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Flashcards in Quiz 1 Deck (45):
1

What special types of virus is HIV?

1. Retrovirus
2. Lentivirus - slow w/ long incubation period
Able to replicate in non-dividing cells

2

What CD4 count should AIDS Pts get Tx?

ANY - doesn't matter the count, start ART

-strength of recommendation inc. as CD4 cell count dec.

3

Should pregnant ladies take ART?

YES

4

Should AIDS Pts w/ cryptococcal meningitis take ART?

NO - can inc. mortality

5

What are the classes of ART drugs?

1. NRTI
2. NNRTI
3. Protease inhibitors
4. CCR5i
5. Fusion inhibitors
6. Integrase strand transfer inhibitors

6

What are the NRTI & how do they work?

1. Emtricitabine - Emtriva
2. Tenofovir - Viread

Try to get into RNA structure

7

Which ART does not undergo CYP metabolism?

NRTI (Emtricitabine & Tenofovir)

8

Which ART drug do you dose adjust for renal impairment?

NRTI (Emtricitabine & Tenofovir)

9

What combo is in Truvada?

1. Emtricitabine - Emtriva
2. Tenofovir - Viread

10

What are the NNRTI & common ADRs?

1. Efavirenz - Sustiva

ADR - neuro & psychiatric

11

Which ART drugs are metabolized by CYP3A4?

1. NNRTI (Sustiva)
2. Protease inhibitors
3. CCR5i

12

What combo is in Atripla?

1. Sustiva (NNRTI)
2. Truvada (Emtricitabine + Tenofovir (NRTI))

13

What are the protease inhibitors for ART & how do they work & what should you monitor?

1. Atazanavir - Reyataz
2. Darunavir - Prezista
3. Ritonavir - Norvir

Inhibits viral assembly - virus can't get out of cell

Monitor glucose in diabetic Pt

14

What ART drug should you be careful w/ PPIs or H2 blockers?

Atazanavir

PPIs - 12h apart
H2 - w/in 10h

15

What is ritonavir boosting?

1. Inhibits 1st pass metabolism of other protease inhibitors
2. Inhibition of CD4 p-gp

16

What is the only ART drug given by injection?

Fusion inhibitors - Enfuvirtide - Fuseon

17

What are the fusion inhibitors & how do they work?

1. Enfuvirtide - Fuseon

effects gp-41 structure

18

Which ART drug inc. risk of pneumonia?

Fusion inhibitors - Enfuvirtide - Fuseon

19

What are the integrase strand transfer inhibitors & how do they work?

1. Raltelgravir - Isentress

Prevents HIV DNA from getting into host DNA

20

Name some ADRs of ISTIs

1. SJS
2. Myopathy - careful w/ statins

21

What are the CCR5i & how do they work?

1. Maraviroc - Selzentry

Inhibits cell entry
Good early on but must determine tropism

22

Name some ADRs of ISTIs

1. Hepatotoxicity
2. MI/Myocardial ischemia
3. Postural HOTN

23

What are the recommended drugs for PEP?

1. Truvada
2. Isentress

4 wks min, start w/in 72h
Risk estimated 0.3%

24

What are the recommended drugs for PrEP?

1. Truvada
or just 2. Tenofovir

25

Which ART drugs must you take with truvada?

1. Prezista - protease inhibitor
2. Isentress - ISTIs

26

Which hepatitis virus is DNA based?

B

all others are RNA

27

What are the recommendations for Hep A vaccine?

all children (1 y/o) - fecal-oral transmisson

1. Havrix
2. Vaqta
3. Twinrix (Hep A & B)

28

Who should get Hep B vaccines?

1. Newborns to 18 y/o
2. Occupational exposure
3. Hemodialysis Pts
4. Frequent blood product recipients

29

Who gets Hep B immunoglobulins?

Acute blood exposure - gives passive immunity w/in 7-14 days
Covers 75% of people

30

How do you treat Hep B?

1. Inferferon-alpha - 16 wks
2. Peginterferon - 48 wks
3. Nucleoside analogs - min 1 yr

31

What is the standard of care for Hep C Tx?

Both
1. Interferon
2. Ribavirin

32

What are the nucleoside analogs for Hep B Tx & how do they work?

1. Entecavir - Baraclude
-act on reverse transcriptase
2. Sofosbuvir - Sovaldi (also used in Hep C)
-act on DNA polymerase

33

When is dual nucleoside analog therapy used in Tx of Hep B?

1. Cirrhotic Pts w/ hepatic decompensation from viral breakthrough
2. Pts w/ suboptimal responses to initial monotherapy
3. Pts coinfected w/ HIV
4. Pts who have had a liver transplant

34

What are the interferons? (For Hep B&C)

All injectable
1. Interferon alpha-2B - Intron-A
2. Interferon alfacon-1 - Infergen
3. Peginterferon alpha 2A - Pagasys
4. Peginterferon alpha-2B - Pegintron

Careful w/ renal & hepatic impairment

35

ADRs of interferons

1. HA
2. Fatigue
3. Fever
4. Psych changes - depression, confusion
5. Bone marrow suppression
6. Rashes & SJS
7. GI problems

36

What do you need to use Ribavirin with to work & when should you not use it?

Tx of Hep C

Peginterferon
Synergistic effect

1. Renal impairment
2. Hepatic impairment
3. Pregnant - teratogenic & embryocidal

37

ADRs Ribavirin

1. Hemolytic anemia
2. Pulm toxicity
3. Worsening of underlying cardiac disease
4. Flu-like Sx
5. GI complaints
6. Pysch - depression, emotional lability, irritability, impaired concentration

38

What are the protease inhibitors for Hep C & when can you use them?

1. Bocepravir - Victrelis
-Wk 4 & above
2. Telaprevir - Incivek
-First 12 wks then stop

39

What does the length of therapy for Ribavirin depend upon?

Genotype of Hep C

40

What do you need to use Protease inhibitors for Hep C with?

1. Ribavirin
2. Peginterferon

41

Significant ADRs of Bocepravir (Victrelis)?

Anemia

dec. dose if seen

42

Significant ADRs of Telaprevir (Incivek)?

1. Anemia
2. Hemorrhoids
3. Anorectal discomfort
4. Rash - Black box warning...SJS & MSOF

43

How do you name influenza

Hemagglutinin component
Neuraminidase component

NEED vaccine every year!!!

44

What are the neuraminidase inhibitors for flu & how do they work?

Both used for prevention & Tx
1. Oseltamivir - Tamiflu
-use 36-48h from onset of Sx
2. Zanamivir - Relenza (inhaled)

Stops neuraminidase from cleaving sialic acid & hemagglutinin bond so virus gets stuck & can't shed

45

What are the adamantanes & how do they work?

Tx of flu - usually only if Pt has allergy to Tamiflu

1. Rimantadine - Flumadine
2. Amantadine - Symmetrel (also Parkinson's drug)

Works on M2 channel to prevent uncoating of virus...can't get into nucleus

Renally adjusted