Ortoski: High-yield Stuff Flashcards Preview

Hematology-Oncology Exam 2 > Ortoski: High-yield Stuff > Flashcards

Flashcards in Ortoski: High-yield Stuff Deck (98):
1

Geography associated with HIV?

Subsaharan Africa

2

More men or women, which race?

Men more than women, African American predominance

3

Top 3 modes of acquisition of HIV?

1. M to M sexual contact
2. Heterosexual
3. IVDA

4

Around what time was there more treatment, so fewer cases of HIV?

93-94

5

Since HIV causes inflammation, what are 2 areas of issue?

Cardiac and cancer

6

HIV is the BLANK leading cause of death currently

6th- Used to be leading in early 90s in the 25-45 age group

7

Reducing viral load reduces what?

Transmission

8

NRTI

Nucleoside reverse transcriptase inhibitor

9

NNRTI

Non-nucleoside reverse transcriptase inhibitor

10

PI

Protease inhibitor

11

D Drugs

d4t, ddl, ddc, AZT

12

Does AZT have a lot of SE?

YES

13

Nadir CD4

Lowest CD4 count ever

14

Naive

No prior drug exposure

15

Sequestered mutations

Found in minority- not detectable

16

BLD

Below level of detection- less than 20

17

Where is HIV 1 found?

Worldwide

18

Where is HIV 2 found?

Africa- Less easily transmitted

19

Group M

Major group worldwide

20

Group O

Other

21

How many subgroups or clades?

11

22

Group M Subgroup B

Americas, Japan, Austrailia, Carribean, Europe

23

Group M Subgroup C

S. Africa, India

24

Typical transmission modes?

1. Sexual
2. Vertical (mother to child)
3. Transfusion
4. IV drug use

25

If mother's viral load is undetectable, is it less likely to transfer to fetus?

YES

26

Risk factors?

1. 3+ nights in prison
2. Prostitution
3. Other STD

27

What should be emphasize?

Routine voluntary testing

28

What test is the best and confidental?

Serology

29

What is needed for a + result?

2 ELISA screening followed by 1 Western Blot for CONFIRMATION

30

What test is done for infants?

DNA test (newborns have positive antibodies no matter what from mom)

31

When is DNA test done?

After 1 month and after 4 months

32

What does the 4th generation ELISA have?

p24 antigen

33

What is required for an AIDS diagnosis?

Positive serology and a CD count under 200 and/or AIDS defining illness

34

CD4+ Under 200

Prevent PCP pneumonia

35

CD4+ Under 100?

Prevent Toxoplasmosis

36

CD4+ Under 50?

Prevent MAC

37

What is used to test kidney and liver function?

CMP

38

Live Vaccines?

NOOOOOO

39

Dosing for Hep B vaccine?

Give HIV pt. 40mcg (normal is 20mcg)

40

When can you give MMR?

Is CD4 is over 200

41

Phase 1:

Greater than 500 CD4 cells, asymptomatic, acute phase, PHI

42

Phase 2:

CD4- 200-500, Early symptomatic

43

Phase 3:

CD4- 50-200, Late symptomatic, full blown AIDS

44

Phase 4

Fewer than 50 CD4 cells- Advanced AIDS

45

What measures extent of immune system damage?

CD4 count

46

What does viral load measure?

Plasma HIV RNA level...higher means more CD4 destruction

47

What is most popular viral RNA assay?

PCR

48

What test does everyone infected get immediately?

Resistance

49

What % of infections are resistant to at least 1 drug because the index patient was resistant to the drug?

15%

50

What is best bang for buck?

Genotyping (can also use trophile/trophism test)

51

R5 Viruses, CCR5 CoReceptor, Macrophages, Early

M TROPIC

52

X4 Viruses, CXCR4 CoReceptor, T-cells, Late, Faster to AIDS?

T TROPIC

53

M184V mutation

M: AA found in wild tpye
184: AA (codon) position
V: AA substitution/variant

54

We only have drugs that kill what trophism?

R5

55

M184V mutation, what drugs won't work?

Lamivudine and Emtricitabine

56

K103N mutation, what drugs will work?

All of the 1st generation NNRTIs

57

4 types of Anti-retroviral treatment?

1. Reverse Transcriptase Inhibitors: Nucleoside RTI (NRTI), non-Nucleoside RTI (NNRTI), Nucleotides
2. Protease Inhibitors: PI
3. Entry Inhibitors: Attachement inhibitors, chemokine receptor inhibitors, fusion inhibitorsa
4. Integrase inhibitors

58

True or False: ART is recommended for ALL HIV infected persons regardless of CD4 count

TRUE

59

Is monotherapy okay?

NO

60

1 exception to monotherapy?

Pregnant woman that normally will accept no treatment, but is willing to take AZT at the time to prevent the baby from contracting the virus

61

Can you piece drugs together?>

NO...ALL OR NONE
-Start all drugs or stop all drugs at the same time

62

Diagnosis of AIDS?

AIDS defining illness and/or CD4 count below 200

63

All protease inhibitors are taken with what?

Ritonavir

64

What is ritonavir?

A boosting agent for P450... not a viral killer anymore and helps with one-a-day dosing of others

65

HS/HLAB*5701, CAD risk, Danger with Rechallenging?

Ziagen or ABACAVIR

66

Less use with AE, hyperchromic macrocytic anemia

AZT (retrovir)

67

If virus has M184V mutation, what won't work?

Lamivudine and emtricitabine

68

Neurological AE short lived, depression issues, low genetic barrier?

EFAVIRENZ (sustiva)

69

Associated with CAD

Protease Inhibitors

70

RENAL STONES

Reyataz and Crixivan

71

Renal Issues

Viread

72

Entry inhibitors (CCR5)?

Fuzeon
Selzentry

73

Injection SC only, painful, cellulitis?

Fuzeon

74

Use with R5 virus only?

Selzentry

75

Work in nucleus?

Integrase inhibitors

76

Now indicated first line with low AE?

Isentres (integrase inhibitor)

77

Are there dietary restrictions with these drugs?

YES

78

Does adjustments to avoid AE in?

1. ED Medication
2. PPI
3. Statins
4. CCBs

79

Can you use Simvastatin?

NO

80

What 3 combos can be used to initiate?

1. NNRTI and 2 NRTI
2. PI (preferably boosted with ritonavir) and 2 NRTI
3. INSTI and 2 NRTI

(non nuc or PI pr INSTI PLUS 2 NUCs)???

81

What are 2 components of lypodystrophy?

1. Lipohypertropy
2. Lipoatrophy

82

Ring-Enhanced Lesion

Toxoplasmosis brain scan related to an HIV case

-CD4 count under 100 and positive antibodies for Toxo

83

Palmar or plantar rash?

SYPHILLIS

84

What do newborns born to an HIV+ Mom get the first 6 weeks of life?

AZT (zidovudine)
-This is started 8-12 hours after birth and discontinued at 6 weeks (DNA BLD)

85

When is PCP prophylaxis initiated for a baby born to HIV + mom?

At 6 weeks

86

Breast feeding?

NO

87

What is given for pre-exposure prophylaxis for dischordant couples that have an accident?

PrEP- Tanofovir

88

Do all states require pretest counseling or signed release?

NO

89

Anemia?

AZT (Zidovudine)

90

HS

Abacavir (Ziagen)

91

Nightmares

Efavirenz (Sustiva- CNS effects)

92

Kidney Stones

2 protease inhibitors- Reyataz and Crixivan

93

Undetectable mean irradicated

NO

94

What is used to assess efficacy of therapy?

Viral loads

95

Best efficacy is how many drugs?

3

96

Pregnant women should at least take what?

AZT

97

Combo therapy should be started and stopped...

ALL OR NONE

98

Can you prescribe simvastatin?

JUST DON'T DO IT