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42 Cards in this Set
- Front
- Back
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How do HIV virus replicate?
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1. Binds to CD4 and chemokine receptor
2. Fusion with host cell membrane 3. Enters viral genome into cytoplasm 4. Reverse transcription into cells DNA 5. Integrates HIV DNA into host cell for replication 6. HIV Proteins are released from cell as new virion to spread |
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Where are the sites for drug interaction for HIV virus?
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1. Inhibiting uncoating
2. Inhibit Reverse transcriptase 3. Translation of DNA Arrest 4. Inhibit Protein Modification 5. Inhibit assembly and Budding(spread) |
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What is the timeline for HIV detection?
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"Window Period"--6-12 weeks: NL CD4,
"Asymptomatic Period"-- 6mo-12yrs: CD4: >500 "AIDS Diagnosis"-- CDR<500 |
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What is the role of genetics with AIDS?
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Genetic mutation common in US whites, slows progression of the AIDS causing virus
(1 in 7 whites, 1 in 59 blacks inherit the protective mutant gene) |
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What is the earliest known case of HIV?
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1959 (Congo)
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What ia the first reported case in the US?
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1981
(peak year for US DIAGNOSIS: 1993) |
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What are the AIDS defining ilnesses defined by the CDC?
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1. Constitutional Diseases: Classical wasting syndrome
2. Neurological disease: Dementia, encephalopathy 3. Opportunistic infections: Pneumocystic carinii 4. Secondary cancers: Kaposi's syndrome |
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Why does a person "need" proper AIDS identificatiion?
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1. cannot receive disability income
2. not eligible for gov't funded prescription drug support 3. Considered a "handicap" =protected |
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What are the newest trends with AIDS?
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1. women with aids
2. Pumlnomary TB on the rise 3. Severely immunocompromised(CD4<500) but without oportunistic infections |
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How does AIDS manifest differently in women?
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Generally do not have wasting syndromes
Low incidence of Kaposi's syndrome -(CDC added: invasive cerv ca, TB, Recurrent pneumonia, and CD<500) |
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What is the trends with women and AIDS?
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HIV in women was 26% in 2001 and has decreased slightly to 20% of all cases.
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What is the rate of Neonatal transmission?
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90% of pediatric AIDS Cases are from neonatal or perinatal transmission
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What is the effect of AZT in HIV infected pregnant women?
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Maternal transmission in HIV infected pregnant women, decreased by 66% in a 1996 treatment group.
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What are the trends in children?
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Pediatric AIDS cases in US have declined 51% from 2001-2005.
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What are teh 4 diagnostic tests for HIV?
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1. ELISA (General- many false+)
2. Western Blot (def. antibody test) 3. p24 Antigen Test (detects HIV antig) 4. PCR (Polymerase Chain Reaction); used in neonates, tests for genetic material of virus. |
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What are the drug therapy strategies of HIV?
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1. slow replication of HIV
2. orevent and treat opportunistic infections 3. Control neoplasms 4. Enhance immune system |
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What are the 5 Antiretroviral drug therapies?
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1. NRTI (oldest)
2. NNRTI's 3. Protease Inhibitors 4. Other Human DNA modulators 5 Fusion Inhibitors |
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How do the NRTI's (Nucleoside and nucleotide Reverse Transcrriptase Inhibitors ) work?
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Block the formation of viral DNA
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How do the NNRTI's work? (Non-nucleotide Reverse transcriptase Inhibitors)
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Bind directly to Reverse transcriptase disrupting it's catalytic site
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How do the fusion Inhibitors Work?
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Inhibit the fusion of viral and cellular membranes.
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What are the first line HIV Drug therapy?
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Aidovudine(ZDV) (formerly AZT)
and Dideoxyinosine(Videx) |
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What are the Second line antiretroviral drugs?
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Zalcitabine (Hivid) and Stavudine(Zerit)
Iamivudine(Epivir) and Abacavir (Ziagen) |
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Are there any anesthetic drug implications with NRTI's/NNRTIs?
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NO
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What are associated problems with protease Inhibitors?
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New onset hperglycemia,
Elevated cholesterol. Hemophilia A & B Also: have to be used in combo due to high viral resistance rates! |
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What are the Intraoperative considerations with HIV drug therapy?
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Thrombocytopenia
Adrenal insufficiency Prone to opportunistic infections Drg side effects |
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Concerns with : Vecuronium and AIDS....
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Increased onset time
prolonged duration (2X) |
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Concerns with : Succinylcholine and AIDS:
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Pseudocholinesterase is lower in HIV but improves with AZT Treatment
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Concerns with: Psychoactive drugs and AIDS?
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Increased sensitivity to sedatives and neuroleptics
Increased EPS symptoms and at lower doses. |
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Drug interations between Protease Inhibitors and Antiarrythmics?
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Can cause dangerous arrhythmia due to increased plasma concentrations of cardiac drugs
( Ritonivir inhibits the cytochrome P450 metabolic pathway) |
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True or false___ Do Protease Inhibitors enhance the effect of drugs that depend on glucuronide formation for metabolism such as -Propofol, morphine, lorazepam, hydromorphone, and theophylline?
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True
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True or False?--- Should Benzo's , narcotics, anticoagulants, anticonvulsants, anti-emetics, CCB and neuroleptics be used cautiously with HIV pts?
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True there is a potential for oversedation or increased drug effects.
(due to the CYP450 inhibition) |
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What is the most common Opportunistic Infection?
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Pneumocystis Carinii pneumonia
(and major cause of morbidity) |
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What is the second most common opportunistic infection?
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Cytomegalovirus (most common life threatening opportunistic viral infection
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What is the key points of Act 148 for HCW?
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They have the right to test existing blood of a patient who refuses to be tested after a documented HCW significant exposure.
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What is the Act 148 of 1990 in PA?
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Confidentiality of HIV-related Information Act - it set standards for testing, disclosure and counseling for both patients and HCW.
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What is latent TB?
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Infected but not symptomatic (have a +PPD test)
-Not contagious -Development of disease depends on state of immune system -can be treated with drug therapy. |
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What is DOT therapy?
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Directly Observed Therapy-- Bangladesh had a 95% cure rate with this!
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what are the symptoms of Active TB?
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Fever
cough weight loss blood tinged sputum persistent cough night sweats |
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How does MDR-TB occur?
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Occurs when infected person fails to take the treatment drugs or has inadequate treatment----
Mutant strains develop. |
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Recommendations for HCW are from OSHA. NIOSH, AANA, and CDC for types of masks and testing requirements- what are they?
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1.5 micron filter masks and testing should be done at start of employment and q6months-year depending on risk.
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Statistics: what is the highest age group for active TB?
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(US) ages 25-44 (32%) then 45-64(30%)
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Statistics: what ethnic group has the highest rate of TB?
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(US) Latinos @ 29% the Black @ 26%
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