Immunity Flashcards
(52 cards)
Respiratory complications HIV
PCP, bacterial pna, TB, aspergillosis, CMV, oral/pharyngeal candidiasis, kaposi’s sarcoma, herpes, direct HIV pulm destruction (leads to RF and chronic disease like emphysema). Tracheobronchial/great vessel compression w/adenoma they, endobronchial kaposi’s (massive hemoptysis)
Cardiac complications HIV
Chronic trophic viral infection, co infection, drug related. Pericarditis, pericardial effusion, myocarditis (late stages), dilated CM, endocarditis (IVDA), pulm htn, thromboembolism, CAD/MI, abd aortic aneurysm/dissection
Gi complications of HIV
Diarrhea, proctitis, GI bleed, cholecystitis, anorexia, NV, dysphagia, candida, esophagitis, hep B/C.
Renal and endocrine complic of HIV
Nephropathy, ATN, nephrotic syndrome, adrenal insufficiency, glucose intolerance (HAART)
Hematologist complic HIV
Leukopenia, lymphopenia, thrombocytopenia, anemia
Neuro complic HIV
Sensory neuropathy (parasthesias, painful), encephalopathy/AIDS dementia complex, opportunistic infections, behavioral changes, HAART related CVD
NRTI effects
Nausea, diarrhea, myalgia, inc LFTs, pancreatitis, peripheral neuropathy, renal toxic, marrow supp, anemia, lactic acidosis, inhib P450 (zidovudine + steroids can lead to severe myopathy inc respiratory muscle dysfunction)
Protease inhibitor effects (ritonavir)
Hyperlipidemia, glucose intolerance, abnormal fat
distribution, altered LFTs, inhibition of cytochrome
P-450 3A4 (decreased fentanyl clearance ~ 67%)
NNRTI effects
Delavirdine inhibits cytochrome P450 may inc
conc of sedatives, antiarrhythmics, warfarin,
Ca-channel blockers. Nevirapine induces cytochrome P450 by 98%!
Integrates strand transfer inhibitor fx
Appear well tolerated, may have unknown SE
CCR5 antagonists and entry inhibitors SE
Appear well tolerated, may have unknown SE. Interacts w midazolam, alters clearance/effect
Ritonavir interactions w anesthetic drugs, avoid what drugs
Midazolam and versed (increased fx- sedation, confusion, resp dep). Avoid: demerol, amio, diazepam (life threatening)
HIV pre op prep
Universal precautions. Na hypochlorate kills virus. Look at disease progression/organ fx. Drug reg/SE. Lab results: CD4 (<200 bad, 500-700 good), T lymph (200 low), viral load, CBC, BMP, coags, cxr, ekg, echo, puts
HIV GA considerations
Avoid intubation if extensive pulm disease. Titrate according to anemia, autonomic neuropathy, adrenal insuff, upper a/w obstruc/difficult a/w w kaposis sarcoma. Careful w sux if periph neurop/SC involvement.
HIV regional consid. Why it is good
Still good for pregnant pts. Decreases opioid req- good bc decreased opioid clearance w/protease inhib
HIV regional consid: contraindications, careful w what
Coagulopathy, infection at site, focal neuro lesions, inc ICP. Try other methods before epidural blood patho (risky)
TB s/s
Non productive cough, wt loss, fever, night sweats, malaise, hemoptysis, chest pain
SE isoniazid
Hepatotoxic, periph neurotoxic, renal toxic possible, drug interactions
Rifampin SE
Hepato and renal toxic, anemia, thrombocytopenia, GI upset, drug interactions
Pyrazinamide and ethambutol SE
P- hepatotoxic, GI upset, arthralgia. E- ocular neuritis
TB drugs
Isoniazid, rifampin, pyrazinamide, ethambutol
No elective sx on tb pt until what
No longer contagious: 3 neg sputu, smears, improving symptoms, chest x ray
How to minimize TB: OR room
N 95 mask (pt wears when outside of rm). Keep pt in neg p rm whenever possible. Use separated OR when most ppl not there, keep doors shut
TB protection for vent
Dedicated machine, filter b/w pt circuit and y piece, bacterial filter on exhalation limb to decrease room exposure, staff wears n 95
