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52 Cards in this Set
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KN is a 28 yr old male with history of HIV x 5 yrs admitted with dyspnea, fatigue, and SOB. Patient complains of night sweats, and subjective fever.
Current medications: efavirenz (Sustiva) 600 mg po HS Emtricitabine-tenofovir (Truvada) 2 tabs po BID Labs: WBC= 7.5 K/mm3, A-a gradient: 39; plts=330 CD4=180 cells/µL; LDH= 550 PaO2= 79 mm Hg Chest X-ray: bilateral infiltrates T=101 F NKDA Per physical exam and current findings, the patient is diagnosed with pneumocystic jiroveci (PCP) pneumonia. Which of the following is the most appropriate treatment for this PCP patient? a. Trimethoprim/sulfamethoxazole 5 mg/kg based on sulfamethoxazole component b. IV q 8 hrs Dapsone 100 mg po daily Atovaquone 1500 mg po daily with food c. Trimethoprim/sulfamethoxazole 2 tab DS po TID d. Trimethoprim/sulfamethoxazole 2 tab DS po TID plus prednisone taper over 21 days e. C or D f. A, C and D |
d. Trimethoprim/sulfamethoxazole 2 tab DS po TID plus prednisone taper over 21 days
2 tabs DS comes out to 15 mg/kg/day based on trimethoprim divided in 3 doses A incorrect - the dose of the drug should be based on the trimethoprim component B is incorrect since at this dose it is used for prophylaxis C is incorrect because the patient has severe illness E is incorrect: patient does not seem to be in severe distress since his PaO2 is >70 mm Hg and would not require prednisone |
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What is (are) most common side effect(s) associated with the treatment of PCP pneumonia?
a. Blood dyscrasias b. Maculopapular rash c. Nausea and vomiting d. Weight gain e. A and B f. A, B, and C g. All of the above |
f. A, B, and C
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A 48 yr old female with a history of cocaine and IV drug abuse presents with fever, chills, cough, diarrhea and abdominal pain. She reported losing 25 lbs over the last 3 months. She is not compliant with her HAART.
Medications: reported to be on HAART, does not remember the names, non compliant Allergies: penicillin Labs: cocaine positive, CD4=35 cells/µL H&H: 9&26; CMP WNL except elevated LFTs, alkaline phosphatase ; T= 99.8 F Chest X-ray: cavitary nodular lesions in the right upper lobe Pending blood, sputum and stool cultures, which of the following statement (s) is (are) correct about mycobacterium avium complex (MAC)? a. MAC usually affects HIV patients with CD4 count <50 cells/ µL b. It is a mycobacterium that affects only the lungs c. Treatment is required for 3 months once CD4 +>100 cells/ µL d. In patients on a NNRT or PI, clarithromycin is the drug of choice for primary MAC prophylaxis e. A &C are both correct f. None of the above |
a. MAC usually affects HIV patients with CD4 count <50 cells/ µL
MAC mostly affects HIV patients with CD4 count <50 cells/µL B is incorrect since it can affect other organs such as spleen, GI, lymph nodes, bone marrow and the lungs, it could lead to a disseminated infection. C is incorrect since treatment should be for 12 months and primary prophylaxis is to be continued for 3 months once CD4 is >100 cells/ µL while on HAART. D is incorrect: Azithromycin is the DOC in this case since Clarithromycin is a CYP3A4 inhibitor and interacts with these medications, whereas azithromcyin is a weak inhibitor |
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Given the patient’s CD4 count of 35 cells/µL, the patient needs to be protected against all the following opportunistic infections except?
a. PCP pneumonia b. Toxoplasmic encephalitis c. Cryptococcal meningitis d. MAC pneumonia |
c. Cryptococcal meningitis
no primary prophylaxis is recommended for cryptococcal meningitis. |
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What is the drug of choice for Trichomonas?
a. Ceftriaxone (Rocephin) b. Metronidazole (Flagyl) c. Clindamycin (Cleocin) d. Cephalexin (Keflex) |
b. Metronidazole (Flagyl)
Metronidazole 2grams as a single dose is the treatment of choice for Trichomoniasis. |
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John is a 54 year old male newly diagnosed as HIV-positive. Which of the criteria listed
below would prompt the decision to start antiretroviral therapy in your patient? a. CD4 count of 400 cells b. Viral load of 400,000 copies/ml c. Treatment for Hepatitis B d. Treatment for Hepatitis C |
c. Treatment for Hepatitis B
Treatment of HIV should depend upon an opportunistic infection or CD4 cell count less than 350 cells, nephropathy, pregnancy, a sharp CD4 cell count decline (>120 cells/yr), and treatment of hepatitis B. |
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Susan diagnosed as HIV positive during her 6 week first perinatal screening appointmen. Her CD4 cell count is 545 cells/mm3 and her viral load is 2,000 copies.
Which of the following medication regimens would you recommend for her if she wanted to start medications now? a. Tenofovir, emtricitabine and efavirenz b. Zidovudine, lamivudine and nervirapine c. Tenofovir, emtricitabine and nervirapine d. Zidovudine, lamivudine and lopinavir/ritonavir |
d. Zidovudine, lamivudine and lopinavir/ritonavir
Nevirapine should never be given to women with a CD4 cell count greater than 250 cells, efavirenz should never be used in the first trimester and zidovudine should always be used in most pregnant women. |
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Which of the following medications requires that the HLA B*5701 test be done prior to prescribing it for use in any patient?
a. Abacavir b. Didanosine c. Tenofovir d. Tavudine |
a. Abacavir
Abacavir is requires the HLA B*5701 test to determine the potential risk of hypersensitivity. |
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Which non-nucleoside reverse transcriptase inhibitor offers the greatest risk of “rash”?
a. Delavirdine b. Efavirenz c. Etravirine d. Nervirapine |
d. Nervirapine
Nevirapine has the greatest risk of rash of the NNRTI drug class. |
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Which of the following regimens should be recommended for patients who are dually infected with HIV and Hepatitis B (HBV) to provide the patient with the BEST first line treatment for both diseases?
a. tenofovir, lamivudine and nevirapine b. tenofovir, emtricitabine and lamivudine c. emtricitabine, tenofovir and efavirenz d. lamivudine, tenofovir and lopinavir/ritonavir |
c. emtricitabine, tenofovir and efavirenz
Use of tenofovir and emtricitabine are first line agents for treatment of Hepatitis B and HIV. Lamivudine is never used with emtricitabine in a treatment regimen as they exhibit cross resistance and low potency. |
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Raltegravir is found in which of the following drug classes?
a. integrase inhibitor b. protease inhibitor c. entry inhibitor d. non-nucleoside reverse transcriptase inhibitor |
a. integrase inhibitor
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Jill has a CD4 cell count of 250 cells/mm3 when she came into the hospital diagnosed with PCP last week. How would you describe her immune status on your SOAP note?
a. HIV b. AIDS c. Unsure at the current time due to OI d. HIV with OI |
b. AIDS
PCP is an AIDs defining illness even though her CD4 cell count is not less than 200 cells. |
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Which of the following medications should never be given together due to limited potency along with the potential for cross-resistance and drug failure?
a. Atazanivir and indinavir b. Lamivudine and emtricitabine c. Stavudine and zidovudine d. Nervirapine and efavirenz |
b. Lamivudine and emtricitabine
This question is directly from the DO NOT USE LIST in the DHHS guidelines. Atazanavir and indinavir have increases in bilirubin, stavudine and zidovudine are antagonistic, and nervirapine and efavirenz are high potency separately but have drug interactions together. |
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Which NRTI does not require renal adjustment for a creatinine clearance of 15ml/min?
a. Abacavir b. Emtricitabine c. Stavudine d. Zidovudine |
a. Abacavir
Abacavir is the only NRTI that does not need renal adjustment. |
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When giving tenofovir, atazanavir and a proton pump inhibitor together in a medical regimen which of the following doses would you expect to sue?
a. Atazanavir 100mg b. Atazanavir 400mg c. Atazanavir 300mg/ritonavir 100mg d. Atazanavir 400mg/ritonavir 100mg |
d. Atazanavir 400mg/ritonavir 100mg
Higher doses of atazanavir are required to overcome the reduction of both the proton pump inhibitor and the tenofovir interactions, thus ritonavir is needed as is the 400mg dose of atazanavir. |
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Which of the following agents is known for extensive diarrhea when used in a patient regimen?
a. Lopinavir b. Nelfinavir c. Saquinavir d. Dauranvir |
b. Nelfinavir
Nelfinavir (Viracept) has a side effect of extensive diarrhea. |
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Which of the following statements on drug resistance is correct?
a. Cross resistance is never a problem b. Resistance is related to the peak (Cmax) drug levels c. Resistance is related to the trough (IC50) drug levels d. Resistance is testing is done on all detectible viral loads |
c. Resistance is related to the trough (IC50) drug levels
The IC50 is the minimum dose required to inhibit the replication of 50% of the virus. When levels are below this the virus replicates in suboptimum drug levels increasing the risk of drug resistance. |
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JS is a 58 year old African American male with HIV/AIDS. He has a history of
Cryptococcal meningitis. His most recent labs show a CD4 cell count of 40 cells/mm3 and a viral load of 185,000 copies/mL. His baseline serologies include Toxoplasma IgG (+), CMV IgG (+), hepatitis A Ab (-), hepatitis B Ag (-), and hepatitis B Ab (-). He is allergic to sulfa medications which caused severe rash. Which of the following regimens are the most appropriate for opportunistic infection prophylaxis in this patient? A. Dapsone, fluconazole, valganciclovir B. Fluconazole, dapsone, pyrimethamine, leucovorin C. Atovaquone, valganciclovir D. Dapsone, fluconazole, atovaquone |
B. Fluconazole, dapsone, pyrimethamine, leucovorin
Patient needs secondary prophylaxis against Cryptococcal meningitis (fluconazole), primary prophyaxis against PCP (dapsone) and Toxoplasmosis (dapsone + pyerimethamine + leucovorin). |
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Which of the following medications used in the treatment of CMV retinitis requires the routine use of hydration and probenicid to minimize the potential for
nephrotoxicity? A. Valganciclovir B. Ganciclovir C. Foscarnet D. Cidofovir |
D. Cidofovir
Both foscarnet and cidofovir can cause nephrotoxicity. Of these 2 agents, cidofovir is the agent that requires use of probenecid and hydration to minimize risk. |
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Which of the following medications requires that an HLA-B*5701 test be performed
prior to its use? A. Abacavir (Ziagen®) B. Maraviroc (Selzentry™) C. Atazanavir (Reyataz®) D. Nevirapine (Viramune®) |
A. Abacavir (Ziagen®)
HLA-B*5701 is a test to determine if a patient is at risk for hypersensitivity reaction to abacavir. |
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Due to significant drug interactions, which of the following antiretrovirals has 3
different dosing regimens (150 mg po bid, 300 mg po bid, 600 mg po bid) depending upon the other antiretrovirals/other medications included in the regimen? A. Maraviroc (Selzentry™) B. Etravirine (Intelence™) C. Raltegravir (Isentress™) D. Darunavir (Prezista®) |
A. Maraviroc (Selzentry™)
Maraviroc is the only agent listed that requires 3 different dosing regimens depending upon the other drugs used in the patients regimen. |
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All of the following protease inhibitors must be combined with low-dose ritonavir
for boosting EXCEPT: A. Darunavir (Prezista®) B. Saquinavir (Invirase®) C. Tipranavir (Aptivus®) D. Nelfinavir (Viracept®)) |
D. Nelfinavir (Viracept®)
All except nelfinavir must be boosted with ritonavir. |
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Which of the following antiretrovirals is a medication in the novel class called
integrase inhibitors? A. Maraviroc (Selzentry™) B. Raltegravir (Isentress™) C. Etravirine (Intelence™) D. Enfuvirtide (Fuzeon®) |
B. Raltegravir (Isentress™)
Maraviroc is a CCR5 antagonist, etravirine is an NNRTI, enfuvirtide is a fusion inhibitor, and raltegravir is an integrase inhibitor. |
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JD is a 78 year old male who has been diagnosed with HIV infection for the past 12
years. The patient has recently established care with a new clinician after being out of care for 3 years. He is prescribed a regimen of Etravirine (Intelence™), raltegravir (Isentress™), and Emtricitabine/Tenofovir (FTC/TDF, Truvada®). He brings the prescriptions to your pharmacy and when you process them, the etravirine is being rejected by his Medicare plan due to need for a prior authorization. Which of the following would be the most appropriate? A. Dispense the other antiretrovirals and ask the patient to contact the prescriber B. Dispense the other antiretrovirals and contact the prescriber to obtain approval for the etravirine C. Do not dispense any of the antiretrovirals and send the patient to another pharmacy D. Do not dispense any of the antiretrovirals, contact the prescriber for prior authorization and then reprocess all of the antiretrovirals once the etravirine is approved |
D. Do not dispense any of the antiretrovirals, contact the prescriber for
prior authorization and then reprocess all of the antiretrovirals once the etravirine is approved Medications should not be dispensed until all antiretrovirals are available for the patient. They should all be processed on the same day so that the patient can refill them on the same day each month to improve adherence. Prior authorization may take a week or more. |
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CG is a 32 year old male who was diagnosed with HIV infection 1 year ago. He is
on an antiretroviral regimen of Emtricitabine/Tenofovir (FTC/TDF, Truvada®) + Lopinavir/ritonavir (LPV/r, Kaletra®). He requires treatment for an anxiety disorder. Which of the following benzodiazepines would be safest to use in this patient? A. Diazepam (Valium®) B. Alprazolam (Xanax®) C. Triazolam (Halcion®) D. Lorazepam (Ativan®) |
D. Lorazepam (Ativan®)
Due to less potential for increased toxicity due to a drug interaction with the protease inhibitors, lorazepam is the safest of these agents to combine with a protease inhibitor (i.e. lopinavir/ritonavir in this case). |
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Which of the following hepatitis B medications is similar to an HIV medication and
has the potential to cause nephrotoxicity? A. Adefovir (Hepsera®) B. Entecavir (Baraclude®) C. Telbivudine (Tyzeka®) D. Lamivudine (Epivir HB®) |
A. Adefovir (Hepsera®)
Explanation: Adefovir is similar to the HIV medication tenofovir and both of these medications can cause nephrotoxicity. Lamivudine is the same as a medication used for HIV but it is not known to cause nephrotoxicty. |
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JK is a 58 year old male with HIV infection. He has been well-controlled on a regimen
of Viread® (tenofovir), Emtriva® (emtricitabine), and Sustiva® (efavirenz) since May of 2003 (HIV viral load < 50 copies/mL, CD4 435 cells/mm3). He was recently changed from taking these medications separately to tenofovir/ emtricitabine/ efavirenz (Atripla®) 1 pill per day at bedtime. He also has chronic active hepatitis B infection, type 2 diabetes, and hypertension. He returns to the clinic for routine follow up of his HIV infection. The nurse practitioner notices that his serum creatinine is increased to 1.8 mg/dL (0.9 mg/dL 3 months prior). Which of his antiretrovirals (if any) would be most likely to be contributing to this increase in serum creatinine? A. Tenofovir B. Emtricitabine C. Efavirenz D. None of these medications have been associated with nephrotoxicity |
A. Tenofovir
Tenofovir is the only agent listed that has been shown to cause nephrotoxcity. |
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Which of the following antiretrovirals should not be combined due to additive risk of
hyperbilirubinemia? A. Didanosine (Videx EC®, ddI) and Stavudine (Zerit®, d4T) B. Lamivudine (Epivir® 3TC) and Emtricitabine (Emtriva®, FTC) C. Nevirapine (Viramune®, NVP) and Efavirenz (Sustiva®, EFV) D. Indinavir (Crixivan®, IDV) and Atazanavir (Reyataz®, ATV) |
D. Indinavir (Crixivan®, IDV) and Atazanavir (Reyataz®, ATV)
Both indinavir and atazanavir can cause hyperbilirubinemia due to inhibition of the UGT1a1 enzyme which is needed to conjugate bilirubin for excretion. |
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LP is a 32 year old female who was recently diagnosed with HIV/AIDS. She states that
her boyfriend of the past 4 years told her that he was taking several oral medications for cancer treatment. Her CD4 is 308 cells/mm3 and her viral load is 87,000 copies/mL. She is interested in starting antiretroviral therapy. Her past medical history is significant for multiple sexually transmitted diseases (Chlamydia, gonorrhea x 2, herpes). She states that her and her boyfriend use condoms for birth control but do not use these consistently. Which of the following antiretrovirals should not be used in this patient due to its teratogenic potential? A. Zidovudine (Retrovir®, AZT) B. Nelfinavir (Viracept®, NFV) C. Lamivudine (Epivir®, 3TC) D. Efavirenz (Sustiva®, EFV) |
D. Efavirenz (Sustiva®, EFV)
Efavirenz has been shown to be teratogenic in animal studies and in humans and should not be used in pregnant women or in those with pregnancy potential. The regimen most commonly used in pregnancy and with the most data supporting lack of teratogenic effect is lamivudine/zidovudine + nelfinavir. |
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Which of the following medications should be avoided due to increased risk of
hepatotoxicity in this patient since she is a female with a CD4 of > 250 cells/mm3? A. Lopinavir/ritonavir (Kaletra®, LPV/r) B. Atazanavir (Reyataz®, ATV) C. Nevirapine (Viramune®, NVP) D. Fosamprenavir (Lexiva®, fos-APV) |
C. Nevirapine (Viramune®, NVP)
All PIs (A, B, C) can cause increased transaminases. Nevirapine is an NNRTI that has been shown to have an increased risk of hepatotoxicity in women with CD4 > 250 and men with CD4 > 400. |
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Which of the following patient characteristics may predict nonadherence to
antiretroviral therapy? A. Low socioeconomic status B. History of alcoholism C. Active mental illness D. Race |
C. Active mental illness
The only characteristic listed that has been shown to predict nonadherence is active mental illness. Race and socioeconomic status cannot predict nonaherence. Active alcohol or drug abuse can predict nonadherence but not prior use. |
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Which of the following HMG-CoA reductase inhibitors is contraindicated (should
never be combined) with the protease inhibitors? A. Simvastatin (Zocor®) B. Atorvastatin (Lipitor®) C. Rosuvastatin (Crestor®) D. Pravastatin (Pravachol®) |
A. Simvastatin (Zocor®)
Simvastatin and lovastatin are the HMG-CoA reductase inhibitors that are contraindicated with protease inhibitors. |
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JB is 38 year old male with HIV/AIDS who was recently discharged from the hospital.
He was admitted with fever, severe headache and mental status changes and was diagnosed with cryptococcal meningitis. Following completion of the acute phase of treatment, what maintenance therapy would be most appropriate? (Current CD4 count is 98 cells/mm3 and viral load is > 750,000 copies/mL). A. Flucytosine (5-FC) 25 mg/kg/dose po q6h B. Fluconazole 200 mg po qd C. Amphotericin B 0.7 mg/kg IV qweek D. None, maintenance therapy (ie, secondary prophylaxis) is not necessary |
B. Fluconazole 200 mg po qd
The acute treatment of cryptococcal meningitis consists of amphoternicin B + flucytosine followed by consolidation with fluconazole 400 mg po qd. All patients should then go on maintenance therapy with fulconazole 200 mg po qd. |
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This patient should receive primary prophylaxis for which of the following
infections? (Patient’s baseline serologies are as follows: Toxoplasma IgG (+), Cytomegalovirus (CMV) IgG (+), Hepatitis BsAg (-), Hepatitis BsAb (-), Hepatitis A Ab (+), herpes simplex virus type 2 (HSV-2) Antibody (+)) A. Pneumocystis jiroveci (formerly carinii) pneumonia, Toxoplasmic encephalitis B. Pneumocystis jiroveci (formerly carinii) pneumonia, Cytomegalovirus retinitis C. Mycobacterium avium complex, Toxoplasmic encephalitis D. Pneumocystis jiroveci (formerly carinii) pneumonia, herpes simplex virus |
A. Pneumocystis jiroveci (formerly carinii) pneumonia, Toxoplasmic encephalitis
Routine primary prophylaxis is only recommended for the following: PCP (CD4 < 200), Toxoplasmosis (CD4 < 100 and positive Toxo IgG), and MAI/MAC (CD4 < 50). Patient meets criteria for prophylaxis of infections listed in A. |
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The patient states that he is experiencing tingling and burning in his fingers and toes. Which of his antiretroviral medications is the most likely cause of this adverse effect?
a. stavudine (d4T) b. lamivudine (3TC) c. indinavir d. ritonavir |
a. stavudine (d4T)
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If the patient requires initiation of drug therapy for hyperlipidemia, which agent is least likely to interact with his antiretrovirals?
a. Lovastatin b. Simvastatin c. Pravastatin d. None of the above could be safely given to this patient |
c. Pravastatin
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What criteria should be used to consider discontinuation of MAC secondary prophylaxis?
a. CD4+ cell count > 200 cells/mm3 for > 6 months in response to HAART b. CD4+ cell count > 200 cells/mm3 for > 3 months in response to HAART and treated for MAC for at least 12 months c. CD4+ cell count > 100 cells/mm3 for > 6 months in response to HAART d. CD4+ cell count > 100 cells/mm3 for > 3 months in response to HAART and treated for MAC for at least 12 months |
d. CD4+ cell count > 100 cells/mm3 for > 3 months in response to HAART and treated for MAC for at least 12 months
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RB is a 63 year old male who was diagnosed with HIV infection 3 months ago. His CD4 count at the time of diagnosis was 325 cells/mm3 and his viral load was 74,800 copies/mL. His CD4 count and viral load done 2 weeks ago were 256 cells/mm3 and 89,500 copies/mL, respectively. After extensive discussion of the benefits/risks of therapy as well as the importance of adherence to therapy, the patient agrees to initiate antiretroviral therapy.
Which of the following components/combinations should not be included in the regimen? A. Atazanavir (Reyataz®) + ritonavir (Norvir®) B. Stavudine (d4T, Zerit®) + lamivudine (3TC, Epivir®) C. Unboosted Saquinavir soft gel capsules (Invirase®) D. Zidovudine (Retrovir®) + lamivudine (Epivir®) |
C. Unboosted Saquinavir soft gel capsules (Invirase®)
Unboosted saquinavir is not recommended, it should be boosted with ritonavir. All of the other combinations listed are appropriate components of an antiretroviral regimen. |
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Which of the following statements regarding monitoring of surrogate markers is true in this patient?
A. In order to be considered an adequate initial response to therapy, the patient’s viral load should decrease to at least 895 copies/mL by 6 weeks B. An increase in CD4 cell count to 375 cells/mm3 would be considered a minimally significant change C. Once the patient achieves an undetectable viral load, the viral load should be monitored every 3-4 months to assess continued response to therapy D. The viral load should not be performed within 2 months of an acute illness or vaccination |
C. Once the patient achieves an undetectable viral load, the viral load should be monitored every 3-4 months to assess continued response to therapy
a. Adequate response defined as 10-fold decrease by 4-8 weeks, to at least 8,950 copies/mL in this patient b. A minimally significant increase would be by 30% or to at least 432. d. Should not be performed within 4 weeks of acute illness or vaccination. |
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The patient is started on a regimen consisting of (Emtricitabine/Tenofovir, FTC/TDF) Truvada® 1 tablet (200 mg FTC/30 mg TDF) po qd and Nevirapine (Viramune®) 200 mg po qd x 2 weeks then 200 mg po bid. Which side effect are you most concerned about with the nucleoside/nucleotide reverse transcriptase inhibitor component of this regimen?
A. Nephrotoxicity B. Rash-associated hepatotoxicity C. Anemia D. Pancreatitis |
B. Rash-associated hepatotoxicity
Rash-associated hepatotoxicity is potential with the non-nucleoside reverse transcriptase inhibitor component (i.e. nevirapine). Anemia and pancreatitis are adverse effects seen with other NRTIs. |
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At a later visit, RB needs to be started on a HMG-CoA reductase inhibitor (statin) for treatment of hypercholesterolemia. What would you expect if you started this patient on Simvastatin (Zocor®) which is metabolized primarily metabolized by CYP3A4?
A. An increase in Simvastatin levels compared to patients not on interacting medications B. No change in Simvastatin since these agents do not affect cytochrome P450- mediated drug metabolism C. A decrease in Simvastatin levels compared to patients not on interacting medications |
C. A decrease in Simvastatin levels compared to patients not on interacting medications
Nevirapine is an enzyme inducer and will decrease levels of simvastatin. |
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AK is a 26 year old female with HIV infection who recently found out that she is pregnant. Which of the following antiretrovirals should not be included in a regimen for this patient?
A. Didanosine (ddI, Videx EC®) B. Efavirenz (EFV, Sustiva®) C. Nelfinavir (NFV, Viracept®) D. Ritonavir (RTV, Norvir®) |
B. Efavirenz (EFV, Sustiva®)
Efavirenz has been shown to be teratogenic and should not be used in HIV-infected pregnant women. |
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Which of the following statements regarding antiretroviral resistance testing is true?
A. Resistance testing cannot be reliably performed unless the patient’s viral load is > 10,000 copies/mL B. Phenotypic resistance testing can yield reliable results regardless of whether the patient is on antiretrovirals at the time of the test C. Due to less cost and faster turn around time, phenotypic resistance testing is the most common method used in clinical practice. D. None of the above |
C. Due to less cost and faster turn around time, phenotypic resistance testing is the most common method used in clinical practice.
a. Viral load should be greater than > 1,000 copies/mL to perform resistance testing reliably b. Just as with genotyping, resistance may not be detected without selective pressure of the antiretroviral agents. c. Genotyping costs less, has a faster turn around time and is the most common method used in clinical practice. |
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JS is a 32 year old HIV-infected male (not on treatment, last CD4 cell count 55 cells/mm3) who presents to the emergency department with new onset seizures and mental status changes. A CT scan of the head shows several ring-enhancing lesions and he is diagnosed with toxoplasmosis. He has no known drug allergies and weighs 75 kg. What is the most appropriate recommendation?
A. Sulfadiazine 1 g po q6h + pyrimethamine 200 mg po x 1 dose then 50 mg po qd + leucovorin 10 mg po qd x 6 weeks followed by secondary prophylaxis with trimethoprim/sulfamethoxazole 1 DS tab po qd B. Trimethoprim/sulfamethoxazole (Septra) DS 1 tab po bid x 6 weeks followed by secondary prophylaxis with Trimethoprim/sulfamethoxazole DS 1 tab po on Mon,Wed, Fri C. Sulfadiazine 1 g po q6h + pyrimethamine 200 mg po x 1 dose then 50 mg po qd + leucovorin 20 mg po qd x 6 weeks followed by secondary prophylaxis with sulfadiaine 500 mg po q6h + pyrimehtamine 25 mg po qd + leucovorin 10 mg po qd D. Clindamycin 600 mg po q12h + pyrimethamine 200 mg po x 1 dose then 100 mg po qd + leucovorin 10 mg po qd x 4 weeks followed by clindamycin 450 mg po q12h + pyrimethamine 25 mg po qd + leucovorin 10 mg po qd |
C. Sulfadiazine 1 g po q6h + pyrimethamine 200 mg po x 1 dose then 50 mg po qd + leucovorin 20 mg po qd x 6 weeks followed by secondary prophylaxis with sulfadiaine 500 mg po q6h + pyrimehtamine 25 mg po qd + leucovorin 10 mg po qd
Recommended regimen for acute Toxoplasmosis treatment in patient with no drug allergies is sulfadiazine 1-1.5 g po q6h + leucovorin 10-20 mg po qd + pyrimethamine 200 mg po x 1 then 50-75 mg po qd x 6 weeks with maintenance therapy with the same agents, slightly lower dose: sulfadiazine 500-100mg po q6h + pyramethamine 25-50 mg po qd + leucovorin 10-20 mg po qd |
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TJ is a 23 year old female HIV-infected patient who is being treated for CMV retinitis with foscarnet 90 mg/kg iv q12h. Which of the following side effects are you most concerned about with this agent?
A. Hemolytic anemia B. Pancreatitis C. Neutropenia D. Nephrotoxicity |
D. Nephrotoxicity
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CF is a 58 year-old male with diabetes, hyperlipidemia, iron deficiency anemia, and GERD who was recently diagnosed with HIV infection. His baseline CD4 and viral load are: CD4 220 cells/mm3, viral load 158,000 copies/mL. His physician would like to initiate a protease-inhibitor-based antiretroviral regimen and asks for your assistance.
Current medications: Lisinopril (Zestril®) 10 mg po qd, atorvastatin 10 mg po qd (Lipitor®), metformin (Glucophage®) 500 mg po bid, ferrous sulfate 325 mg po bid, pantoprazole (Protonix®) 40 mg po qd Which of the following protease inhibitors should not be used in this patient due to its requirement of an acidic environment for optimal absorption? A. Lopinavir/ritonavir (Kaletra®) B. Nelfinavir (Viracept®) C. Saquinavir (Fortovase®) D. Atazanavir (Reyataz®) |
D. Atazanavir (Reyataz®)
Atazanavir is the protease inhibitor that requires an acidic environment for absorption and cannot be given with proton pump inhibitors |
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Which of the following nucleoside reverse transcriptase inhibitors (NRTIs) would be
most likely to exacerbate anemia in this patient? A. Abacavir (ABC, Ziagen®) B. Zidovudine (AZT, Retrovir®) C. Didanosine (ddI, Videx EC®) D. Stavudine (d4T, Zerit®) |
B. Zidovudine (AZT, Retrovir®)
Zidovudine most commonly causes anemia. |
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Which of the following nucleoside reverse transcriptase inhibitors (NRTIs) backbones is not recommended for use as initial therapy in antiretroviral naïve patients due to increased risk of toxicities such as lactic acidosis and pancreatitis?
A. Zidovudine (AZT, Retrovir®) + Stavudine (d4T, Zerit®) B. Zalcitabine (ddC, Hivid®) + Lamivudine (3TC, Epivir®) C. Stavudine (d4T, Zerit®) + Didanosine (ddI, Videx EC®) D. Abacavir (ABC, Ziagen®) + Emtricitabine (FTC, Emtriva®) |
C. Stavudine (d4T, Zerit®) + Didanosine (ddI, Videx EC®)
Zidovudine and stavudine should not be combined due to antagonism; zalcitabine and lamivudine should not be combined due to antagonism; there are no restrictions on combining abacavir and emtricitabine; the combination of didanosine and stavudine is no longer recommended in antiretroviral-naïve patients and these agents are rarely combined in experienced patients due to increased risk of toxicity. |
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2. Which of the following antiretroviral agents should not be combined due to antagonism (competition for intracellular phosphorylation)?
A. Lamivudine (3TC, Epivir) + didanosine (ddI, Videx EC) B. Abacavir (ABC, Ziagen) + lamivudine (3TC, Epivir) C. Zalcitabine (ddC, Hivid) + didanosine (ddI, Videx EC) D. Zidovudine (AZT, Retrovir) + Stavudine (d4T, Zerit) |
D. Zidovudine (AZT, Retrovir) + Stavudine (d4T, Zerit)
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What are the most common side effects of the “D” drugs [i.e. didanosine (ddI, Videx EC), stavudine (d4T, Zerit), zalcitabine (ddC, Hivid)?
A. Peripheral neuropathy and pancreatitis B. Nausea and diarrhea C. Hyperlipidemia and lipoatrophy D. Anemia and neutropenia |
A. Peripheral neuropathy and pancreatitis
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4. All of the following protease inhibitors have been associated with hyperlipidemia EXCEPT:
A. Ritonavir (RTV, Norvir) B. Atazanavir (ATV, Reyataz) C. Saquinavir (SQV, Fortovase/Invirase) D. Nelfinavir (Viracept) |
B. Atazanavir (ATV, Reyataz)
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5. An HIV-infected patient with a CD4+ cell count of 45 cells/mm3 and a negative Toxoplasma IgG antbody should receive prophylaxis against which of the following?
A. Pneumocystis carinii pneumonia, Candida espohagitis B. Mycobacterium avium complex, Toxoplasmic encephalitis C. Pneumocystis carinii pneumonia, Cryptococcal meningitis D. Pneumocystis carinii pneumonia, Mycobacterium avium complex |
D. Pneumocystis carinii pneumonia, Mycobacterium avium complex
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