 17

protease inhibitor example

Answer 17

Indinavir

Question 18

protease inhibitor MOA

Answer 18

blocks HIV copies from being cut into right size proteins so new virus is not infective

Question 19

protease inhibitor SE

Answer 19

1. increase in lipids
2. lipodystrophy
3. GI s/e
4. lots of drug interactions
5. increased cardiovascular disease risk

Question 20

Entry inhibitors MOA

Answer 20

block HIV fusion to CD4 cells

Question 21

PrEP example

Answer 21

Truvada (TDF + emtricitabine)

Descovy

Question 22

PrEP MOA

Answer 22

prevents replication of virus and prevents infection

Question 23

PrEP Indications

Answer 23

1. MSM
2. HIV + partner
3. commercial sex workers
4. IV drug users

Question 24

PrEP dosage

Answer 24

once daily drug, given in 3 month supply

Question 25

what needs to be check before giving PrEP?

Answer 25

kidney function! | also viral load, viral Ab/Ag

Question 26

when to stop PrEP

Answer 26

1. HIV + 2. any issues w/ kidney function 3. becomes pregnant 4. non-compliant

Question 27

what should you check during every f/u if taking PrEP

Answer 27

1. HIV test 2. pregnancy test 3. STI 4. renal function

Question 28

PEP example

Answer 28

Tenofovir + emtricitabine + raltegravir (I.I)

Question 29

when to test for HIV with PEP

Answer 29

at baseline, 6 and 12 weeks, 6 months

Question 30

special considerations with HIV patients

Answer 30

age quicker - will see disease in 30-50 y/o that may not have developed until 50-70s - sooner screening, monitor lipids, blood sugar, renal disease, bone loss

Question 31

strongest predictor of disease progression

Answer 31

CD4

Question 32

goal of treatment

Answer 32

decrease viral replication - undetectable viral load | raise CD4 count >200

Question 33

what do you use to evaluate response to treatment

Answer 33

HIV RNA (viral load)

Question 34

time frame to treat HIV before it goes into reservoirs

Answer 34

4 weeks

Question 35

truvada and descovy dose adjust for who?

Answer 35

renal patients w/ low creatinine clearance

Question 36

lab abnormality with NNRTIs

Answer 36

elevated LFTs b/c cytochrome P450 system

Question 37

special considerations with protease inhibitors

Answer 37

all require use of pharmacokinetic booster so that lower doses can be used (norvir, cobistat)

Question 38

special considerations with integrase inhibitors

Answer 38

avoid Ca, Fe, minerals - separate by 2 hours prior or 6 hours after

Question 39

rapid start regimen

Answer 39

Tivicay + Descovy

Question 40

important factor in HIV treatment

Answer 40

adherence - missing 3-4 doses can cause loss of class of drugs - needs to be 95%

Question 41

lab to check before starting HIV treatment

Answer 41

creatinine clearance

Question 42

considerations before prescribing PrEP

Answer 42

1. age 2. plans for pregnancy 3. osteopenia/osteoporosis