Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

🄼💊Chemotherapy/AntiViral/Botanicals > HIV Rx > Flashcards

HIV Rx Flashcards

1
Q

Which conditions cause Pancytopenia in HIV? (6)

A

Many HIV Pts Lose Cells Broadly

  1. •MAC
  2. •Histoplasmosis (Disseminated Fungal)
  3. •Parvovirus B19
  4. •CMV
  5. •Lymphoma
  6. •Medications [BAD PG] (Bactrim / AZT / Dapsone / Pyrimethamine / Ganciclovir)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What’s the normal CD4 count

A

800-1500

(ART should INC CD4 by 50-150 / year)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Virologic Suppression (Undetectable) is defined as what lab value?

A

Less than 50 HIV RNA copies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe the main differences between HIV2 and HIV1 (3)

A

HIV2 is…

  1. Endemic to West Africa
  2. Has longer Asx stage with lower viral loads and mortality
  3. May present as negative serology/viral load but with DEC CD4 suggestive of HIV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List the [Nucleoside/tide Reverse Transcriptase Inhibitors (NRTI)] (7)

A

ADELS TmZ

  1. Abavavir (ABC)
  2. Didanosine (ddl)
  3. Emtricitabine
  4. Lamivudine
  5. Stavudine
  6. Tenofovir
  7. Zidovudine (formely AZT)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

NRTI MOA

A

Nucleoside/tide analogs lacking [3 OH group] that enter cell–>are phosphorylated–>form synthetic substrates that compete with native nucleotides–> terminate proviral DNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

NRTI Metabolism and half life

A

Renal Excretion with [half life=1-10 hours]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Explain how NRTI are able to be taken QD vs. BID

A

Intracell reservoirs of active anabolite DEC dosing frequency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

NRTI SE (5)

A

Didanosine > Stavudine > Zidovudine

LHAMP

[Lactic Acidosis Hepatic Steatosis Syndrome]

Anemia

Myopathy

Pancreatitis

[HepB flare when discontinued]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Explain which drugs cause [Lactic Acidosis Hepatic Steatosis Syndrome] and why. (4)

A

NRTIs: Didanosine > Stavudine > Zidovudine > Tenofovir

… inhibit [DNA polymerase gamma] –> blocks mitochondria DNA synthesis –> [inhibits oxydative phosphorylation complex] activity–> INC cytosolic lactate –> [Lactic Acidosis Hepatic Steatosis Syndrome]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which NRTIs cause [HepB Flare] when discontinued (3)

A

U LET these NRTIs go…there will be Hep problems!

Lamivudine (also–>Emtricitabine resistance)

Emtricitabine (also–>Lamivudine resistance)

Tenofovir

These NRTIs have Anti-HepB Activity so D/C –> HepB Flare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Abacavir Indication

A

Combo therapy for experienced HIV1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Abacavir SE

A

Hypersensitivity in [HLA-B 5701 + pts]. This is a Contraindication!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Zidovudine Indication

A

Px Combo therapy for Both HIV in children/adult/prego

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Zidovudine SE (2)

A

Anemia

[Granulocytopenia: Neutropenia]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name the drugs contraindicated with Zidovudine (4)

A

Doves Really Creates Stinky Goop

Stavudine

Cotrimoxazole

Ganciclovir (BM tox)

Ribavirin (blocker)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Didanosine SE (3)

A

[Lactic Acidosis Hepatic Steatosis Syndrome]

Pancreatitis

Peripheral Neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which NRTIs does Didanosine have drug-drug interactions with (3)

A

Stavudine - Cx

Zalcitabine - Cx

Tenofovir (INC serum Didanosine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which NRTIs are preferred for naive pts (2)

A

ET was a very naive alien

Emtricitabine

Tenofovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which NRTIs has DDI (drug-drug interaction) with Zalcitabine? (2)

A

Lem & Dal didn’t like Zal

Lamivudine

[Didanosine - Cx]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Tenofovir SE (3)

A

Hep B Flare

Nephrotoxic

[Lactic Acidosis Hepatic Steatosis Syndrome]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe the DDI between Tenofovir and Atazanavir

A

Tenofovir [DEC serum Atazanavir]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Name the [NonNucleotide Reverse Transcriptase inhibitors (NNRTIs)] (5)

A

NO DEENR!

Delavirdine

EfaVirenz

Etravirine

Nevirapine

Rilpivirine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

NNRTIs MOA

A

Noncompetitve inhibitors that allosterically bind to RT and induce conformational change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
**N**NRTIs metabolism and half life
**N**NRTI: [Rapidly absorbed and Liver metabolized] Half life = (Delavirdine 2-11) to (EfaVirenz 40-55)
26
NNRTI Indication
HIV1
27
Can NNRTI be used as monotherapy? Why or why not?
NO! Rapid resistance development
28
What are the advantages and disadvantages (2) of NNRTI?
Advantage: Using NNRTI saves [Protease Inhibitors] for later Disadvantage: Resistance and [Heavy influence on CYP450]
29
General NNRTI SE
Common DDI (heavy influence on CYP450)
30
EfaVirenz Indication
**Initial** HIV1 tx
31
EfaVirenz Contraindication
[1st Trimester preggo] or [Women planning to conceive] ## Footnote *EfaVirenz causes Birth and Transient CNS Defects*
32
EfaVirenz DDI (2)
CYP**3A4** inducer 1. DEC serum Methadone 2. DEC exposure to [Protease Inhibitors]
33
Nevirapine Indication
Combination HIV1; alternative to EfaVirenz in [Naive women with pretx CD4\<250] and [Men\<400]
34
Nevirapine Contraindication (2). What happens as a result?
1. [Women with pretx **Greater than 250 CD4**] or 2. [Men **Greater than 400 CD4**] These pts given Nevirapine --\> Severe Hepatotoxicitiy
35
Which DDI does Nevirapine have (2)
CYP**3A4** inducer --\> DEC serum methadone DEC exposure to Protease Inhibitors
36
Name the [Protease Inhibitors] (8)
**INDRAFTS** 1. **I**ndinavir 2. **N**eLFinavir 3. **D**arunavir 4. **R**itonavir 5. **A**tazanavir 6. **F**osamprenavir 7. **T**ipranavir 8. **S**aquinavir
37
[Protease Inhibitors] MOA
**INDRAFTS** inhibit [HIV aspartyl protease] --\> Blocks Proteolytic processing necessary for packaging & assembly --\> Blocks maturation
38
[Protease Inhibitor] General Characteristics (4)
**PPPP**rotease Inhibitors! * [**P**oor PO bioavailability sometimes enhanced with fatty meals] * he**P**atic CYP metabolism * **P**-glycoprotein substrates * **P**lasma protein bound
39
Describe the effectiveness of [Protease Inhibitors] to DEC Viral load
HIGHLY Effective when used as combo therapy
40
[Protease Inhibitors (PTI)] SE (6)
**M**any **P**TIs **D**on't **NN**eglect **L**ipids 1. **M**etabolic Syndrome 2. **N**VD and [**N**ephrolithiasis w/Indinavir] 3. **P**aresthesia 4. [**L**ipodystrophy-Chronic use] 5. [**D**DIs-(*Q W SPERM*S)]
41
Name the DDIs [Protease Inhibitors] have and why there is an interaction (7)
*[Protease Inhibitors]* **Q**lash's **W**ith **SPERMS**! **Q**uinidine - CYP3A4 substrate **W**arfarin - CYP3A4 substrate **S**t.John Wart - strong inducer of CYP3A4 **P**henobarbital-strong inducer of CYP3A4 **E**rgotamine - CYP3A4 substrate **R**ifampin - strong inducer of CYP3A4 \*\* **M**idazolam - CYP3A4 substrate **S**AL statins (Sim/Ator/Lovastatin)-substrates
42
Ritonavir Indication
Both HIV (1 and 2)
43
Ritonavir SE
Paresthesias
44
Explain why Ritonavir is often co-prescribed with other Protease inhibitors? Which HIV strain is this most useful for?
Ritonavir (RTV) is a PI that **potently inhibits CYP3A4** --\> enhances/boost exposure of other PIs --\> Reduced dosing frequency/INC efficacy. HIV2 benefits most from this
45
Other than Ritonavir, name an alternative boosting agent
Cobicistat (used in Stribild) - has **no** HIV reduction activity
46
How should you manage an HIV+ pt with Hypercholesterolemia on ART
Switch them from PTIs (if they're on it) --\> NRTIs ## Footnote *Remember that PTIs inhibits CYP3A4*
47
Raltegravir MOA
Binds/Inhibits Mg+ cofactors required for strand transfer during viral **integration**
48
How can HIV develop resistance to Raltegravir
Mutations altering orientation of Mg+ co-factors --\> Resistance of INTIs
49
Raltegravir Indication
Combo therapy [Raltegravir + PTI + NRTI] for naive AND experienced pts
50
Raltegravir SE (3)
Nausea Diarrhea HA
51
Raltegravir half life and dosage
9 hours (take BID after high fat meal)
52
Raltegravir is the main ____ inhibitor. What's unique about Elvitegravir?
Raltegravir is the main **Integrase** inhibitor. Elvitegravir = short half life unboosted and is the only approved INTI that is a CYP substrate. Only in Combo pill (Stribild)
53
Raltegravir is the main ____ inhibitor. What's unique about Dolutegravir?
Raltegravir is the main **Integrase** inhibitor. Dolutegravir = LONGEST INTI half life but is *in development* as **microparticle injectable formulation**, with half life of 3-7 weeks total
54
Enfuvirtide MOA
Binds to [surface Gp**41**] --\>Blocks confirmation required for fusion
55
Enfuvirtide Dosage and Indication
**Injected BID** as combo therapy in [**Refractory** experienced pts]
56
Which HIV strain is Enfuvirtide not active against and why?
HIV**2**; Mutation of binding site at [HR1 of Gp41]
57
Enfuvirtide SE
Hypersensitivity at injection site. Cx in pts with known Hypersensitivity
58
Maraviroc MOA
slowly and reversibly blocks [Human CCR5] interaction with [HIV Gp**120**] --\> prevents [**Tropic** HIV1] attachment
59
Maraviroc Indication
Combo therapy in [Refractory experienced pt with **tropic** HIV1]
60
Why is a Trofile assay required when using Maraviroc? (2)
mutation in the [HIV Gp**120**-CCR5 amino acid binding sequence] or Emergence of CXCR4 tropic HIV both lead to Maraviroc Resistance
61
Maraviroc Contraindications (3)
Rifampin Ritonavir Liver Failure (use cautiously)
62
Describe the 3 major complications of treating TB in [HIV ART pts]
Give Rifa**B**utin to HIV T**B** pts 1. Co-admin of Rifa**B**utin (preferred TB tx in HIV pts) with ART still requires monitoring/dose adjustment 2. Rifampin DEC efficacy of [ALL PTIs and NNRTIs] except EfaVirenz 3. Rifamycin is a potent CYP Inducer
63
Combination ART Tx for Naive patients (2)
[**1 NNRTI** (EfaVirenz \> Nevirapine)] + [**2 NRTI** (E + T)] OR [**1 PTI** (A+R) vs. (D+R) vs. (F+ RBID)] + [**2 NRTI** (E+T)] *PTI boosed with RTV*
64
In using Combo ART for naive pts, which PTI can... A: not be used in pts with high dose PPI B: Not used in combo with tenofovir or [Didanosine/lamivudine]
A: A + R B: Unboosted Atazanavir
65
List the Dual NRTI options for [Combination ART tx in naive pts] (1 preferred and 3 Alternataive)
66
Definition of Viral Suppression Failure (3)
* HIV RNA \> 400 after 24 weeks of ART * HIV RNA **\> 50** after 48 weeks of ART * Virologic Rebound (repeated detection of HIV RNA above undetectable even after once being suppressed)
67
What is IAS-USA?
HIV education organization that keeps updates on Drug Resistance Mutations in HIV1
68
List the 3 Combination Therapies in HIV pts that are **NOT** recommended? Rationale for each?
69
What is the exception to using **Non-**recommended [Triple NRTI regimens] (2)
Z + A + L or Z + L + T in pts that have worst options
70
Why shouldn't you use PTI [Atazanavir + Indinavir]? Any exception?
71
Why shouldn't you use NRTI [Didanosine + Stavudine]? Any exception?
72
Why shouldn't you use [Double NNRTI combination tx]? Any exception?
73
Why shouldn't you use NRTI [Emtricitabine + Lamivudine]? Any exception?
74
Why shouldn't you use [Etravirine + Unboosted PTI]? Any exception?
75
Why shouldn't you use [Etravirine + (boosted ATV vs. FPV vs. TPV)]? Any exception?
76
Why shouldn't you use [Etravirine + (boosted ATV vs. FPV vs. TPV)]? Any exception?
77
Why shouldn't you use NRTI [Stavudine + Zidovudine]? Any exception?
78
Why shouldn't you use PTI [Unboosted Darunavir + Saquinaivr + Tipranavir]? Any exception?
79
Definition of [Functional Cure] in HIV. Example?
Preventing virus from inducing immune deficiency. CCR5 Zinc Fingers?
80
Definition of [Sterilizing Cure] in HIV. Example?
Complete Elimination of Virus Berlin Pt with stem cell transplant

🄼💊Chemotherapy/AntiViral/Botanicals (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions