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357 Cards in this Set

  • Front
  • Back
What BBW for NRTI?
lactic acidosis and severe hepatomegaly with steatosis
Didanosine BBW
lactic acidosis, severe hepatomegaly with steatosis, pancreatitis
stavudine BBW
lactic acidosis, severe hepatomegaly with steatosis, pancreatitis
saquinavir BBW
tablets and hard gel caps not interchangeable
ritonavir BBW
can't coadminister with antiarrhythmic, ergot, or sedative hypnotic
maraviroc BBW
hepatotoxicity
tipranavir BBW
hepatotoxicity, intracranial hemorrhage
delavirdine BBW
need other drugs, resistance if monotherapy
What drugs can be used for hepB/HIV coinfection?
lamivudine, tenofavir, emtricitabine
How many pts fail ART tx in 1st year?
25%
How much do condoms decrease HIV transmission?
20x
What HIV drugs are wt based dosing?
didanosine, stavudine
What is most common HIV in US?
group M subtype B
Which NRTI is metabolized by alcohol dehydrogenase?
abacavir
Which NRTI is metabolized by glucuronidation?
zidovudine
How are other NRTI metabolized?
renal
What age has opt out screening for HIV?
13-64
What is a clinical response in HIV?
greater than 0.5 log 10 decrease in HIV RNA
When do rapid progressors get AIDS?
5 years or less
When do nonprogressors get AIDS?
greater than 10 years
When do you tx for HIV regardles of CD4 count?
preg, HIV nephropathy, Hep B
What CD4 do you tx?
less than 350
What AE for NRTI?
peripheral neuropathy, pancreatitis, lipoatrophy, hepatotoxicity, lactic acidosis, steatosis
Are NNRTI or NRTI noncompetitive?
NNRTI
Which HIV is NRTI effective for?
HIV 1 and HIV 2
Which HIV is NNRTI effective for?
HIV 1
Which drug class has a low barrier to resistance?
NNRTI
Which drug class has a high barrier to resistance?
PI
What PI AE?
metabolic (Tg, CAD, DM), GI distress
What does enfuviritide bind to?
GP41
Does NRTI bind to active site?
yes
What is the order of HIV drugs in HIV?
maraviroc, enfuvirtide, RTI, integrase inhibitor, PI
Which drug is renally dosed if CrCl is less than 60?
didanosine, others are less than 50
Which drug is buffered?
didanosine, calcium
What BBW for abacavir?
lactic acidosis, steatosis, hypersensitivity (HLA-B 5701 allele)
What route is enfuvirtide?
SQ
What is the only nucleotide RTI?
tenofovir
What drug has neutropenia and anemia as AE?
stavudine
Which NNRTI are inhibitors of 3A4?
delavirdine
Which NNRTI are inducers of 3A4?
efavirenz, nevirapine, etravirine
What AE for NNRTI?
rash, increase liver enzymes
What BBW for nevirapine?
rash/SJS, hepatotoxicity (dont give to women with CD4 greater than 250, men greater than 400)
What PC is efavirenz?
D, teratogen
Which drug can have a false positive marijuana or BDZ test?
efavirenz
Should efavirenz be taken with food?
don't take with fatty foods, increase psychosis
What is drug indicated for NNRTI resistance?
etravirine
What DI for PI?
3A4, statins, rifampin
What statin is preferred in PI tx?
atorvastatin
Which PI has special considerations for PPI?
atazanavir, 12hrs after PPI, 20mg equivalent to omeprazole
What drug causes peripheral neuropathy?
didanosine
Which HIV drug is moisture sensitive?
indinavir
Which drug causes hyperpigmentation?
emtricitabine
Which drugs cause hyperbilirubinemia?
indinavir, atazanavir
Which PI is effective w/o ritonavir?
atazanavir
Which PI have to be taken with ritonavir?
lopinavir, darunavir, tipranavir
Which PI has the most effect on lipids?
ritonavir
Which PI has least effect on lipids?
atazanavir
Which drug are capsules refrigerated and solution is room temp?
ritonavir
Trizivir
abacavir, lamivudine, zidovudine
What metabolizes ritonavir?
CYP3A4, 2D6
How long do you prophylactic if exposed to HIV?
28 days
When should prophylaxis be started?
within 72hrs
What is prophylaxis for high risk (large blood)?
2NRTI and PI boost
What is prophylaxis for low risk (small blood)?
2 NRTI
What is prophylaxis for urine?
none
When does resistance testing for failing regimen need to be done?
within 4 weeks
What type of resistance testing is preferred?
genotype, faster, cheaper
What does maraviroc bind to?
GP120
What does enfuvirtide bind to?
GP41
Which HIV drugs are daily dosing?
ones in atripla (efavirenz, emtricitabine, tenofovir), abacavir, didanosine
Epzicom
lamivudine/abacavir
What PC is efavirenz?
PC D
Which drug causes fanconi syndrome?
tenofovir
Which meds should be taken with rifampin because of liver toxicity?
saquinavir
Which med should be avoided in alcohol?
abacavir
Which med can't be taken with sulfonamide allergy?
darunavir, tipranavir, fosamprenavir
Which med is taken 1hr apart from antacid?
delavirdine
Which HIV med has vitamin E?
tipranavir
What is preferred for tx naive?
2NRTI + NNRTI or + PI/ritonavir or + integrase inhibitor
What is goal for HIV RNA in tx experienced?
less than 400 after 24 weeks, less than 50 (undetectable) at 48 weeks, keep 50-200
Kaletra
lopinavir/ritonavir
How does administration of Kaletra solution differ from tablet?
solution must be taken with meals, tablet doesn't matter
Which drug is taken with a light snack?
nelfinavir
When do you prophylactic for PCP?
CD4 less than 200, pregnant, thrush
When do you stop prophylaxis for PCP?
CD4 above 200 for 3 months
What is tx for PCP?
bactrim
What is alternative for PCP?
dapsone
What causes toxoplasmosis?
protozoan
When do you prophylactic for toxoplasmosis?
less than 100
When can you stop toxoplasmosis prophylaxis?
over 200 for 3 months
What is prophylactic tx for toxo?
bactrim
What is alternative for prophylaxtic for toxo?
dapsone
What is alternative for prophylaxis and sulfonamide allergey for toxo?
pyremethamine, clindamycin
What is tx for toxo?
sulfadiazine (need hydration), pyrimethazine, leucavorin
What is alternative tx for toxo?
dapsone, pyrimethamine
When do you prophylact for MAC?
CD4 less than 50
When do you stop prophylaxis for MAC?
CD4 greater than 100 for 3 months
What is prophylaxis for CMV?
don't prophylact
When do you get CMV?
CD4 less than 50
When do you stop tx for CMV?
greater than 100 for 6 months
How long is tx if you actually get CMV?
lifetime
When do you get cryptococcosis?
CD4 less than 100
When do you prophylact for cryptococcosis?
CD4 less than 50
What is prophylaxic for cryptococcosis?
fluconazole
What is tx for cryptococcosis?
Amph B, flucytosine, switch to fluconazole when stable
What causes PCP?
pneumocystis jiroveci, fungus
What is prophylaxis for M. tuberculosis?
Isoniazid (if sensitive) + pyridoxine x 9 months
alternative of if isoniazid resistant: rifampin x 4 months
What is prophylaxis for MAC?
azithromycin or clarithromycin
What is alternative prophylaxis for MAC?
rifabutine
What is tx for CMV?
ganciclovir or valcanciclovir or foscarnet
What is most common manifestation of CMV?
retinitis
What is most common presentation of cryptococcosis?
meningitis
What is most common presentation of toxoplasmosis?
encephalitis
What s/s of MAC?
fever, night sweats, anorexia, malaise, wt loss (more than 10%), anemia, lymphadenopathy, diarrhea
What is tx for MAC?
1st drug: macrolide, clarithromycin (alternative azithromycin)
2nd drug: ethambutol
3rd: rifabutin, cipro, amikacin
Psoriasis
Psoriasis
Does smoking exacerbate psoriasis more in me or women?
women
Does alcohol exacerbate psoriasis more in men or women?
men
What is Koebner response?
psoriatic lesions at site of injury on normal skin
What is Auspitz sign?
salmon pink skin and bleeding after removal of scales
What is a keratolytic?
salicylic acid
What AE for salicylic acid?
salicylism: n/v, tinnitus, hyperventilation (metabolic acidosis)
What drugs exacerbate psoriasis?
NSAIDs, some antimalarials (Chloroquine), BB, Li
What drugs for malaria prophylaxis with psoriasis?
proguanil, atovaquone/proguanil, doxycycline, mefloquine
not chloroquine
Malarone
atovaquone/proguanil
Lariam
mefloquine
Daraprim
pyrimethamine
Qualaquine
quinine
Fansidar
sulfadoxine/pyrimethamine
What is guttate psoriasis?
small drop like plaques, caused by group A strep
What is tx for travelers diarrhea?
bactrim or pepto
What is prophylactic for travelers diarrhea?
pepto
Stelara
ustekinumab, tx mod/sev plaque psoriasis
What route is stelare?
SQ
What PC is Stelara?
B
What MOA of Stelare?
binds and interferes IL-12, IL-23, TNF alpha
What is required for biologics to be FDA approved?
75% decrease in PASI
What are the class 1 CS?
most potent, halo, betamethasone (optimized vehicle), clob (propionate)
What are class 7 CS?
hydrocortisone 1%, dexamethasone, methylprednisolone
What is potency measuring in CS classes?
vasoconstriction
Why are ointments better?
hydrating, oily occlusive phase
Why not use ointments in groin?
folliculitis
What SE for Vit D analogue?
hypercalcemia
What vit D analog is 100-200x less potent in its effects on calcium utilization than natural hormone?
calcipotriene
What is the topical retinoid?
tazarotene (Tazorac)
What is warning for tarotene topical?
don't apply to greater than 20% of body, systemic
What AE for coal tar?
epidermal hyperplasia, odorous
How does anthralin work?
DNA intercalation
How do you know anthralin is working?
skin staining
Are topical calcineurin inhibitors approved for psoriasis?
no, tacrolimus, pimacrolimus
What benefit of calcineurin inhibitors over CS?
don't cause skin atrophy
What are the TNF alpha inhibitors?
infliximab, adalimumab, etanercept
What is a T cell activation inhibitor?
Alefacept, CD2
When should alefacept be stopped?
if CD4 is below 250
Why was efalizumab pullef from the market?
PML (progressive multifocal leukoencephalopathy)
What do you give with acitretin for hyperlipidemia?
gemfibrizil
What AE for acitretin?
hypervitaminosis A
How long off of acitretin before pregnancy?
off for 3 years before pregnancy
How long should women not consume alcohol after acitretin?
2 months
What is goeckerman therapy?
UVB + Tar
What is Ingram therapy?
UVB + anthralin
What is PUVA?
psoralen + UVA
What is spectrum of UVB?
290-330, 310-315 is best, lights 310-313
How long before light does methoxypsoralen need to be applied?
2hrs, light breaks it down
Does PUVA systemic or topical need higher dose?
systemic (more melanoma)
What is the most effective approach to psoriasis?
goekerman therapy
What route is infliximab?
IV
What route is alefacept?
IM
What route are other biologics?
SQ
VVC
VVC
What are s/s of bacterial vaginosis?
Ph greater than 4.5, fishy, gray/white
What are s/s trich infection?
pH elevation, bad smell, yellow/green frothy
What is normal discharge?
white/clear
Does IUD increase risk of VVC?
yes
What is tx for bacterial vaginosis?
metronidazole
What is alternative tx for bacterial vaginosis?
clindamycin
What is tx for trich?
metronidazole, tinidazole
What is tx for VVC?
azole
What is complicated VVC?
more than 4 in 12 months, severe, non albicans, preg,
What is tx for complicated?
boric acid, flucytosine
What is 2nd most common candida?
glabratta
What is tx for glabratta?
flucytosine
Why does estrogen (OC) increase risk of VVC?
increase binding affinity of fungus
What is tx if trich and allergic to metronidazole or tinidazole?
desensitize
alternative: douche
Which infection do you treat the partner?
trich
When are metronidazole and tinidazole CI?
1st trimester pregnancy
metronidazole PC B, tinidazole PC C
How long for VVC tx?
1, 3, or 7 day
How long for complicated VVC tx?
10-14 days
What is diagnosis for bacterial vaginosis?
KOH, wiff test
Is VVC a STD?
no
Monistat 3, 7, combo pack
miconazole
Femstat
butoconazole 2% OTC
Gynazole 1
butoconazole 2% sustained release
Lotrimin AF
clotrimazole
Terazol
terconazole
Monistat 1/ Vagistat 1
tioconazole
What are the Rx tx for VVC?
nystatin, clotrimazole vag tab, gluconazole, terconazole
Parkinson's
Parkinson's
What are symptoms of PD?
bradykinesia, postural disturbances, rigidity, tremor
What age most common for PD?
65-80 years
What street drug can cause PD?
MPTP, meperidine analog
How many receptors must you lose for PD?
70-80%
What are Lewey bodies?
abnormal aggregates of protein in nerve cells in PD
How is DA and Ach affected in PD?
DA down, Ach up
What is first symptom of PD?
tremor, unilateral
What is stage 1 PD?
unilateral
What is stage 2 PD?
bilateral
What is stage 3 PD?
postural instability
What is stage 4 PD?
need assistance
What is stage 5 PD?
need assistance/bed bound, doesn't respond to drugs
How does rigidity present?
cogwheel
How does tremor present?
pill rolling
When do you start PD tx?
bradyinesia/rigidity
Stalevo
carbidopa/levodopa/entacapone
Max dose/day Stalevo?
6x
Max dose/day of carbidopa/levodopa or entacopone?
8x/day
Max dose/day of tolcapone?
3x
What converts Ldopa to DA?
dopadecarboxylase
What converts Ldopa to 3 O methyl dopa?
COMT
What is ropinorole metabolized by?
1A2
What AE from DA agonist?
orthostatic hypotension, change in mood behavior, hallucinations, somnolence, nausea
What is tx for increased somnolence?
provigil (modafanil)
What BBW tolcapone?
liver damage
Is pramipexole or ropinorole more poten?
pramipexole, 3x
What major SE of amantadine?
livedo reticularis
Selegiline
eldepryl, MAO-B inhibitor
Selegiline ODT
zelapar, MAO-B inhibitor
What kind of metabolites does selegiline have?
amphetamine
Why was rotigatine patch voluntarily withdrawn?
pathc, crystals affect absorption
What happens if ldopa or DA agonist is withdrawn to quickly?
neuroleptic malignant syndrome
What is half life of ldopa?
1.5hrs
What metabolizes selegiline?
CYP2B6, 3A4
How much carbidopa is needed to saturate dopadecarboxylase?
75-100mg
Parcopa
carbidopa/levodopa ODT
What ratio of carbidopa/ldopa if less than 750mg?
4:1
What ration of carbidopa if more than 750mg?
10:1
What DI CI for selegiline?
dextromethorphan and meperidine
What dose of selegiline become not selective for MAO-B?
high dose, 20mg, watch what you eat
What CrCl for pramipexole?
IR: greater than 60 ok, ER: greater than 50 ok
What does ropinorole (Requip) have affinity for?
D3
How long is honeymoon period?
5 years
What AE for apomorphine?
n/v
What is tx for n/v from apomorphine?
trimethobenzamide 3 days prior for 2 months, don't give zofran because hypotension
What is test dose for apomorphine?
0.1mL
What route is apomorphine?
SQ
What DI for anticholinergics and ldopa?
stops stomach and stops clearance
What DI for ferrous sulfate and ldopa?
chelation, decrease absorption by 50%
Why are anticholinergic not given to older people?
AE, mental
What metabolizes tolcapone?
2D6, 3A4
What cranial nerves are affected in PD?
5 (jaw), 7 (facial fold), 10 (swallowing), 11 (en bloc), 12 (tongue)
What can amantadine cause after 1-3 months?
tachyphylaxis
What PD drugs are renal dosed?
pramipaxole and amantadine
What climate worsens livedo reticularis?
cold
Apokine
apomorphine
Does CR or IR Sinemet have higher dyskinesia?
CR
What MOA of CoQ10?
mitochondrial synthesis
What Vit E in PD?
alpha tocopherol
Bipolar
Bipolar
When is lamotrigine used?
maintenance only
What bipolar med can be used by 12 year old?
lithium
Does Li dose change in pregnancy?
increase
What is Li liquid?
Li citrate
How much IR Li is absorbed?
90-100%
How much Liquid Li is absorbed?
100%
How much ER Li is absorbed?
60-90%
What Li toxicity above 1.5?
apathy, lethargy, nausea
What Li toxicity 1.5-2.5?
coarse tremor, slurred speech
What Li toxicity above 2.5?
seizure, renal failure, coma
What do you do if Li level is above 4?
intermittent hemodialysis
When does ebstein anomally occur?
Li, 1st trimester
Which bipolar drug is worst in pregnancy?
valproate, neural tube defects 1:20
What birth defect for CBZ?
0.1% neural tube defects
What birth defect for Li?
Ebstein Anomaly 1:1000
What PC Li, valproate, CBZ?
D
Can you breast feed with valproate?
yes
Can you breast feed with Li?
no
What med for pregnancy?
typical AP (chlorpromazine), CCB
M-Tab
risperdone ODT
Zydis
olanzapine ODT
Discmelt
aripiprazole ODT
What BBW for lamotrigine?
skin reactions, SJS
What can exacerbate psoriasis?
Li
What program for pregnant if continue lamotrigine?
NAAED
What sex more likely to get bipolar I or II?
women
What sex more likely to get subthreshold bipolar?
men
What drug CI with CBZ?
nefazodone
Symbyax
olanzapine/fluoxetine
What BBW CBZ?
aplastic anemia, agranulocytosis
How does CBZ induce its own metabolism?
3A4
Does hyper/hypo thyroid cause mania?
hyperthyroid
Triliptel
oxcarbazepine
What Li concentration for acute bipolar?
1-1.2
What Li concentration for maintenance?
0.6-0.8
What Li concentration for elderly?
0.4-0.6
What BBW for valproate?
hepatotoxicity, teratogenicity, pancreatitis
What AE for valproate?
hyperammonemic encephalopathy
What must you do before starting antidepressant in bipolar?
stabilized on mood stabilizer
Which IM AP is not given with BDZ?
olanzapine, respiratory depression
CBZ/valproate combo results?
valproate displaces CBZ, CBZ levels increase
What is the worst AAP with Li?
aripiprazole, t1/2 to long to calm down quick
What is better AAP with Li?
risperidone
When is Li stopped/restarted with ECT?
d/c 2 days before, start back 2-3 days after
What drugs shouldn't be given with Li?
NSAIDs, ACEI, thiazide (reabsorb more Li), caffeine/theophylline
How does Li cause diarrhea?
osmotic
When is CR Li taken?
night
Does Li affect liver?
no
What drug can cause prolonged bleeding?
valproate
What are goal valproate levels?
50-125mcg/mL 12hrs post dose
What OTC for bipolar?
omega 3 FA
ANAPHYLAXIS What wt gets epi pen?
above 30kg
What wt gets epi pen Jr?
below 30kg
What concentration for epi pen?
1:1000
What concentration for epi pen Jr?
1:2000
What is dose of epi pen?
0.3mg/0.3ml
What is dose of epi pen Jr?
0.15mg/0.3ml
How long do you wait when giving epi pen?
10 seconds
Where is epi pen given?
anterolateral aspect of the thigh
What is type I rxn?
IgE
Whay is type II rxn?
cytotoxic, IgG, IgM
What is type III rxn?
serum sickness, IgE, immune complex
What is type IV rxn?
cell mediated, delayed HSN, CD4/CD8
What is example of Type IV?
TB skin test, poison ivy
Does 1st or 2nd gen cephs cause more anaphylaxis?
1st
What kind of rxn is red man syndrome?
anaphylactoid, doesn't involve IgE, direct release of Histamine
What is an example of type III rxn?
lupus
What causes the most anaphylaxis/phylactoid rxn?
ASA/NSAIDs, pens, insulin
How long do you monitor pt after anaphylaxis?
12hrs for delayed rxn
What route is least likely to make you sensitive?
IV
What route is most likely to make you sensitive?
topical
Do you need to be sensitized for anaphylactoid?
no
What type of rxn is pen rxn?
can be all 4
Can you give aztreonam if have pen allergy?
yes
Can you give carbopenem if have pen allergy?
no
What do you give have anaphylaxis and on BB?
glucagon
What vasopressor is recommended?
NE
What is used to reduce late phase rxn?
hydrocortisone
What is used for bronchospasm?
albuterol and aminophylline
How often vital for anaphylaxis?
every 2-5 minutes
WhHow much oxygen for anaphylaxis?
8-10L/minute
Transplant
Transplant
What transplant has the best survival?
kidney
What transplant has the lowest survival?
heart
Can you get a transplant if have HIV?
yes
What is absolute CI for heart transplant?
infection, other diseases, malignancies, severe irreversible pulmonary HTN
What is absolute CI for liver transplant?
HCV in 6 months after transplant, HCV at anytime, alcohol or substance abuse
What is CI for kidney transplant?
unstable cardiac disease, malignancies, risk from surgery, chronic immunosuppression
What is reason for most liver transplants?
noncholistatic cirrhosis (hep C)
What are calcineurin inhibitors metabolized by?
3A4
What premedication of polyclonal antibodies?
diphenhydramine, hydrocortisone, acetaminophen
Which transplants ned HLA matching?
kidney
What AE for cyclosporine?
HTN (BBW), hyperlipidemia
What AE fror tacrolimus?
hyperglycemia, alopecia
How do you know if you have acute rejection with heart transplant?
asymptomatic, routine biopsy
Is chronic rejection reversible?
no
What PC for basaliximab?
B
What is MOA of basiliximab?
IL-2 antagonist
What is empiric tx if rejection is suspected?
high dose corticosteroids (methyprednisolone IV)