PrEP

Question 1

what are 3 meds approved for use as PrEP?

Will protect all individuals at risk of getting HIV thru sex or injection drug use except for???

Answer 1

1. truvada (Emtric 200, Tenof Diso fumarate 300) F/TDF –>
2. Descovy (Emtric 200/Tenof ala 25mg) F/TAF -> cannot protect if you’re female at birth at risk of getting HIV from receptive vaginal sex
3. Apretude (Cabotegravir 200 mg/mL injectable) CAB

Question 2

Lab tests before starting PrEP?

Answer 2

HIV Testing

Bacterial STI (syph, gonor, chlamyd)

Renal function (for descovy and Truvada)

Hep B serology

Hep C serology (MSM, TGW and PWID only)

Lipid profile (for Descovy)

Question 3

Same day prep prescribing .. u will need to establish the following?

Answer 3

1. HIV testing
2. renal function
3. Medication acquisition
4. Follow up (contact for HIV results and or renal dysfunction)
5. STI testing (ideal but not necessary for first day)

Question 4

F/TDF TRUVADA : Drug compoents and how to take?
What does eGFR have to be?

F/TAF DESCOVY : GENERIC? DRUG COMPONENTS AND HOW TO TAKE ?
EGFR?

Answer 4

1. 300mg/200mg one tab once daily

> = 60 mL/min

2. 300 mg/25 mg once daily
   egfr > 30 mL/min

Question 5

Which drug has hypersensitivity rxns? and which polymorphism do u have to test ?

Answer 5

Abacavir

HLA B5701

Question 6

Which drugs can u use to treat HEPB as well?

Answer 6

Tenofovir

Lamivudine

Question 7

Which NNRTI causes CNS effects?
Also neural tube defects?

Answer 7

Efavirenz

Question 8

Which NNRTI should u avoid with PPI’s?

At what viral load does this drug become problematic >100,000

Answer 8

Rilpivirine

Question 9

Whats the class effects of NNRTI’s?

Answer 9

Hepatotoxic and RASH

Question 10

Diarrhea is the worst with which PI?

What are the geenral class effects of PIs?

Lowest effects with which 2 drugs?

Answer 10

1. Nelfinavir
2. GI effects
   Hepatic (incr transaminases)
3. Metabolic (Dyslipidemia, hyperglycemia, Lipodystrophy)
4. Atazanavir
   Darunavir

Question 11

Which PI needs an acidic medium for absorption?

Answer 11

atazanavir must limit omep to 20mg /day

Question 12

which PI’s are we concerned about in sulfa allergy pt’s?

Answer 12

Darunavir , tipranavir, fosamprenavir

Question 13

Which drug has ae’s of intercranial hemorrhage and hepatotoxic?

Answer 13

Tipranavir

Question 14

If a pt wants a PI that’s not boosted, what drug would u recc?

Answer 14

Nelfinavir

Question 15

WHich drug can u give u major kidney stones?

Answer 15

Indinavir

sometimes Atazanavir

Question 16

Which drug class must u avoid cation containing drugs?

Answer 16

INSTIs

Question 17

Which NRTI causes hematologic ae’s like anemia and granulocytopenia?
What other side effect may it cause?

Answer 17

zidovudine

lipoatrophy

Question 18

Which INSTI MUST BE BOOSTED WITH COBICISTAT?

Answer 18

Elvitegravir
-Cobicistat doesnt have any anti HIV effects, but it helps incr concentration of elvitegravir

Question 19

Which INSTI should be avoided in women of child bearing potential and why ?

Answer 19

Dolutegravir (Tivicay) because can cause neural tube defects

Question 20

Which class needs to be boosted?

Answer 20

INSTI’s

Question 21

What are the drugs in Biktarvy ?

Answer 21

Bictegravir / TAF/FTC

Question 22

Drugs in Triumeq?
Only can give this drug if?

Answer 22

Dolutegravir/abacavir/ lamivudine
HLA negative and no HBV

Question 23

What drugss are in Tivicay + Truvada?
Tivicay + Descovy?

Answer 23

Dolutegravir + TDF/FTC or Dolutegravir + TAF/FTC

Question 24

What drugs are in Dovato ?
What criteria can you NOT use this drug in ?

Answer 24

Doluteg/3TC

HIV RNA > 500,000 copies/mL, HBV coinfection, or in whom ART is to be started b4 results of HIV genotypic resistance testing for reverse transcriptase or HBV testing are avail

Question 25

what drug do u give if u wanna start prior to genotypic testing?

Answer 25

Symtuza (Boosted darunavir with cobicistat, FTC, TAF)

Question 26

What should you NOT USE in the context of rapid start ART's?

Answer 26

Triumeq (cuz of abacavir) NNRTI regimens such as Odefsey and Atripla

Question 27

Recommended for rapid start?

Answer 27

Biktarvy (Single tab) Tivicay + Descovy --> neural tube defects in women of child bearing age 2tabs/day Symtuza (Single tab but NOT recommended for most ...)

Question 28

WHat 2 labs can tell you if a drug is working or not? Drop in viral load to undetectable within how many wks? Primary goal?

Answer 28

HIV RNA (Viral load) CD4 count (Should be high) 24-48 wks (<50 copies/mL) Achieve an undetectable viral load

Question 29

All NRTI's have this class side effect?

Answer 29

lactic acidosis and hepatic steatosis

Question 30

what drug is isentress?

Answer 30

Raltegravir

Question 31

What drugs are in Genvoya?

Answer 31

Elvitegravir/cobicistat/FTC/TAF

Question 32

For people with HIV who do not have a history of using long acting cabotegravir (CAB-LA) as pre-exposure prophylaxis (PrEP) the following regimens are recommended ?

Answer 32

biktarvy triumeq Tivicay + Truvada or Descovy Dovato

Question 33

Whats the DOC for Candida Aspergillosis Coccidioid Cryptococc

Answer 33

Micofungin --> FLuconazole Voriconazole Fluconazole --> Itraconazole is alternative Flucytosine

Question 34

Which azole does the following : Shortens QT Needs acidic beverage

Answer 34

Isavuconazole Itraconazole