HIV/TB Flashcards
(109 cards)
1
Q
Isoniazid MOA
A
Bactericidal against active TB
Bacteriostatic against dormant TB
2
Q
Isoniazid Use
A
Latent TB
Active TB 1st line
3
Q
Isoniazid A/E
A
Peripheral neuropathy (from B6 deficiency) -MC N/D Dizziness Optic neuritis Seizures
4
Q
Isoniazid Pt edu
A
Take Vit B6 (pyridoxine) to prevent peripheral neuropathy
Limit alcohol intake
Can develop resistance
5
Q
Isoniazid Toxicity
A
Hepatotoxic
-monitor for anorexia, malaise, yellowing of eye
may need to stop drug
6
Q
Isoniazid Monitoring
A
SxS of hepatotoxicity
LFTs
Monthly
7
Q
Direct observation therapy
A
Administration of each dose is carried out in the presence of an observer
By the Health department
Preferred
8
Q
Intermittent Dosing
A
Can be done at home 2-3 times a week dosing Larger doses but less frequently No additional risk for A/E As effective as daily dosing
9
Q
Latent TB Standard Tx
A
Isoniazid daily for 9mo - self administered
10
Q
Latent TB Tx for allergy to Rifampin
A
Isoniazid and Rifapentine once weekly for 3 mo
DOT
Not safe for everyone
11
Q
Active TB Induction phase
A
Eliminate actively dividing extracellular TB
Rifampin, Isoniazid, Ethambutol, Pyrazinamide x2mo
12
Q
Active TB Continuation phase
A
Eliminate intracellular “persisters”
Rifampin and Isoniazid x4.5 mo
May last longer
13
Q
Drug resistant TB
A
Inherent resistance, Development of resistance during tx, Inadequate drug therapy
Tx can be up to 24 mo
14
Q
TB Tx Goal
A
Cure, prevent spread to others
15
Q
Rifampin MOA
A
Suppresses RNA synthesis and protein synthesis
Inhibits bacterial DNA- dependent RNA polymerase
16
Q
Rifampin Use
A
Broadspectrum abx
1st line Active Tb
Kills active and semi-dormant TB
17
Q
Rifampin Drug interactions
A
CYP3A4 Warfarin PO BC Protease inhibitors NNRTI -All decrease effect of Rifampin
18
Q
Rifampin A/E
A
Red-orange body fluids (every body fluid, wear glasses because it will stain contacts)
N/V/D
Flu-like symptoms
Pruritus
19
Q
Rifampin Toxicity
A
Hepatotoxicity
20
Q
Rifampin Pt edu
A
Use barrier method of sexual protection
21
Q
Rifampin Monitoring
A
Drug resistance
LFTs
22
Q
Pyrazinamide Use
A
1st line Active TB
23
Q
Pyrazinamide A/E
A
Non Gouty polyarthralgias
N/V/D
Rash
24
Q
Pyrazinamide Toxicity
A
Hepatotoxic
25
Pyrazinamide Contraindications
Liver disease
26
Pyrazinamide Pt edu
Limit alcohol
| Manage polyarthralgias with NSAIDS (ibuprofen or aspirin)
27
Pyrazinamide Monitor
LFTs
| -before and 2 weeks after
28
Ethambutol MOA
Bacteriostatic- stops from reproducing
| Suppresses incorporation of mycolic acid in the cell wall
29
Ethambutol Use
1st line active TB
Previously treated with other drugs
Resistant to Isoniazid and/or Rifampin
30
Ethambutol A/E
```
Optic neuritis (blurred vision, constriction of visual field, disturbance of color)
-especially in children
```
31
Ethambutol Contraindications
Children under 8 - due to optic neuritis
32
Ethambutol Pt edu
Monitor vision changes
| Take food if GI upset
33
Ethambutol Monitoring
Monthly
Blurred vision
Color discrimination
Visual field disturbances
34
TB and HIV considerations
May require longer durations of treatment
At risk for developing immune reconstitution syndrome (IRIS) - exaggerated inflammatory response (another infection)
Drug interactions
35
TB Vaccine
BCG: only given in countries with high rates of TB and only given to children, once given, they will always test positive on a PPD
36
Efavirenz interaction with Rif
Least interactions
37
Protease inhibitors interaction with Rif
Replace Rif with Rifabutin
38
Raltegravir interaction with Rif
Increase dose of Raltegravir
39
Dolutegravir interaction with Rif
Increase Dolutegravir frequency
40
Maraviroc interaction with Rif
Increase Maraviroc dose
41
Acyclovir MOA
Inhibits viral replication by suppressing synthesis of viral DNA
Activation of acyclovir to acycloguanosine monophosphate (GMP) by thymidine kinase (GTP), the compound directly responsible for inhibiting DNA synthesis
42
Acyclovir Use
1st line for HSV, VZV
HSV type 2
Prophylaxis in immunocompromised pts
Not a cure, only treatment of symptoms as they happen
43
Acyclovir A/E IV
Phlebitis
| Inflammation
44
Acyclovir A/E PO
N/V/D
HA
Vertigo
45
Acyclovir A/E Topical
Local burning/stinging
46
Acyclovir Toxicity
```
Nephrotoxicity
Neurotoxicity (agitation, tremors, delirium, hallucinations, myoclonus, delirium, coma
```
47
Influenza Vax Types
Inactive- most common
Recombinant- not made with egg
Live attenuated- nose spray
48
Influenza Vax Protection
Begins 1-2 weeks after vax
| Last 6 mo
49
Influenza Vax Use
Anyone greater than 6 mo old
Pregnant- only inactivated
Children 2-8 need to get it 2 times to be effective
50
Influenza Vax A/E Inactivated
```
Soreness at site
Fever
Myalgia
Malaise
Guillain-barre syndrome
```
51
Influenza Vax A/E Live
```
Runny nose
Congestion
Sore throat/ cough
HA
Fever
Myalgia
```
52
Influenza Vax precautions
Do not vaccinate person who is acutely ill (fever greater than 100)
Can vaccinate person who is minor illness (fever less than 100)
53
Influenza Vax Contraindications
Hypersensitivity to eggs - inactivated
Severe reaction to influenza vax in the past
Guillain-barre syndrome
54
Oseltamivir Use
Can improve symptoms and duration of flu A/B
Not for sx past 48hr
Can be prophylaxis
55
Oseltamivir A/E
```
N/V
Hypersensitivity reaction
Anaphylaxis
Rash
Neuropsychiatric effects (hallucinations in children)
```
56
Oseltamivir Drug interaction
Blunts vax response
| D/C: 2 days before live vax and for 2 weeks after vax
57
Oseltamivir Pt edu
Take with food for N/V
58
Nucleoside Reverse Transcriptase Inhibitors (NRTI) Drugs
Abacavir
Tenofovir
Emtricitabine
59
NRTI MOA
Incorporates into viral DNA strands by reverse transcriptase terminating DNA synthesis
Blocks enzyme of HIV it needs to make copies of itself
Prevents DNA strands from growing
60
NRTI
HIV
61
NRTI A/E
```
Hepatosteatosis (mitochondrial breakdown of fatty acids and deposited onto the liver)
Lactic acidosis (mitochondrial breakdown- Vs, and ABG monitoring, Nausea, fatigue, respiratory acidosis)
Lipoatrophy (redistribution of fat in the shoulder blades, face and neck)
```
62
Abacavir A/E
Hypersensitivity reaction
63
Abacavir Drug interaction
Ganciclovir/Valganciclovir
64
Abacavir Testing done before treatment
HLA-B*5701 genetic testing
65
NRTI Monitoring
LFTs
66
Tenofovir A/E
Osteomalacia
Renal insufficiency
N/V
67
Tenofovir Drug interactions
Didanosine
68
Tenofovir Nursing considerations
Adjust dose for renal impairment
| Already has a phosphate group attached
69
Tenofovir Monitoring
Cr clearance
70
Emtricitabine A/E
Hyperpigmentation of hands and soles of feet
71
Emtricitabine Drug interaction
Lamivudine
72
Emtricitabine Nursing considerations
Adjust dose for renal impairment
73
Emtricitabine Monitoring
Cr clearance
74
Test for HIV pt before starting Tx
```
CD4 count
Plasma HIV RNA (viral load)
Genotype resistant test
Hep A, B, C
STIs
```
75
Initial phase of HIV
High rate of replication
| Experience flu-like acute retroviral symptoms
76
Middle phase of HIV
Can be up to 10 years
Prolonged clinical latency
Low HIV blood levels
Asymptomatic
77
Latent phase of HIV
CD4 levels typically fall below 200
AIDS and opportunistic infections more likely to occur
Peripheral neuropathy
CNS problems
78
HIV Goals
```
Reduce HIV associated morbidity
Prolong the duration and quality of life
Suppress HIV viral load
Restore and maintain immune function
Prevent transmission
No cure
```
79
Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI) Drug
Efavirenz
80
Efavirenz MOA
Binds directly and non-competitively to reverse transcriptase, blocking DNA polymerase activity
Blocks DNA as it activates
Prevents DNA strand altogether
81
Efavirenz Use
1st line therapy for HIV
82
Efavirenz A/E
Rash
Increased liver enzymes
CNS effects (vivid dreams/ nightmare)
Dizziness/drowsiness with food
83
Efavirenz Toxicity
Hepatotoxicity
84
Efavirenz Drug interactions
CYP3A4
BC
St. John Wort
85
Efavirenz Contraindication
Pregnancy
86
Efavirenz Pt edu
Take on empty stomach at bedtime
| Use barrier method of protection of contraception
87
Efavirenz Monitoring
LFTs
88
NNRTIs
Not structurally related to nucleoside
Active when administered
Take on empty stomach
X preggo
89
NRTIs
```
Chemically related to nucleoside and nucleotide
Intracellular conversion
Fewer drug interactions
W/wo food
✔︎ preggo
```
90
Protease inhibitor Drug
Lopinavir/Ritonavir
91
Protease inhibitor MOA
Prevents HIV protease enzyme from cleaving polyprotein into individual proteins responsible for assembling new viron
Prevents budding off and infeeting new cells
92
Protease inhibitor A/E
GI effects N/V/D
Increased bleeding with hemophilia
Lipodystrophy
Hyperlipidemia
Hyperglycemia- new onset DM ~ 2 mo after start of tx
Increased serum transaminases - liver injury
93
Protease inhibitor Drug interactions
CYP3A4
-Statins: use something else to control HLD
Usually given with 2 reverse transcriptase inhibitors which is part of antiretroviral management
94
Protease inhibitor Use
HIV
95
Lopinavir/Ritonavir MOA
Lopinavir is active
| Ritonavir boosts effects of lopinavir
96
Lopinavir/Ritonavir A/E
Diarrhea
| PR/QT prolongation (AV block/ Torsades de Pointes)
97
Lopinavir/Ritonavir Drug interactions
BC
Disulfiram
Metronidazole
98
Lopinavir/Ritonavir Contraindication
Those who have a HST of heart problems and or take drugs that cause heart problems (zofran)
99
Lopinavir/Ritonavir Pt edu
Take with food
| Refrigerate
100
CCR5 Antagonist Drug
Maraviroc
101
Maraviroc MOA
Blocks entry into the cell
102
Maraviroc Use
Must have genotype testing done for CCR5 trophic (HIV strain must have CCR5 trophic before initiation)
Must be combined
BID
Mostly used when other resistance
103
Integrase inhibitor Drug
Raltegravir
104
Raltegravir MOA
Inhibits integrase, preventing incorporation of viral DNA into hose genome
Metabolized by uridine diphosphate glucuronosyltransferase
105
Raltegravir Use
1st line in combo for HIV
| Resistant strains
106
Raltegravir A/E
Insomnia
HA
Hypersensitivity reaction (SJS)
107
Raltegravir Drug interactions
PPI: Increase plasma drug level
Rifampin: Would have to double dose of Rifampin
108
Raltegravir Toxicity
Hepatotoxicity
109
Raltegravir Monitoring
LFTs
