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PHRM 865 > Kleyn\ > Flashcards

Kleyn\ Flashcards

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1
Q

pathogenesis of HIV infection

A

glycoprotein 120 (gp120) from surface HIV virus binds CD4 receptors on T cells
CD4 lymphocytes are infected and destroyed by cytolytic effect

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2
Q

what are the three routes of transmission of HIV

A

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

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3
Q

how do we diagnose HIV

A

positive multitest
positive virologic test (HIV NAT)

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4
Q

how does at home HIV test work

A

swab cheek and place in solution 20 mins

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5
Q

does a positive result in at home test mean you have HIV?

A

no, need another test and should see doctor

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6
Q

does a negative result in at home test mean you don’t have HIV?

A

no, there is a three month seroconversion window so does not tell us about last three months

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7
Q

if patient worried about exposure in past three months what is reccommendation with at home test

A

wait three months to test
see provider for a 4th gen test

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8
Q

two surrogate markers for assessing progress infection and effectivenss

A

CD4 count
HIV RNA PCR (viral load)

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9
Q

CD4 count test most useful for what

A

before initiation of therapy

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10
Q

HIV RNA PCR test most useful for what

A

assess effectiveness of therapy
higher levels indicate faster disease progressiob

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11
Q

HIV infection vs AIDS

A

AIDs is CD4 <200
HIV CD4 200-500

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12
Q

nuceloside reverse transcriptase inhibitors MOA

A

synthetic purine and pyrimidine analogues which result in elongation termination of growing proviral DNA chain

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13
Q

NRTI drugs

A

abacavir
emtricitabine
lamivudine
tenofovir disoproxim fumarate
tenofovir alafenamide
zidovudine

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14
Q

adverse effects of NRTIs

A

renal dose adjustment
mitochondrial toxicity and lactic acidosis (except TEAL)

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15
Q

abacavir side effect

A

hypersensitivity if HLAB5701 allele

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16
Q

tenofovir disoproxil fumarate side effect

A

renal insufficiency
osteomalacia

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17
Q

zidovudine side effect

A

bone marrow suppression

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18
Q

non-nucleoside reverse trancriptase inhibitors

A

efavirenz
nevirapine
etravirine
rilpivirine
doravirine
(-vir)

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19
Q

NNRTI MOA

A

bind to an allosteric site of the reverse transcriptase enzyme reducing functionality

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20
Q

efavirenz side effect

A

CNS effects (abnormal dreams, suicide)

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21
Q

efavirenz dosing consideration

A

empty stomach

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22
Q

which drugs take on empty stomach

A

efavirenz

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23
Q

nevirapine dosing consideration

A

dose titration over 14 days

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24
Q

etravirine dosing consideration

A

take with food

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25
ripivirine dosing consideration
take with meal (not protein shake)
26
class adverse effects of NNRTIs
rash
27
which drugs take with food
etravirine rilpvirine atazanavir elvitagravir
28
protease inhibitors MOA
inhibit action of viral protease preventing assembly, maturation, and release of new virions
29
protease inhibitor drugs
"navir"
30
atazanavir dosing considerations
taken with cobicistat take with food
31
atazanavir side effect
indirect hyperbilirubinemia
32
ritonavir side effect
N/V/D
33
protease inhibitors class adverse effects
GI intolerance insulin resistance lipodystrophy
34
what is used with protease inhibitors to boost
cobicistat and ritonavir CYP3A4 inhibitors
35
integrase strand transfer inhibitors INSTIs MOA
inhibits HIV integrase, preventing proviral DNA integration into the host cell genome
36
INSTIs drugs
"tegravir"
37
raltegravir side effects
CK elevations
38
elvitagravir dosing consideration
take with food
39
dolutegravir dosing
50 mg PO daily if INSTI naive 50 mg PO BID if INSTI experienced - also in patients taking efavirenz, ritonavir,rifampin bc UGT1A1
40
class adverse effects of INSTIs
weight gain
41
attachment inhibitor drug
fostemsavir
42
fostemsavir class and MOA
attachment inhibitor binds gp120 and blocks attachemnt to CD4 T cell receptor
43
ibalizumab MOA and class
post attachment inhibitor binds domain of D2 of CD4 T cell co-receptor and interrupts post attachemnt steps for entry of HIV into host cell
44
ibalizumab dosing consideration
IV piggyback
45
chemokine coreceptor 5 antagonist drug
maraviroc
46
maraviroc MOA and class
CCR5 antagonist binds CCR5 on CD4 host cell and blocks binding of gp120 preventing entry of HIV into host cell
47
maraviroc consideration
must get tropism assay performed before taking - can only take if CCR5 exclusive
48
lenacapavir class and MOA
capsid inhibitor
49
lenacapavir dosage form
SUBq injection
50
acid reducers considerations
seperate INSTIs by 6 hours do not give with raltegravi Al/Mg atazanavir and rilpivirine reduced by acid reducers
51
which drug contraindicated with PPIs
ripvivirine
52
benzodiazepine considerations
when taken with protease inhibitos and cobicistat use lorazepam, oxazepam, temazepam (LOT)
53
corticosteroids considerations
when taken with protease inhibitors and cobicistat use beclomethasone
54
statins considerations
when taken with protease inhibitors and cobicistat use lower doses - atorva, rosuva, pitava, prava when taken with NNRTIs must dose increase
55
metformin considerations
dolutegravir increases concentrations, decrease metformin dose
56
PDE5 inhibitors considerations
use lower dose with protease inhibitors and cobicistat (take every 48-72 hours)
57
polyvalent cation supplement consideration
integrase inhibitors must be spaced by 6 hours (gravirs) can take Ca/Fe with dolutegravir and bictegravir if taken with food
58
which drugs require dose adjust in renal insufficiency
NNRTIs except abacavir
59
website for federally approved HIV/AIDs practice guidelines
clinicalinfo.hiv.gov
60
goals of therapy of treatment with antiretroviral agents
o Maximally suppress plasma HIV RNA to below lower level of detection of the assay o Restore and preserve immunologic function o Reduce HIV associated morbidity and prolong duration and quality of life o Prevent transmission
61
principles of antiretroviral agents
ART consists of 2-3 agents from 2+ classes
62
when to start ART?
ASAP for all HIV regardless of CD4 - except meningitis from TB or crypto
63
who is it especially important to initiate ART asap for
AIDs defining conditions acute/recent HIV infection pregnancy
64
first line therapy HIV
2 NRTIs + INSTI bictegravir/tenofovir alafenamide/emtricitabine dolutegravir + tenofovir alafenamide or disoproxil + emtracitabine/lamuvidine dolutegravir/lamivudine
65
when would we not use the dolutegravir/lamivudine option
HIV RNA >500,000 HBV no genotyping history cabotegravir
66
preferred HIV tx if hx of cabotegravir
darunavir cobicistat emtricitabine tenofovir
67
alternative therapy drug choices
2 NRTIs + PI boost or NNRTI
68
when should we get resistance tests
entry into care virologic failure or suboptimal viral response
69
which tests are used in resistance testing
genotype - for 1st/2nd line fail phenotype - extensive tx hx
70
what is the viral load needed for best likelihood of good resistance test result
> 500 copies/mL
71
barrier to resistance for NNRTIs and boosted PIs
boosted PIs: high barrier to resistance NNRTIs: low barrier to resistance
72
PEP regimen
emtricitabine/tenofovir disoproxil fumarate 200/300 mg PO daily + raltegravir 40 BID or dolutegravir 50 PO QD x 28 days! - initiate within 72 hourxs
73
PEP monitoring
rapid test at baseline repeat testing q4-6 weeks and 3 months with 4th gen test
74
PrEP regimens
emtricitabine/tenofovir disoproxil fumarate 200/300 mg PO daily for anyone emtricitabine/tenofovir disoproxil fumarate 200/300mg 2 tabs PO 2-24 hours before sex then q24h for 2 days (MSM only) emtricitabine/tenofovir alafenamide 200/25 mg PO daily (MSM only) cabotegravir 600 mg IM injection: one dose then another at 1 month then q2months therafter
75
PrEP monitoring oral
test in 1 month then q3 months for HIV RNA, HIV, STIs, pregnancy CrCl q6 months if 50+ or CrCl<90 yearly cholesterol and TG levels, HCV
76
PrEP monitoring injection
HIV RNA in 1 month HIV RNA and HIV Ag q2 months HIV RNA q4 months

PHRM 865 (33 decks)

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