hiv/aids

Question 1

CD4 goal after treatment

Answer 1

greater than 350

Question 2

patients are not hospitalized for HIV, they are hospitalized…

Answer 2

because of opportunistic infection

Question 3

greatest risk for transmission of HIV in acute care setting…

Answer 3

accidental blood exposure via needlesticks or scalpel cuts

Question 4

airborne precautions & cause

Answer 4

less than 5 microns
private room
closed door
N95 fitted mask

HAV

Question 5

droplet precautions & causes

Answer 5

greater than 5 microns
private room
closed door optional
mask @ less than 3 feet

TB, pneumonia

Question 6

contact precautions & causes

Answer 6

universal precautions

HIV

Question 7

thorough sexual history

Answer 7

• gender preference
• positional preference
• prophylaxis
• past STDs
• how many partners last 90 days
• partner monogamous?
• women: G?P?, LMP, abnormal paps, HPV, breast exam

Question 8

HIV symptoms prompting screening

Answer 8

acute flu-like illness (classic)

weight loss, fatigue, thrush, rashes, psoriasis over 40 YO

Question 9

HIV screening protocol

Answer 9

order antibody test AND viral load

Question 10

PreExposure Prophylaxis (PrEP) drug

Answer 10

Truvada

Question 11

PreExposure Prophylaxis (PrEP) guidelines

Answer 11

• pretest for HIV, HBV
• HIV test q 2-3 months
• STD tests q 6 months
• confirm creatinine clearance > 60mL/min

Question 12

PreExposure Prophylaxis (PrEP) use

Answer 12

serodiscordant patients

injection drug users

Question 13

highly active antiretroviral therapy (haart)

Answer 13

drug “cocktails”
- 3 from at least 2 classes
(currently 35 drugs in 6 classes)

Question 14

combination therapy

Answer 14

one pill, once a day - multiple drugs

• 2+ drugs at once (vs 3+ which is haart)
• fixed dose formulations convenient when patient can tolerate side effects of all meds AND is not resistant to any meds in formulation
• patient needing renal dosing cannot use

Question 15

drug resistance

Answer 15

inaccuracies in viral replication can lead to mutations with drug resistance
- durability depends on class

Question 16

how does drug resistance develop? x3

Answer 16

• viral replication levels
• proofreading
• fitness

Question 17

protease inhibitor interaction with calcium channel blockers

Answer 17

increased concentration of calcium channel blocker

Question 18

HIV drug effect on beta blockers

Answer 18

increased serum levels of beta blocker, use with caution!

Question 19

HIV drug effect on Plavix

Answer 19

contraindicated: decreases active metabolite

Question 20

protease inhibitor effect on statin

Answer 20

CYP450 inhibits statin metabolism (except Pravastatin)

PI inhibits CYP450 and P-gyp = increase statin

Question 21

NNRTI effect on statin

Answer 21

decrease statin

Question 22

protease inhibitor effect on phosphodiesterase inhibitors

Answer 22

increase drug levels 2-16 fold

Question 23

ritonavir and alpha blockers (bph)

Answer 23

alfuzosin is CYP3A substrate and contraindicated with RTV

Question 24

protease inhibitor effect on benzodiazepines

Answer 24

increase concentration

Question 25

NNRTI effect on benzodiazepine

Answer 25

lower levels

Question 26

safest benzodiazepine to use with ART

Answer 26

lorazepam due to different metabolism pathway

Question 27

unsafe benzos to use with ART

Answer 27

everything but lorazepam

Question 28

protease inhibitor effect on Dilantin + alternative

Answer 28

levels increased due to CYP450 inhibition, use Keppra instead

Question 29

ART + hormonal contraceptives

Answer 29

unpredictable response to ART since they use the same metabolic pathway
- use TWO methods

Question 30

protease inhibitors + steroids

Answer 30

contraindicated, significant concern for iatrogenic Cushing’s Syndrome