Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
18 Cards in this Set
- Front
- Back
|
Describe the monitoring plan of an HIV/AID's patient.
|
CD4 count at entry to care, every 3-4 months, and at treatment failure or switch
HIV RNA at entry to care, at 2-4 weeks, every 4-8 weeks until levels fall below detection and then every 3-4 months Hepatitis B serology at entry to care. Basic chemistry, LFT's, CBC, Lipid Profile, Fasting Glucose, Urinalysis, Pregnancy test |
|
|
What test needs to done with initiating Abacavir?
|
HLA-B 5701
|
|
|
What 5 situations necessitate ART therapy?
|
CD4 Count < 500
Pregnancy HIV associated Nephropathy Hepatitis B co-infection AIDs defining illness |
|
|
Describe the classes of drugs in each preferred regimen.
|
NNRTI + 2 NRTI's
PI + 2 NRTI's PI + 2 NRTI's INSTI + 2 NRTI's |
|
|
Name the drugs in each preferred regimen
|
Efavirenz + Tenofovir/Emtricitabine
Atazanavir/r + Tenofovir/Emtricitabine Darunivir/r + Tenofovir/Emtricitabine Raltegravir + Tenofovir/Emtricitabine |
|
|
Describe the pill burden of each of these regimens.
|
Efavirenz, Tenofovir, Emtricitabine = 1 pill once daily
Atazanivir/r + T/E = 3 pills once daily Darunivir/r + T/E = 4 pills once daily Raltegravir + T/E = Raltegravir is dosed twice daily, T/E once daily |
|
|
Describe what is unique to know about Efavirenz.
|
Do not use in pregnant women or even women of child-bearing age. It is pregnancy category D
It must be taken without food to avoid unnecessarily high concentrations and adverse CNS effects It is a CYP 3A4 inducer and therefore could decrease the concentration of any drug that is a substrate of this enzyme. |
|
|
Describe what is unique to know about Atazanivir.
|
It's absorption is acid dependent and no more than 20 mg Omeprazole or Pantoprazole 40 mg should be used as well as spaced by 12 hours.
|
|
|
What ART drugs need to be taken with food?
|
Atazanivir
Darunivir |
|
|
What is notable about Ritonavir?
|
Used as a booster
CYP 3A4 substrate, and inhibitor as well as an inducer of 2C19 (used by warfarin) |
|
|
PI's utilize the CYP 3A4 system. Statins also use this system. Describe your options in dealing with this problem.
|
Simvastatin and Lovastatin are contraindicated with Protease Inhibitors. You can use the other statins if you start at a low dose and monitor or you can use Pravastatin which does not use CYP3A4 and only has an interaction with Darunivir.
You can also use Raltegrevir instead of a PI. |
|
|
What is the side effect of all PI's?
|
Hyperlipidemia - another reason to use Raltegrevir in someone taking a statin.
|
|
|
Describe the major side effects of the NRTI's.
|
Tenofovir - Renal Toxicity (Monitor SCr, CrCl, Urine output, Electrolytes)
Emtricitabine - Hyperpigmentation of palms Zidovudine - Bone marrow suppression (monitor RBC's, Hgb) Lamivudine - Very well tolerated Abacavir - Serious hypersensitivity reaction (get HLA-B 5701 testing) |
|
|
What is the major side effect of Efavirenz?
|
CNS symptoms (vivid dreams, hallucinations, dizziness)
|
|
|
What is a major concern with Tenofovir?
|
Nephrotoxicity
Use Abacavir/Lamivudine regimen is renal function is compromised. |
|
|
What drugs is resistance conferred to in the presence of a M184V mutation?
|
Emtricitabine and Lamivudine
|
|
|
What drug does the K103N mutation confer resistance to?
|
Efavirenz
|
|
|
If pravastatin is used, what LDL reduction should you typically see?
|
About 34%
|
