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SG - Pharm 4 > HIV/AIDS > Flashcards

Flashcards in HIV/AIDS Deck (36)
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1
Q

***Focus on ______***

A

Pharmacotherapy awareness

(whatever the fuck that means…)

2
Q

_______ block CD4 receptors on the surface of certain immune cells that HIV needs to enter the cells.

A

Post-attachment inhibitors

3
Q

8 classes of HIV medications

(PPP)

(NN)

(CIF)

A
  • PE: Pharmacokinetic Enhancer
  • PI: Protease Inhibitor
  • PAI: Post Attachment Inhibitor
  • NNRTI: Non-nucleoside Reverse Transcriptase Inhibitor
  • NRTI: Nucleoside Reverse Transcriptase Inhibitor
  • CA: CCRS Antagonists
  • INSTI: Integrase Inhibitor
  • FI: Fusion Inhibitor
4
Q

Some of the barriers to Adherence to Antiretroviral Therapy

A
  • Lack of education/understanding of HIV disease
  • Denial / Anxiety
  • Depression / Mental illness
  • Substance abuse
  • Medication SE
  • Complicated dosing regimen
  • Poor social situation
  • Lack of family / community support
  • Inadequate health insurance
  • Poor clinician - patient relationship
5
Q

MOA of which drug class?

  • NRTIs block reverse transcriptase, an enzyme HIV needs to make copies of itself
A

NRTIs: Nucleoside Reverse Transriptase Inhibitors

  • Abacavir
  • Tenofovir
  • Emtricitabine
  • Lamivudine
  • Zidovudine
6
Q

MOA of which drug class?

  • Bind to and later alter reverse transcriptase, an enzyme HIV needs to make copies of itself
A

NNRTIs: Non-Nucleoside Reverse Transcriptase Inhibitors

  • Doravirine
  • Etravirine
  • Rilpivirine
  • Efavirenz
  • Nevirapine
7
Q

MOA of which drug class?

  • Block HIV protease, an enzyme HIV needs to make copies of itself
A

PIs: Protease Inhibitors

  • Atazanavir
  • Darunavir
  • Fosamprenavir
  • Ritonavir
  • Saquinavir
  • Tipranavir

(All end in AVIR)

8
Q

MOA of which drug class?

  • Block HIV from entering the CD4 cells of the immune system
A

Fusion Inhibitors

  • Enfuvirtide
9
Q

MOA of which drug class?

  • Block coreceptors on the surface of certain immune cells that HIV needs to enter the cells
A

CCR5 Antagonists

  • Maraviroc
10
Q

MOA of which drug class?

  • Block HIV integrase, an enzyme HIV needs to make copies of itself
A

Integrase Inhibitors

  • Dolutegravir
  • Raltegravir
11
Q

MOA of which drug class?

  • Block CD4 receptors on the surface of certain immune cells that HIV needs to enter the cells
A

Post-Attachment Inhibitors

  • Ibalizumab-uiyk
12
Q

MOA of which drug class?

  • Used in HIV treatment to increase the effectiveness of an HIV medicine included in an HIV regimen
A

Pharmacokinetic Enhancers

  • Cobicstat
13
Q

What are the 5 Combination HIV Medications?

A
  • Triumeq: Abacavir, dolutegravir, lamivudine
  • Trizivir: Abacavir, lamivudine, zidovudine
  • Epzicom: abacavir & lamivudine
  • Evotaz: Atazanavir, cobicistat
  • Biktarvy: bictegravir, emtricitabine, tenofovir, alafenamide

(TTEEB)

14
Q

Key Concepts:

  • HIV infects cells expressing CD4 receptors, what does CD4 stand for?
  • What are the 5 types of cells infected?
  • Infection is via an interaction between glycoprotein 160 (gp 160) on HIV with CD4 (primary interaction) and _________ (secondary interactions) present on the surfaces of these cells
A
  • Cluster of Differentiation 4
  1. T-helper lymphocytes
  2. Monocytes
  3. Macrophages
  4. Dendritic cells
  5. Brain Microglia
  • Chemokine Co-receptors
15
Q

Key Concepts:

  • Hallmark of UNTREATED HIV infection is _________ and _________.
  • 2 Current goal of combination anti-retroviral therapy (ART) ?
A
  • Profound CD4 T-lymphocyte depletion & Severe immunosuppression
  1. Suppression of HIV replication
  2. Increase in CD4 lymphocytes
16
Q

Key Concepts:

  • Initial treatment of HIV advocate a minimum of ____ active antiretroviral agents from at least _____ drug classes.
  • First HIV regimen includes:
    • _____ + ______, an _____, or a ____ w/ _____ or ______
    • ____ or _____ boost the effectiveness of the ____.
A
  • 3
  • 2
  • 2 NRTIs + INSTI, an NNRTI, or a PI boosted w/ cobicistat (Tybost) or Ritonavir (Norvir)
  • Cobicistat or Ritonavir increase/boost effectivness of the PI

(Key point: Start out with TWO NRTIs & most individuals also need an INSTI)**

17
Q

Short or Long Term SE of HIV meds?

  • Fatigue
  • Nausea
  • Vomiting
  • Diarrhea
  • HA
  • Fever
  • Muscle Pain
  • Occasional dizziness
  • Insomnia
A

Short Term

18
Q

Short or Long Term SE of HIV meds?

  • Lipodystrophy
  • Hyperlipidemia
  • Osteoporosis
  • Nephrotoxicity
  • Hepatotoxicity
  • Cardiovascular - HLD
  • Diabetes / Insulin Resistance
  • Peripheral neuropathy
  • Mental health related effects
A

Long Term

19
Q

There is a relationship of CD4 count to the development of _______.

A

Opportunistic Infections

  • TB
  • Herpes simplex
  • Kaposi sarcoma
  • Cocci
  • MAC
  • CMV retinitis
  • CNS lymphoma
20
Q

AIDS tx for Ois (opportunistic infections)

  • Primary Prophylaxis for P jirovecci?
A

Trimethoprim-Sulfamethoxazole (Bactrim)

(single strength or DS tablet daily)

21
Q

AIDS tx for Ois

  • Primary prophylaxis for Toxoplasmosis
A

Trimethoprim-Sulfamethoxazole (Bactrim)

(single strength or DS tablet daily)

22
Q

AIDS tx for Ois

  • Primary Prophylaxis for Mycobacterium avium
A

Azithromycin weekly

23
Q

AIDS tx for Ois

  • Secondary prophylaxis for Mycobacterium TB
A

Isoniazid (depending on sensitivities)

24
Q

AIDS tx for Ois

  • Secondary prophylaxis for Cryptococcosis
A

Fluconazole

25
Q

AIDS tx for Ois

  • Secondary Prophylaxis for Coccidomycosis
A

Fluconazole or Itraconazole

26
Q

AIDS tx for Ois

  • Secondary Prophylaxis for Histoplasmosis
A

Itraconazole

27
Q

AIDS tx for Ois

  • Secondary Prophylaxis for Cytomegalovirus (CMV)
A

Ganciclovir

28
Q
  • Combination of what 2 HIV meds are used for Pre-exposure prophylaxis (PrEP)?
  • Indicated for pts at very high risk for HIV
  • Taken how often to lower their risk?
  • Adherence is critical
  • PrEP reduces risk by more than ___%
  • IVDU risk is reduced by more than ___%
  • Combine PrEP w/ condoms and any other prevention method is recommended
A
  • Tenofovir & Emtricitabine (Truvada)
  • Daily
  • 90%
  • 70%
29
Q
A
30
Q

PrEP (Pre-exposure prophylaxis) = Truvada

  • Reaches maximum protection from HIV
    • receptive anal sex at about __ days of daily use
    • receptive vaginal sex and injection drug use at about __ days of daily use
    • no data yet available about how long it takes to reach maximum protection for ____ anal or _____ vaginal sex
A
  • 7
  • 20
  • insertive
31
Q

Emergency Sharps Information

  • What are the 5 “Initial Steps”

(WFIRI)

A
  1. Wash needlesticks and cuts w/ soap and water
  2. Flush splashes to the nose, mouth, or skin w/ water
  3. Irrigate eyes w/ clean water, saline, or sterile irrigants
  4. Report the incident to your supervisor
  5. Immediately seek medical treatment
32
Q

Emergency Sharps Information

  • What are the 2 medications?
  • Duratioin?
A
  • Truvada
    • 1 tablet by mouth once daily
  • PLUS raltegravir
    • (400mg by mouth twice daily or dolutegravir once daily)

28 days

33
Q

What are the 3 websites used for info?

A
  • FDA
  • CDC
  • AidsInfo
34
Q

What antiretroviral is used during pregnancy?

A

NRTIs

  • Abacavir

(No change in dose, PK not altered, no evidence of tetratogenicity)

35
Q

Vaccine Recommended w/ HIV

  • What are the 6?

(HHTIMP)

A
  • Hep B
  • HPV (for those up to 26 y/o)
  • Influenza
  • Meningococcal
  • Pneumococcal
  • TDAP (tetanus, diptheria, and Pertussis)
36
Q
A