Module 3: Chapter 46 HIV drugs Flashcards
(104 cards)
1
Q
what cells are necessary for normal immune fn
A
CD4
2
Q
what is the fn of the CDR4 cell
A
recognizes foreign antigens and infected cells
helps activate the antibody-producing B lymphocytes
3
Q
what cells induce cell-mediated immunity
A
CD4
4
Q
is HIV bacteria or a virus
A
retrovirus
5
Q
how can you tell the difference btw. a retrovrius and virus
A
difference is in the genetic material
6
Q
How does CD4 activate T cells to destroy antigens
A
activate B lymphocytes
which produce antibodies activating T cell
T8 Killer cell attacks antigen
7
Q
Binding between what two things begins an HIV infection
A
gp120 on HIV virus to CD4 receptor on a cell
8
Q
what happens one the virus is bound to the cell
A
viral envelope and the plasma membrane fuse
9
Q
What types of cells have a CD4 protein receptor site
A
monocytes
macrophages
certain nerve cells
10
Q
what happens in the cell once GP120 attaches to a CD4 receptor
A
in the cell viral RNA is transcribed into a single strand of viral DNA
11
Q
what cells does the HIV virus have an infinity for
A
CD4 cells
12
Q
how is HIV infection tested
A
initially made by a screening test followed by a confirmatory assay
13
Q
Are screening tests highly sensitive or highly specific
A
highly sensitive
14
Q
are confirmatory assays highly sensitive or highly specific?
A
highly specific
15
Q
combination use of screening tests and confirmatory assays produces results thatare
A
highly accurate
16
Q
what was the first class of drugs approved by the FDA to treat HIV infection and AIDS
A
nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
17
Q
what are NRTIs chemically similar to
A
human nucleotides “building blocks” of DNA
18
Q
what must NRTI’s do to be effective?
A
convert to their active forms.
19
Q
what do NRTIs do?
A
inhibit reverse transcriptase an enzyme critical to HIV replication
20
Q
what is the prototype drug for NRTI’s
A
zidovuidine (AZT, ZDV, Retrovir)
21
Q
what 3 conditions is zidovudine commonly used to treat
A
epstein-Barr Virus
hepatitis B virus
HIV infection
22
Q
how is zidovudine administered
A
parenterally or orally
23
Q
where is zidovudine commonly metabolized? excreted?
A
liver
kidneys
the usual
24
Q
how does zidovudine work
A
inhibits the synthsis of DNA by reverse transcriptase
25
are there any contraindications or precautions to zidovudine therapy
hypersensitivity
breast-feeding
lactic acidosis
26
what are some adverse effect of zidovudine
```
GI symptoms
headache
seizures
somnolence
hematologic toxicities
```
27
what are known drug interactions for zidovudine
```
ganciclovir
acetaminophen
interferon beta-1b
probenecid
rifampin
trimethoprim
valproic acid
```
28
what do you need to assess for regarding female patients and zidovudine
assess pregnancy and lactation
| understanding of HIV transmission
29
when should zidovudine be administered
1 hour before meals
30
what type of diet should a patient undergoing zidovudine have
low fat
31
what should be done to minimize adverse effects regarding patients zidovudine
IM injections
32
how often should laboratory data be obtained for a patient receiving zidovudine
every 2-4 weeks
33
what are absolute contraindications regarding zidovudine use
hypersensitivity
breast-feeding
existing lactic acidosis
34
what is the second class of drugs used to treat HIV infection
nonnucleoside reverse transcriptase inhibitors (NNRTIs)
35
NNRTI's stand for
nonnucleoside reverse transciptase inhibitors
36
Do NNRTI's only affect HIV-1 or HIV-2
HIV-1
37
how do NNRTIs work
inhibit a specific site on the reverese transciptase that is required to carry out the process of DNA synthesis
38
what is the prototype drug for NNRTIs
efavirenz (Sustiva)
39
What is Sustiva used for
to treat HIV-1 infection
40
why do NNRTIs not work on HIV-2
, they do not reverse transciptase in HIV-2
41
How is efavirenz administered
orally
42
is efavirenz protein bound?
yes
43
where does efavirenz metabolized?
| excreted?
liver
| urine and feces
44
how does efavirenz work?
inhibits HIV reverse transciptase
45
what are some adverse effects for efavirenz
```
diziness
impaired concentration
insomnia
abnormal dreams
hallucinations
```
46
what drugs interact with efavirenz
drugs that are metabolized by P-450 CYP3A4
47
What pregnancy class is efavirenz
category D
48
how many times a day is efavirenz administered? is there a preferred time(s)?
once
| at bedtime
49
what should a patient do if they miss a dose of efavirenz
take the next dose as soon as they remember unless it's for the next day
50
what is one way that the adverse effects of efavirnez can be minimized
on an empty stomach
51
what is important patient and family education regarding efavirenz therapy
importance of adherence to drug therapy
advise pts. experienceing depression, anxiety, behavior changes, and those feeling paranoid or manic to contact the health care provider immediately
52
what ongoing assessment is necessary in a patient being treated with efavirenz
periodic examinations and blood monitoring
53
What pregnancy category is efavirenz
D
| teratogenic during all trimesters
54
What is the third major class of drugs used in treating HIV infection and AIDs
protease inhibitors
55
what class of drugs has changed the opinion of experts as to the ultimate fatality of HIV and AIDS
preotease inhibitors
56
what class of HIV drugs is the most potent anti-HIV drugs
Preotease Inhibitors
57
what is the prototype drug for protease inhibitors
saquinavir (Invirase)
58
What is the purpose of saquinavir
treating HIV infection in adults
59
how is saquinavir administered
orally
60
true or false: saquinavir has great bioavailability
false, poor bioavailability
61
where is saquinavir exreted
feces and urine
62
how does saquinavir work?
competetive inhibitor or HIV protease, an enzyme required for HIV replication
63
are there any precautions or contraindications regarding saquinavir
hypersensitivity
| children under age 16
64
What are the adverse effects of squinavir
```
Nausea
diarrhea
stomach discomfort
insomnia
headahce
```
65
are there any drug interactions for squinavir?
interacts with drugs that are metabolized by P-450 CYP3A4
66
what things should be assessed for regarding saquinavir
pregnancy or lactation
| patients ability to adhere to drug therapy
67
When shoudl saquinavir tablets be administered
2 hours after eating a full meal
68
what should be administered with each dose of squinavir
ritonavir
69
what can be done to decrease GI distress if it is experienced during saquinavir treatment
small frequent meals
70
if a patient complains of headahces during saqunavir treatment what should be adminsitered
acetaminophen
71
What are two key pieces of information that the patient and family need to be educated on regarding squinavir
periodic clinical and blood monitoring
| S & S of diabetes
72
due to the poor bioavailability of squinavir given alone , what medication is commonly given in combination with saquinavir to increase bioavailability
ritonavir: significantly inhibits squinivars metabolism resulting in an increased serum concentration of squinavir
73
what does HAART stand for
highly active antiretroviral therapy (for HIV)
74
what is the newest class of HAART therapy approved for management of HIV disease
Integrase inhibitors
75
what is integrase
enzyme that is a key component that allows converted HIV viral DNA to enter the host cell
76
how do integrase inhibitors work?
block or inhibit the host cell DNA to produce genetic material for new viruses
77
what is the prototype for integrase inhibitors
raltegravir (Isentress)
78
what is raltegravir commonly used for
HIV strains that are resistant to multiple antiretroviral regimens and epereince ongoing viral replication while reciving HAART
79
what is the half life for raltegravir
9 hours
80
how is raltegravir metabolized? excreted?
liver
| feces, urine
81
How does raltegravir work?
HIV virus integrase strand transfer inhibitor
82
known contraindications for raltegravir?
use cautiously with drugs that can cause muscle problems
83
what are the adverse effects of raltegravir?
```
diarrhea
nausea
abdominal distension
pain
flatulence
headache
fatigue
```
84
known drug interactions with ratlegravir
many HAART medications
firampin
proton pump inhibitors
85
what should be assessed for regarding raltegravir
wheterhe treatment expereinced or treatment naive
86
what pregnancy category is raltegravir
C
87
what needs to be stressed with raltegravir?
need for safe sex
88
does raltevir need to be given with food
with or without is fine
89
true or false: RAltegravir should not be used as monotherapy
true
90
what should a patient taking raltegravir take for common adverse effects
OTC medications
91
what should be monitored for during raltegravir treatemtn
opportunistic diseases
92
What pregnancy category is raltegravir
C - no well controlled studies, women should contact their prescriber immediately if they believe they are pregnant
93
what are entry inhibitors also known as
fusion inhibitors
94
what new class of drugs inhibits the HIV virus from binding to it, fusing with it and entering a human cell
entry inhibitors
95
what is the prototype drug for entry inhibitors
enfuvirtide (Fuzeon)
96
What is the purpose of enfuvirtide?
managing HIV infection in pts who have expereicend treatment failure
97
how is enfuvirtide administered
SC
98
how does enfuvirtide work
binds to the pg41 protein on the surface of HIV
99
what are the adverse effects of enfuvirtide
```
injection site rxn
anorexia
nausea
weight loss
fatigue
anxiety
headache
insomnia
peripheral neuropathy
infections
```
100
what pregnancy category is enfuvirtide
category B
101
what lifestyle, diet and habit teaching should be done with patients on enfuvirtide therapy
avoid risk factors that predispose him or her to infection
102
how can therapeutic effects be maximized for enfuvirtide
reconstitute it with sterile water and then allow the solution to sit for 10 mintues to ensure that the powder dissolves completely
**aseptic technique important**
103
what ongoing assessment should be done for a patient taking enfuvirtide
assess the patient taking enfuvirtide for signs of infectious disorders such as pneumonia, sinusitis, herpes simplex, influenza and conjunctivitis
104
what is a major adverse effect of enfuvirtide
injection site rxn
