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PHRM 865 exam 5 > HIV-AIDS - 12 questions > Flashcards

HIV-AIDS - 12 questions Flashcards

(44 cards)

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1
Q

Route of transmission

A

-exposure of mucous membrane or damaged tissue to infected body fluids
- blood stream exposure to infected body fluids
- mother-to-child

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2
Q

OraQuick - rapid at home testing

A

Seroconversion window is 3 months

one line is a negative test

2 lines is a positive

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3
Q

Nucleoside reverse transcriptase
drugs, MOA, and class adverse effects

A

result in elongation termination of growing proviral DNA chain

AE: mitochondrial toxicity and lactic acidosis

*Emtricitabine
*Lamivudine
*Tenofovir DF
*Tenofovir alafenamide
Abacavir
Zidovudine

*Seen in first line regimens

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4
Q

NRTIs - Abacavir AE

A

Hypersensitivity reaction
- Must get HLAB57 genetic testing before starting to avoid the hypersensitivity reaction

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5
Q

NRTIs - Tenofovir disoproxil fumarate AE

A

Osteomalacia and renal insufficiency

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6
Q

NRTIs - Zidovudine

A

Bone marrow suppression

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7
Q

Non-nucleoside reverse transcriptase inhibitors
MOA, Drugs, and class adverse effects
all have -vir- in middle

A

bind to allosteric site of reverse transcriptase enzyme reducing its function

Class AE
- rash

Efavirenz
Nevirapine
Etravirine
Rilpivirine
Doravirine

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8
Q

NNRTIs - Efavirenz
counseling and AE

A

Take on empty stomach at bedtime

AE - CNS (suicidality, abnormal dreams)

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9
Q

NNRTIs - Nevirapine
Counseling

A

Titrate dose over 14 days to avoid rash - Administer 200mg daily for 14 days then increase to 200mg BID or 400mg daily (stevens-johnsons syndrome)

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10
Q

NNRTIs - Etravirine
Counseling

A

Take with food

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11
Q

NNRTIs- Rilpivirine
counseling

A

Take with meal (not protein shake)
must be at least 390 calories

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12
Q

Protease inhibitors and boosting
MOA, Class AE, and drugs
all end in -navir

A

inhibit viral protease preventing the assembly, maturation, and release of new virions

Class AE
- GI intolerance, insulin resistance, and lipodystrophy

Atazanavir/ cobicistat
Darunavir/ cobicistat
Fosamprenavir
Lopinavir/ritonavir
Nelfinavir
Ritonavir
Tipranavir

Boosting: adding ritonavir or cobicistat at low doses (do not have any antiviral effect at this dose) are potent inhibitors of CYP3A4 - adding increases absorption, lengthened elimination half-life

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13
Q

PIs- Atazanavir
Counseling and AE

A

Take with food

Indirect hyperbilirubinemia

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14
Q

PIs - Ritonavir
AE

A

Even with antiviral dose and low dose for bosting can cause nausea, vomitting, and diarrhea

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15
Q

Integrase Strand Transfer inhibitors
MOA, Class AE, and drug names
- all end in -tegravir

A

Inhibit HIV integrase, prevents HIV DNA from integrating into the host cell

Class AE
weight gain

*Dolutegravir
*Bictegravir
Elvitegravir
Raltegravir
Cabotegravir

  • are first line options in combo therapy with other classes
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16
Q

INSTIs - Raltegravir
drug specific side effect

A

CK elevation

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17
Q

INSTIs - Cabotegravir
administration

A

30mg tablets; 200mg/ml injectable solution
30mg daily lead in for > or equal to 28 days

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18
Q

INSTIs- Elvitegravir
Counseling

Study These Flashcards
A

TAKE with food

19
Q

INSTIs - Dolutegravir
Dosing specifics

Study These Flashcards
A

50mg daily - for INSTI-naive patients
50mg BID - for INSTI-experienced

BID dosing regimen is also required when co-administered with UGT1A/CYP3A4 inducers (rifampin, Fosamprenavir/ritonavir, tipranavir/ritonavir)

20
Q

Attachment inhibitor - Fostemsavir
MOA, AE

Study These Flashcards
A

Bind to gp120 on the surface of HIV, blocking attachement to CD4 T-cells

Last line therapy for those who have failed multiple other therapies

AE
- Nausea
- QTc prolongation
-elevated transaminases

21
Q

Post-Attachment inhibitor - Ibalizumab-uiyk

Study These Flashcards
A

Bind to domain D2 on the CD4 cell and inhibits the post attachment steps required for HIV to enter host cell

IV administration

22
Q

Chemokine coreceoptor 5 antagonist - Maraviroc
MOA, Precautions and interactions

Study These Flashcards
A

binds to CCR5 on the CD4 cell and inhibits the binding of gp120 thus preventing entry of the HIV into host cell

**Before treatment can be considered MUST do a tropism assay (ONLY ACTIVE AGAINST CCR5-TROPIC strains of HIV) - EXAM Q
- Tropism assay for CXCR4 or CCR5 - would use this drug in patients who’s results come back exclusively CCR5

23
Q

Capsid inhibitor - Lenacapavir
MOA, administration, what is it approved for

Study These Flashcards
A

Bind to the interface between capsid protein (p24) subunits and interfere with uptake of proviral DNA, assembly and release, and capsid core formation

Only approved in patients with multidrug resistant infection who are failing their antiretroviral regimen

927mg SUBQ every 6 months (plus lead-in of 600mg PO daily for 2 days)

24
Q

Single tablet regimen - first line options

Study These Flashcards
A

Biktarvy - Bictegravir + emtricitabine + tenofovir alafenamide daily

Dovato - Dolutegravir + lamivudine

25
Other combination tablets - first line options
Truvada - Emtricitabine 200mg + Tenofovir Df 300mg daily Descovy - Emtricitabine 200mg + Tenofovir Alafenamide 25mg daily Cimduo and Temixys - Lamivudine + Tenofovir DF (both 300mg daily
26
Website housing the federally approved HIV/AIDs medical practice guidelines
HIV.gov HIV-drug interactions.org
27
Goals of therapy
Maximally and durably supress plasma HIV RNA to below the lower level of detection of the assay restore and preserve immunologic function reduce HIV associated morbidity and prolong the duration and quality of survival prevent transmission
28
When to start therapy and what to start
Recommended for all HIV-infected persons regardless of CD4 count monotherapy is a big NO NO want to start Two NRTIs in combo with a third active ARV from of three drug classes 1. INSTI (-tegravir) 2. NNRTIs (-vir-) 3. PI boosted (-navir)
29
INSTI based initial regimens
1. Biktarvy - once daily 2. Dolutegravir + Truvada (tenofovir DF + Emtricitabine) OR Descovy (Tenofovir alafenamide + emtricitabine) OR Cimduo/Temixys (Lamivudine + Tenofovir DF) 3. Dovato: Dolutegravir + Lamivudine - Except for individuals with HIV RNA >500,000 4. Dolutegravir/abacavir/lamivudine ONLY IF HLAB*57 NEGATIVE
30
PI-based regimen initial treatment options
1. Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (symtuza) 2. Doravirine/cobicistat PLUS abacavir/lamivudine - IF HLAB*57 NEGATIVE
31
NNRTI-based regimen initial treatment options
1. Doravirine/tenofovir DF/Lamivudine (delstrigo) OR Doravirine/tenofovir alafenamide/emtricitabine 2. Rilpivirine/Tenofovir alafenamide/emtricitabine (odefsey) -IF HIV RNA <100,000 and CD4 >200
32
Drug interactions and what to do ACID reducers -EXAM Q
Separate antacids from PO INSTIs by 6 hours, but NEVER give raltegravir with Al or MG Atazanavir and PO rilpivirine are reduced by acid reducers; rilpivirine is contraindicated with PPIs
33
Drug interactions and what to do Benzodiazepines - EXAM Q
With protease inhibitors and cobicistat, preferred benzodiazepines are lorazepam, oxazepam, and temazepam (LOT)
34
Drug interactions and what to do Cortiocosteroids - EXAM Q
with protease inhibitors and cobicistat, beclomethasone is preferred
35
Drug interactions and what to do Statin - EXAM Q
With protease inhibitors and cobicistat, low doses of atorvastatin, rosuvastatin, pitavastatin, or pravastatin are preferred. With NNRTIs, dose may need increased.
36
Drug interactions and what to do Biguanide - EXAM Q
Dolutegravir increases metformin, so a dose decrease of metformin may be necessary.
37
Drug interactions and what to do PDE5 inhibitors - EXAM Q
With protease inhibitors and cobicistat, use very low doses q48-72 hours.
38
Drug interactions and what to do Polyvalent cation supplements - EXAM Q**
With integrase inhibitors, space apart by 6 hours. Coadministration of Ca/Fe with dolutegravir or bictegravir OK if also taken with food.
39
Genetic resistance NNRTIs and boosted-PIs
boosted-PIs need 3 or 4 mutations to have resistance - high genetic barrier to resistance NNRTIs - have a lower genetic barrier to resistance - only need 1 mutation to cause resistance
40
Resistance testing
1.ALWAYS at entry to care 2. Virologic failure or suboptimal viral response - genotype is recommended when failing 1st and 2nd regimen - Specimen should contain >500 copies/ml for best likelihood of yielding a successful standard resistance test - EXAM Q
41
Undetectable equals untransmittable
Maintaining plasma HIV RNA <200 copies/ml with ART prevents sexual transmission of HIV to sexual partners Another form of prevention should be used for at least 6 months and until HIV RNA <200 (condoms PrEP, abstinence)
42
Pre-exposure prophylaxis (PrEP) Who should start it, contraindications, lab testing needed before starting, what are options
- those with sexual partner HIV positive - those having unprotected sex with unknown HIV status partner - A recent bacterial sexually transmitted infection - injection drug use with sharing needles - anyone who requests Contraindications: Weight <77kg HIV infection suspected exposure in last 72 hours Lab testing before starting: If considering oral get CrCl, Hep B, Cholesterol and triglycerides Oral regimens 1. Emtricitabine/Tenofovir DF for all risk groups - NO if CrCl <60 - Emtricitabine/Tenofovir alarenamide PO daily for men and transgender women who have sex with men - NO if CrCl <30 Injectable - Cabotegravir 600mg IM - second dose 1 month after first then q2 months thereafter
43
Post-exposure prophylaxis (PEP) who is recommended for it, what are the regimens
recommended after an accidental exposure to HIV has occured : Healthcare setting, sexual assult, accidental condom break Emtricitabine/tenofovir DF for 28 days + raltegravir PO BID for 28 days OR Dolutegravir 50mg PO daily for 28 days) Must initiate withing 72 hours or little benefit will be optained monitor - rapid testing at baseline, at 4-6 weeks, and at 3 months
44
Stages of HIV
stage 1: CD4 > or equal to 500 and CD4 % > or equal to 26 Stage 2: CD4 200-499 and CD4% 14-25 Stage 3 (AIDs): CD4 <200 and CD4% <14

PHRM 865 exam 5 (12 decks)

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