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48 Cards in this Set
- Front
- Back
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when doing the western blot, what antibodies indicate pt has HIV
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gp160/120
gp 41 gp 24 2 out of 3 means pt has HIV |
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what CD4 count and % indicates AIDS
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CD4 < 200
CD4 % < 14% |
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what CD4 do you start therapy
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CD4 b/t 350-500
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what are the NRTI (zeke loves ebuka terri adom danny saroosh )
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zidovudine (thymidine analog)
lamivudine (cytosine analog) emtricitabine (cytosine analog) tenofovir abacavir didanosine stavudine (thymidine analog) |
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what must you monitor with tenofovir and emtricitabine
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tenofovir - renal insufficiency/dysfunction (increase SCr), osteomalacia (no kids <12)
emtricitabine - hyperpigmentation |
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abacavir causes hypersensitivity reactions so what test must be done
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HLA B5701 prior to initiating therapy
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why is Didanosine and Stavudine not used must
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P side effect
peripheral neuropathy, pancreatitis |
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how are NRTI eliminated
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renally except for abacavir (hepatic)
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what are the class effects of NRTI
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lactic acidosis/hepatic steatosis
-can lead to mitochondrial toxicity thymidine analogs (zidovudine, stavudine) cause lipoatrophy but can switch to abacavir and tenofovir since they have less of an effect |
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what are the drug interactions with NRTI
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zidovudine and stavudine can't be given together because both are thymidine analogs therefore would antagonize each other
limivudine and emtricitabine are cytosine analogs therefore antagonize each other |
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which NRTI is not a nucleoside
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tenofovir it is a nucleotide therefore only phosphorylated twice
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which NNRTI has no cross resistance to the others
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etravirine
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why are NNRTI never used as monotherapy
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due to rapid development of resistance
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what NNRTI can only be used to tx experience pt and can only be used to tx naive pts
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etravirine - tx eperienced pt only
rilpivirine - tx naive pt only |
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are NNRTI CYP3A4 inducers or inhibitor
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inducers
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what would cause a pt to fail therapy containing Efavirenz and what other NNRTI could you not use
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K103N mutation and due to cross resistance pt can't use Nevirapine
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what are the NNRTI, never ever eat raisons
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nevirapine
efavirenz etravirine rilpivirine |
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what CD4 levels can you not use Nevirapine
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CD4 > 250 women
CD4 > 400 men |
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what pregnancy catergory is Efavirenz
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category D
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what are the SE of efavirenz and nevirapine
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nevirapine increases LFT therefore avoid in pt with hepatic issues, rash (SJS)
efavirenze take on empty stomach to decrease CNS SE (false cannaboid, vivid dreams) |
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if pt is suffering from depression what drug may exacerbate it
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efavirenz
ritonavir |
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what drugs can you use if pt has K103N mutation
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etravirine
rilpivirine |
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what can Rilipivirine not be used with
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H2 blocker and PPI because they decrease Rilipivirine concentration
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why can't you abruptly stop NNRTI
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they have low genetic barrier therefore resistance develops rapidly
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what is the class effect of NNRTI
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rashes
increase transaminases |
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what is the MOA of Protease inhibitors
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prevent cleavage of HIV polyprotein
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are Protease inhibitors CYP3A4 inhibitors or inducers
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inhibitors
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what drug must be given 12 hrs apart from PPI and why
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atazanavir (PI), must be spaced out because it has pH dependent absorption
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what protease inhibitor can not be give with truvada
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atazanavir
unless you give it with rotinavir |
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what are the SE of kaletra and atazanavir
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kaletra: diarrhea
atazanavir: nephrolithiasis and hyperbilirubinemia |
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what are the SE of Ritonovir
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increases triglycerides
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what is Ritonavir primarily used for
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to increase concentration of other Protease inhibitors so there's less chance for resistance
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what are the drug interactions with protease inhibitors
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NEVER GIVE WITH LOVASTATIN OR SIMVASTATIN b/c ritonavir will increase their concentration leading to rhabdomyolysis
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what is the class effect of protease inhibitors
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increase bleeding
hyperglycemia lipodystrophy |
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what drugs cause lipodystrophy and what is it
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protease inhibitors cause it
lipodystrophy is increase fat redistribution in areas such as the abdomen and neck (buffalo hump) |
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what are the protease inhibitors
kill all funky red tailed donkeys |
kaletra (lopinavir + ritonavir)
atazanavir fosampronovir ritonovir tipranovir daranavir |
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how does Enfuvirtide work
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entry inhibitor binds to gp41 and inhibits HIV from fusing with CD4 cell
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what kind of patients can enfuviritide be given to tx-experienced or tx-naive
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tx-experienced
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how does Maraviroc work
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CCR5 antagonist
CYP3A4 substrate |
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what must be done prior to using Maraviroc
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CCR5 tropism test
-if pt tests positive for CXCR4 or is dual mixed then pt can not receive maraviroc |
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what is Raltegravir metabolized by
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UGT1A1
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what is the black box warning for maraviroc
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hepatotoxicity due to increase LFT
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what does Raltegravir do
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integrase inhibitor
low genetic barrier |
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if Raltegravir is given with what drug would you have to double the dose
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rifampin b/c it is a UGT1A1 inducer
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what are the regimens for treatment naive pt
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2NRTI + NNRTI (PI sparring)
2NRTI + BOOSTED PI 2NRTI + INTEGRASE INHIBITOR |
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what are the regimens for treatment experienced pt
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2 new NRTI + boosted PI (if failed NNRTI)
2 new NRTI + NNRTI or new PI w/ RTV (if failed PI) |
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what is the SE of zidovudine
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myalgia
macrolytic anemia fatigue |
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what is the SE of abacavir
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hypersensitivity
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