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NAPLEX 2021 > HIV > Flashcards

HIV Flashcards

(117 cards)

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1
Q

Which cell type does HIV cause death of

A

T-Cells

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2
Q

How does HIV replicate

A

CD4+ T-helper cells

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3
Q

ART

A

antiretroviral therapy (HIV treatment)

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4
Q

As HIV replicates _____ increases while ____ decreases

A

viral load increases

CD4+ count decreases

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5
Q

CD4+ count that causes AIDS diagnosis

A

CD4+ count <200 cells/mm3

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6
Q

Treatment goal

A

normal CD4+ count (800-1200)

undectable HIV viral load

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7
Q

HIV viral load indicates _____

A

response to ART

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8
Q

High viral load can indicate 2 things

A
  1. medication nonadherence

2. drug resistance

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9
Q

Lab tests for HIV

A

CD4+ count, HIV viral load, drug resistance genotyping, CMP, CBC with differential, lipid panel, urinary analysis, Hep B+C, pregnancy test, drug-specific allele screening

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10
Q

What drug do you screen for HLA-B*5701 allele?

A

abacavir

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11
Q

what drug do you get a tropism assay for?

A

maraviroc

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12
Q

What must a patient be willing to commit to in order to prevent resistance?

A

ADHERENCE

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13
Q

what must the adherence rate be to prevent resistance?

A

> /=95% (no more than one dose/month for once daily dosing)

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14
Q

One pill, once daily initial ART options in treament-naive adults

A

Biktarvy, Triumeq, Dovato

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15
Q

Biktarvy

A

2 NRTIs: Tenofovir alafenamide, emtricitabine

1 INSTI: Bictegravir

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16
Q

Triumeq

A

2 NRTIs: Abacavir, lamivudine

1 INSTI: Dolutegravir

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17
Q

Dovato

A

1 NRTI: Lamivudine

1 INSTI: Dolutegravir

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18
Q

2 pill initial ART in treatment naive adults

A

Tivicay + Truvada
Tivicay + Descovy
Isentress + Truvada
Isentress + Descovy

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19
Q

TDF vs TAF

A

TDF has more renal and bone issues, use TAF if renal impairment or high fracture risk

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20
Q

Supplementation while using TDF

A

calcium and vit D.

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21
Q

HLA-B*5701 present

A

high risk of hypersentivity reaction to ABACAVIR - CONTRAINDICATED

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22
Q

Do not use Dovato when…

A

HIV RNA is >500,000 copies/mL or hep B co-infection present (only has two drugs/not as strong)

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23
Q

NRTIs MoA

A

competitively block reverse transcriptase preventing viral RNA from being converted into DNA

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24
Q

List of NRTIs

A 
TDF- Viread
TAF - combos and Vemlidy (Hep B) 
Lamivudine - Epivir 
Emtricitabine - Emtriva 
Abacavir - Ziagen 
Zidovudine - Retrovir 
Stavudine + didanosine (old, many AEs)
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25
What NRTI is given during labor to protect baby if mother's IV load is >1000
zidovudine
26
when do we give zidovudine during labor?
if mother's viral load is >1000
27
_____ impairment indicates decrease NRTI dosing (except abacavir)
renal!
28
Tenofovir combo place in therapy
ART regmines usually compose of tenofovir and emtricitabine | also used in PrEP & PEP (Truvada and Descovy)
29
Why are 2 NRTIs a backbone of treatment-naive therapy?
good tolerability few interactions lack of resistance in ART naive patients
30
Caution in older NRTIs (didanosine, zidovudine, + stavudine)
HIGHER risk of lactic acidosis and hepatomegaly with steatosis and pancreatitis
31
Caution: abacavir
hypersensitivity risk - allele testing required prior to use | CI if history of reaction - NEVER rechallenge
32
Do not use ______ if treating HIV and HBV
abacavir
33
What drug class should a patient avoid if taking TDF (tenofovir disoproxil fumarate)
NSAIDs
34
Side effects of NRTIs
N/D, increase LFTs, headache Abacavir: rash, increase risk of MI emtricitabine: hyperpigmentation of palms of hands and soles of feet
35
______ and _______ can be replaced by each other in treatment regimens, but don't use together because they are antagonistic
emtricitabine and lamivudine
36
INSTIs MOA
block integrase enzyme preventing viral DNA from integrating into host cell DNA
37
list of INSTIs
``` "-tegravir" Bictegravir Elvitegravir Doletegravir Raltegravir ```
38
Caution with INSTIs:
Don't mix with cations (Al,Mg)
39
Which INSTI needs to be used with caution with UGT1A1s?
Raltegravir
40
Which drug should be avoided when using INSTIs
Rifampin
41
Which INSTIs can exacerbate HBV if discontinued? (two)
bictegravir, elvitegravir
42
Side effects of INSTIs
headache, insomnia, diarrhea, weight gain, rhabdomyolysis, proteinuria
43
____ can be increased by bictegravir and dolutegravir but _____ is not effected
SCr can be increased, GFR not effected
44
NNRTIs MoA
inhibit reverse transcriptase by non-competitively binding unlike NRTIs (competetitive)
45
list of NNRTIs
efavirenz (Sustiva) | rilpivirine (Edurant)
46
NNRTIs place in therapy
not-first line | used with 2 NRTIs
47
Rilpivirine administration
take with a real meal (not protein drink) | requires acidic gut for absorption, do not use with PPIs and separate from H2RAs and Antacids
48
which drug class can not be used with rilpivirine
PPIs
49
Which NNRTI should be taken on an empty stomach at bedtime
Efavirenz
50
Atripla
efavirenz/emtricitabine/tenofovir | not first-line anymore due to CNS/psych effects
51
NNRTI boxed warnings:
hepatotoxicity: do not start in women with a CD4+ count >250 or men >400 rash (SJS) psych effects
52
Do not use Rilpivirine if_____ (counts)
viral load > 100,000 and/or CD4+ counts <200
53
PI (protease inhibitors) MOA
inhibits protease enzyme to prevent protein strands from being cut into small pieces needed for assembly of new virions. Replication still occurs but virions produced are immature and non-infectious
54
list of PIs
``` "-navir" atazanavir - Reyataz darunavir - Prezista fosamprenavir - lexiva indinavir - Crixivan lopinavir + ritonavir Kaletra (rit is booster) ```
55
Why are PIs not first line?
metabolic porblemcs lipodystrophy CVD risk Interactiosn with CYP3A4
56
What do PIs require that is unique to this class
Boosters!
57
_____ and _____ require one of the two boosters ____ or ____
atazanavir and darunavir | boosters: ritonavir or cobicistat
58
Which PIs don't require to be taken with food
fosamprenavir solution - don't take with food | Kaletra (lopi/rito) - with or without
59
Kaletra and Ritonavir have high ______ content
ALCOHOL | do NOT take with metronidazole or disulfiram
60
Boxed warning for Tinpranavir
hepatitis | intracranial hemorrhage
61
Side Effects with PIs
diarrhea, nausea, metalic taste
62
Atazanaivr specific side effects
hyperbilirubinemia ("bananavir") PR interval prolongation skin reactions
63
Darunavir, fosamprenavir, tipranavir: caution with ____ allergy
sulfa! | SJS
64
PIs are strong ______
CYP3A4 inhibitors
65
Drugs that should NOT be used with PIs (could make ART resistant)
- alfuzosin, colchicine - dronedarone, amoidarone - apixaban, edoxaban, rivaroxaban - hormonal contraception - lovastatin and simvastatin
66
which statins SHOULD be used with PIs
rosuvastatin and atorvastatin
67
Booster MOA
CYP3A4 inhibitors preventing the metabolism of ART increasing/enhancing the effect.
68
Why is Ritonavir used as a booster?
It has too many metabolic issues when used at its full PI dose
69
What are restrictions with ritonavir and cobicistat?
NOT interchangeable | do NOT use together
70
Interactions and boosters:
COMMON! can boost other drugs | Any combo with a booster will have many interactions
71
Cobicistat side effects:
nausea, diarrhea, headache, ^SCr, hyperbilirubinemia
72
Ritonavir side effects:
circumoral paresthesia (tingling, burning around mouth), bitter taste/change in taste
73
Cobicistat Combo Drugs
- Stribild (not for CrCl <50) elvitegrar/cobi/emtricitabine/TDF - Genoya (not for CrCl<30) elvitegravir/cobi/emtricitabine/ TAF -Symtuza: darunavir, cobi, emtricitabine, TAF -Evotaz: atazanavir/cobi =Prezcobix: darunavir/cobi
74
Maraviroc is useful if the ___ is present not if it and ____ are present
CCR5 receptor is the only one present but not useful if the CXCR4 is also present
75
AIDS defining conditions
CD4+ count <200 Opportunistic infections Cancer types - Kaposi's sarcoma HIV Wasting syndrome
76
what is IRIS
Immune reconstitution inflammatory syndrome - paradoxical worsening of new or known condition that has been suppressed but becomes unmasked after ART is started or changed to a more effective regimen. It occurs because the immune system is recovering and could become capable of mounting a response
77
What to do if IRIS occurs
Continue ART and treat unmasked condition
78
HIV and pregnancy
continue treatment if effective even if dolutegravir is being used. If not on ART, start either w NRTIs + Boosted PI or INSTI Do not breastfeed as it can pass HIV to the baby
79
What is PrEP?
pre-exposure prophylaxis to prevent infection
80
Requirements before starting PrEP
- confirm HIV-negative with antibody testing - CrCl >/= 60 - Screening for hep B and STIs
81
After starting PrEP (Truvada or Descovy) what needs to be done every 3 months?
- HIV test and document negative result - 90 Day supply only - document pregnancy status - counsel on adherence and safe sex/behaviors - Crcl and STI testing q 6 months
82
PrEP options
Must have negative HIV test Truvada Descovy: not for vaginal-receptive PrEP but less risk of BMD and renal tox
83
PEP options
within 72 hours of exposure - taken for 28 days More drugs needed due to actual possible exposure: Truvada + Trivicay or Isentress
84
PEP must be started within _____ hours of exposure
72! Emergency situtation!
85
Abacavir
must be HLA-B*5701 negative
86
Triumeq
abacavir/lamivudine/dolutegrative | HLA-B*5701 negative
87
didanosine, stavudine
pancreatitis, hepatomegaly w/ steatosis (no alcohol)
88
Emtricitabine
hyperpigmentation Don't use with lamivudine headaches
89
Truvada
emtricitabine/TDF | PrEP, PEP, and two pill regimens
90
Descovy
emtricitabine/TAF | PrEP
91
Lamivudine
HBV indication, don't stop suddenly | headache
92
TDF
do not take with didanosine kidney and fracture issues supplement with vitamin D and calcium avoid NSAIDs
93
Retrovir
``` zidovudine myopathy neutropenia anemia food required ```
94
Biktarvy
bictegravir/emcitritabine/TAF | separate Al and Mg due to bictegravir
95
Stribid
elvitegravir/cobicistat/emcitritabine/TDF take with food avoid NSAIDS CrCl should be >/= 50
96
Gentoya
elvitegravir/cobicistat/emcitritabine/TAF take with food CrCL>30
97
Tivicay
dolutegravir caution if pregnant (neural tube defects) preferred with descovy or truvada
98
Isentress
Raltegravir | Descovy or Truvada
99
Efavirenz
``` CNS effects (dreams, confusion) goes away in 2-3 weeks empty stomach ```
100
Symfi
efavirenz/lamivudine/TDF empty stomach bedtime
101
Atripla
efavirenz/TDF/emtricitabine empty stomach bedtime calcium + vit D for bone problems (TDF)
102
nevirapine
high risk for liver damage and rash
103
etravirine
after meaal
104
rilpivirine
with water and meal (not protein drink)
105
Prezista
darunavir food booster caution with sulfa allergies
106
Reyataz
atazanavir take with food booster
107
fosamprenavir
empty stomach | sulfa allergies
108
indinavir
kindey stones | bad metabolic issues
109
Lopinavir/ritonavir
empty stomach | solution has high alcohol level
110
Norvir
ritonavir booster in low dose take with food
111
Saquinavir
qt prolongation
112
tipranavir
sulfa allergy liver damage intracranial hemorrahge
113
recommended treatement for naive patients 1 ____ and 2___- or 1 of each with ____-
1 INSTI 2 NRTIs or one each with Dovato
114
Caution with sulfa allergy
tipranavir, fosamprenavir, tipranavir
115
What labs do are PIs known to raise
HDL, TGs, BG
116
which drug raises bilirubin and also known as "bananavir"
atazanavir
117
If oraquick comes back positive, what is the confirmation test needed?
Antibody differentiation assay

NAPLEX 2021 (28 decks)

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