HIV

Question 1

At what CD4+ T cell count level makes someone more susceptible to opportunistic infections

Answer 1

< 200

Question 2

Normal CD4+ count

Answer 2

800-1200

Question 3

What is the recommended treatment for HIV

Answer 3

INSTI with 2 NRTIs

Question 4

what test needs done prior to using Abacavir

Answer 4

HLA-B*5701

- If positive do not use Abacavir (Ziagen)

Question 5

Caution for Tenofovir Disoproxil Fumarate

Answer 5

• Renal insufficiency

- Deceased bone density

Question 6

CI for Triumeq

Answer 6

do not start if CrCL < 50

do not use if HLA-B*5701 positive

Question 7

CI for Biktarvy

Answer 7

do not start if CrCl < 30

Question 8

What does INSTI stand for

Answer 8

Integrase strand transfer inhibitors

Question 9

NRTIs MOA

Answer 9

Competitively bind to the enzyme reverse transcriptase, blocking HIV viral RNA-dependent DNA polymerase.

This results in DNA chain termination and stops further viral DNA synthesis

Question 10

Warning for all NRTIs (2)

and which 3 are affected most

Answer 10

Lactic acidosis
Hepatomegaly with steatosis

Zidovudine
Stavudine
Didanosine

Question 11

Tenofovir toxicities (3)

Answer 11

Nephrotoxicity
Osteoporosis
Fanconi syndrome

Question 12

List NRTIs (5)

Answer 12

• Abacavir (Ziagen)
• Lamivudine (Epivir)
• Emtricitabine
• Tenofovir DF (Viread)
• Tenofovir AF
• Zidovudin (Retrovir)

Question 13

NNRTIs MOA

Answer 13

Non-competitive binding to reverse transcriptase and blocking the RNA-dependent and DNA-dependent DNA polymerase activities including HIV replication

Question 14

List NNRTIs

Answer 14

• Efavirenz (Sustiva)

- Rilpivirine

Question 15

Protease inhibitors MOA

Answer 15

Inhibiting HIV protease and rendering the enzyme incapable of cleaving the Gag-Pol polyprotein, resulting in non-functional viral proteins and preventing the assembly and maturation of HIV virions

Question 16

generic names of PIs end in

Answer 16

-navir

Question 17

List PIs (2)

Answer 17

• Atazanavir (Reyataz)

- Darunavir (Prezista)

Question 18

What is a PI commonly taken with?

Answer 18

PK booster

ritonavir or cobicistat to increase the levels of the PI

Question 19

Main drug interactions for PIs

Answer 19

All Pis are CYP3A4 substrates and most are strong inhibitors of CYP3A4

Question 20

Pharmacokinetic boosters agents

Answer 20

• Ritonavir (Norvir)

- Cobicistat

Question 21

Integrase strand transer inhibitors MOA

Answer 21

Block the integrase enzyme needed for viral DNA to integrate with the host cell DNA/human genome

Question 22

Generic name for INSTIs end with?

Answer 22

-tegravir

Question 23

List INSTIs (4)

Answer 23

Bictegravir

Dolutegravir (Tivicay)

Elvitegravir

Raltegravir (Isentress)

Question 24

Common ADE for INSTIs

Answer 24

Increased CPK

Question 25

CCR5 antagonist MOA

Answer 25

Inhibit binding to the CCR5 co-receptor on the CD4+ cells and prevents HIV from entering the cell

Question 26

List CCR5 antagonist

Answer 26

Maraviroc Note: Patient must undergo a Tropism Test prior to start of this med

Question 27

Fusion inhibitors MOA

Answer 27

Block the fusion of the HIV virus with the CD4+ cells by blocking the conformational change in gp41 required for membrane fusion and entry into CD4+ cells

Question 28

List fusion inhibitors

Answer 28

Enfuvirtide

Question 29

Common complication of ART (4)

Answer 29

- Lipodystrophy: changes in fat distribution - Immune reconstitution inflammatory syndrome (IRIS); worsening of preexisting OI or malignancy when ART is initiated - Lactic acidosis - Severe hepatomegaly with steatosis

Question 30

Indication for Megestrol in HIV

Answer 30

Anorexia or Cachexia (wasting of the body and weakness) associated with AIDS It increases appetite

Question 31

Indication for Dronabinol in HIV

Answer 31

AIDS-related anorexia

Question 32

Pre-exposure prophylaxis

Answer 32

Emtricitabine/Tenofovir

Question 33

Ziagen generic and class

Answer 33

Abacavir NRTI

Question 34

Epivir generic and class

Answer 34

Lamivudine NRTI

Question 35

Viread generic

Answer 35

Tenofovir Disoproxil Fumarate

Question 36

Retrovir generic and class

Answer 36

Zidovudine NRTI

Question 37

Sustiva generic and class

Answer 37

Efavirenz NNRTI

Question 38

Prezista generic and class

Answer 38

Darunavir PI

Question 39

Reyataz generic and class

Answer 39

Atazanavir PI

Question 40

Tivicay generic and class

Answer 40

Dolutegravir INSTI

Question 41

Isentress generic and class

Answer 41

Raltegravir INSTI

Question 42

Which agents need to be taken with food?

Answer 42

- Protease Inhibitors - Genvoya - Symtuza - Stribild - Rilpivirine in combo meds such as Complera, Juluca, Odefsey - Cobicistat

Question 43

Which agents DoNot need to be taken with food?

Answer 43

- Atripla - Efavirenza (Sustiva) and combo meds such as Symfi - Didanosine - Indibavir (unboosted)

Question 44

What is the non-occupational post-expoure prophylaxis treatment regimen?

Answer 44

``` Truvada + Raltegravir (Isentress) + Dolutegravire (Tivicay) ``` Within 72 hours for 28 days supply

Question 45

What treatments are available for PrEP therapy?

Answer 45

- Truvada - Descovy Patient must be seen and tested every 3 months

Question 46

What is the occupational post-expoure prophylaxis treatment regimen?

Answer 46

``` Truvada + Raltegravir (Isentress) + Dolutegravire (Tivicay) ``` Within 72 hours for 28 weeks

Question 47

CI for Genvoya

Answer 47

do not start if CrCl < 30

Question 48

CI for Stribild

Answer 48

do not start if CrCl < 70

Question 49

Which combo meds have PI and Booster in them? What are some clinical pearls to recognize?

Answer 49

- Stribild - Genvoya - Symtuza PI are CYP3A4 inhibitors PI can cause rash (SJS/TEN)

Question 50

All INSTI agents and combo-medication with INSTI must....

Answer 50

Separate dose from polyvalent cation

Question 51

Complete Regimens (1 tab QD) NNRTI-based agents

Answer 51

- Atripla - Complera - Odefsey

Question 52

Complete Regimens (1 tab QD) INSTI-based agents

Answer 52

- Stribild - Genvoya - Biktarvy - Triumeq