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186 Cards in this Set
- Front
- Back
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List the NRTIs
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abacavir
didanosine emtricitabine lamivudine stavudine tenofovir zalcitabine zidovudine |
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List the NNRTIs
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delavirdine
efavirenz etravirapine nevirapine |
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List the PIs
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amprenavir
atazanavir darunavir fosamprenavir indinavir nelfinavir ritonavir saquinavir tipranavir lopinavir |
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List the fusion inhibitors
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enfuviritaide
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List the CCR5 antagonists
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maraviroc
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List the integrase inhibitors
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raltegravir
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List the brand name, common abbreviations, and dosing of zidovudine
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Retrovir (AZT)
Dosing – 200 mg PO TID or 300 mg PO BID – Available IV! Taken without regard to food Renal dose adjustment |
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List the AE's of zidovudine
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– nausea
– malaise, myalgias, weakness – insomnia – hyperpigmentation of nails and toes (next slide) – bone marrow suppression – lactic acidosis - lipodystrophy - anemia |
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List the major DDIs of zidovudine
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– avoid ribavirin (inhibits AZT phosphorylation)
– methadone increases zidovudine concentrations monitor for nausea, vomiting, headache, myelosuppression |
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List the generic name, common abbreviations, and dosing of lamivudine.
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-Epivir (3TC)
Dosing – 150 mg PO BID or 300 mg PO daily Taken without regard to food – Renal dosing requirements |
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List the common AEs of lamivudine
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– diarrhea
– malaise, fatigue – headache -pancreatitis |
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List the brand name, common abbreviations and dosing of stavudine.
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Zerit (d4T)
Dosing – > 60 kg = 40 mg PO BID – < 60 kg = 30 mg PO BID – Other dose adjustments Taken without regard to food |
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List the common AEs of stavudine
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– fulminant pancreatitis
– peripheral neuropathy – headache – lactic acidosis - hepatomegaly |
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List the significant common DIs of stavudine
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didanosine
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What combo agent contains abacavir, lamivudine, and zidovudine
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Trizivir
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What are class AE's and issues associated with NRTIs?
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-mitochondrial toxicity
-lipodystrophy -lactic acidosis -hepatic steatosis *all except abacavir require renal dose adjustment |
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What is the brand name, common abbreviations, and dosage regimen for didanosine?
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Videx (DDI)
– >60 kg = 200 mg BID tab, 250 mg BID powder, 400 mg QD EC – < 60 kg = 250 mg EC capsule PO daily, 125 mg tab PO BID, 167 mg powder PO BID -Take 1/2 hour before or 2 hours after food – Renal dose adjustment – Pediatric suspension reconstitution |
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What are the common AEs associated with didanosine?
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– nausea, diarrhea
– peripheral neuropathy – pancreatitis – lactic acidosis |
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What is the brand name and dosage of zalcitabine?
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Hivid (ddC)
– 0.75 mg PO TID -Take without regard to food -Product discontinued December 31, 2006 |
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What are some common AEs associated with zalcitabine?
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– peripheral neuropathy
severe! black box warning – stomatitis – pancreatitis – lactic acidosis |
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What is the brand name and dosage regimen of abacavir?
|
-Zigen
– 300 mg PO BID or 600 mg PO daily -Take without regard to food -no renal dose adjustment needed |
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What are the common AEs associated with abacavir?
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fatigue, rash, headache, GI upset
– hypersensitivity reaction 85% of cases occur in first six weeks of therapy flu-like symptoms, fever, rash, n/v, SOB, fatigue must discontinue immediately and never rechallenge! (can lead to death) |
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What test needs to be done before administering abacavir?
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HLAB5701 test for hypersensitivity
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What drug interaction is common with abacavir?
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-alcohol increases levels by 41%
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What is the brand name and usual dosing of emtracitabine?
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Emtriva
-200 mg po daily -take w/o regard to food |
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What common AEs are associated with emtracitabine?
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– minimal toxicity
– lactic acidosis – hyperpigmentation – skin discoloration |
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What NRTIs are also effective against Hep B?
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-emtricitabine
-lamivudine -tenofovir |
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What is the brand name and dosing of tenofovir?
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Viread
-300 mg PO daily -taken without regard to food -renal dosing |
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What are the common AEs of tenofovir?
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– asthenia
– headache – nausea, vomiting, diarrhea, flatulence – renal insufficiency – lactic acidosis |
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What DDIs are common with tenofovir?
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-didanosine
-atazanivir |
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What two NRTI's were shown in one study to increase MI?
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-abavacir
-didanosine |
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What is the generic name, dosing and special considerations for abacavir plus lamivudine?
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Epzicom
-1 tablet po daily (normal daily dose of each agent) not for use with CrCl < 50 |
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What is the brand name and dosing for emtricitabine plus tenofovir?
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Truvada
-1 tablet PO daily (normal dose of each agent) -not for use with CrCl <30 |
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What is the brand name and dosing for zidovudine plus lamivudine?
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Combivir
- 1 tablet BID - not for use with CrCl < 50 |
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What is the brand name and dosing for zidovudine plus lamivudine plus abacavir?
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Trizivir
-1 tablet PO BID (normal dose of each agent) -not for use with CrCl < 50 |
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What is the brand name and dosing for emtricitabine + tenofovir + efavirenz?
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Atripla
-1 tablet PO daily (normal dose of individual agents) -not for use with CrCl <50 |
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What are some class related AEs of NNRTIs?
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– Rash
– Hepatotoxicity issues – Drug interactions |
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What NNRTI should be avoided with moderate-severe hepatic impairment?
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nevirapine
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Do NNRTIs require renal dose adjustments?
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No
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What NNRTIs should be used with caution in patients with hepatic impairment?
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-efavirenz,
-delavirdine |
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What is the brand name and dosing regimen for Efavirenz?
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Sustiva
-600 mg po qd at bedtime (due to CNS AE) |
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What are the common AEs of efavirenz?
|
central nervous system (CNS) effects (dizziness, hallucinations, vivid dreams, drowsiness...)
52% of patients in clinical trials subside after 4-6 weeks – rash – elevated liver function tests (LFTs) – teratogenic - seizures possible but uncommon – false-positive cannabinoid test! |
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What is the brand name and dosing for nevirapine?
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Viramune
-200 mg po QD for two weeks then 200 mg po BID (minimizes hepatotoxicity and rash) |
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What common AEs are associated with nevirapine?
|
– maculopapular rash
– increased LFTs – hepatitis, including fatal hepatic necrosis – higher frequency of liver tox in women with CD4 > 250, men with CD4 > 400 avoid initiation in these populations NOTE: if #s rise above this after tx innitiation it is ok |
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What is the brand name and dosage regimen for delavirdine?
|
Rescriptor
-400 mg po TID (4 X 100 mg tabs or 2 X 200 mg tabs) -take without regard to food |
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What are the common AEs of delavirdine?
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-rash (very common)
-increased LFTs -HA |
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Why is delavirdine less commonly used?
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-less potent
-more frequent rash |
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What should be considered when taking delavirdine with didanosine or antacids?
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avoid taking it within 1 hour of didanosine or antacids
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What is the brand name and dosing for lopinavir + ritonavir?
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Kaletra
2 tablets/5 ml BID or 4 tablets/10 ml daily |
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What ARTs require an acidic environment for absorption?
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indinavir
fosamprenavir atazanivir tipranavir delaviridine |
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How should drug interactions with ARTs require acid for absorption be managed?
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-seperate antacids by at least 2 hrs, 4-6 hours if possible
-seperate from H2RAs by 12 hours -avoid PPIs |
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What is the exception to avoidance of PPIs in ART requiring acid for absorption?
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omeprazole 20 mg Q12 ( i.e. Prilosec OTC) can be used with atazanivir IF boosted by ritonavir
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With which ART are PPIs C/I?
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delavirdine
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What DDI can occur with NRTIs/NNRTIs and quinolones/tetracyclines and how can it be avoided?
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-chelation ran
-use enteric coated didanosine |
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What statins are C/I with all PIs and delavirdine? What statins should be used instead?
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-simvistatin/lovastatin (>20 mg atorvastating also C/I)
-pravastatin or rosuvastatin (pravastatin is not metabolized by thy CYPs |
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What ARTs are C/I with rifampin? What can be considered instead of rifampin?
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-all PIs except for ritonavir
-all NNRTIs except efavirenz (must dec. efavirenz to 800 mg daily) -consider rifabutin instead of rifampin |
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What ARTs are C/I with amiodarone?
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ritonavir
indinavir |
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What ARTs should not be used with fluticasone?
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ritonavir and many PIs
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What ARTs are C/I with midazolam and triazolam and what are the alternatives?
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-all PIs, efavirenz, and delavridine
-use lorazepam, oxazepam, or temazepam instead |
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What ARTs are C/I with ergot alkaloids and what are the alternatives?
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-all PIs, efavirenz, and delavridine
-triptans or pain relievers can be used instead |
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What ARTs are Ci with St John's Wort and what are the alternatives?
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-all PIs and NNRTIs
-use RX antidepressants instead |
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What dose adjustments are required with Sildenafil when used with delavridine and all PIs?
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Reduce dose to 25 mg Q48 hours
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What dose adjustments are required with vardenafil and indinavir or ritonavir?
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Reduce dose to 2.5 mg Q72 hours
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What dose adjustments are required for vardenafil when used with delavirdine and PIs other than indinavir or ritonavir?
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Reduce dose to 2.5 mg Q72 hours
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What dose adjustments are required for tadalafil when used with PIs or delavirdine?
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Start with 5 mg dose
– Do not exceed 10 mg Q72 hours |
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What ARTs decrease methadone and may induce withdrawal symptoms and require a dose increase?
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-PIs (except indinavir)
-efavirenz -nevirapine |
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What antifungal is C/I for use with ritonavir?
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voriconazole
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What interaction occurs between atazanivir and clarithromycin and how should it be managed?
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-prolonged QT interval
-decrease clarithromycin by 50% -switch to azithromycin |
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What interaction occurs between clarithromycin and maraviroc?
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-increased levels of maraviroc
-decrease dose by 50% or switch to azithromycin |
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What ARTs increase the levels of voriconazole, itraconazole, and ketoconazole? How should it be managed?
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-PIs, efavirenz, maraviroc
-switch to fluconazole to avoid interaction |
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What is the interaction between voriconazole, keticonzole, or itraconizole and maraviroc?
|
increases maraviroc concentrations
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What ARTs interact with phenytoin, phenobarbital and carbemazepine?
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-PIs
-NNRTIs |
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What is the interaction between ARTs and phenytoin/pehnobarb/CBZ?
|
-inhibitors increase anticonvulsant levels
-inducers (nevirapine) decrease anticonvulsants -anticonvulsants are inducers and can decrease ARTs |
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What anticonvulsants are alternatives to avoid ART interactions?
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-topiramate
-levitiracetam -gabapentin |
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With which ARTs should OC use be avoided?
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atazanavir
amprenavir fosamprenavir |
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What ARTs decrease OCs and require use of a back-up method?
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-Efavirenz
-Nevirapine -all PIs except indinavir |
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What ART has an increased risk of rash when used with OC?
|
tipranavir
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What ARTs should not be used with OC b/c of greatly increased hormone levels of OC, and possible decrease in ART level?
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atazanavir
amprenavir fosamprenavir |
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What ART is a recommended alternative if use with OCs is necessary and patient is unwilling to use back up method?
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indinavir
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What is the reaction between diltiazem and atazanavir and how should it be managed?
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-inhibition of diltiazem metabolism
-decrease diltiazem by 50% and monitor EKG |
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What ARTs interact with warfarin, what is the interaction, howshould it be managed?
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-PIs
-efavirenz -inhibit warfarin metabolism and increase INR -monitor INR and adjust warfarin if needed |
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What is ribavirin used for?
|
Hep C
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What ARTs interact with ribavirin?
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-didnosine
-zidovudine -stavudine |
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What is the interaction between didanosine and ribavirin? What alternative should be used?
|
-increase toxic active metabolites of didanosine
-may inhibit eachother so neither works -use another NRTI except AZT |
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What is the interaction between ribavirin and stavudine or zidovudine?
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-ribavirin inhibits phosphorylation of AZT
-can inhibit eachother so neither works -use another NRTI except didanosine |
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What ARTs can be used with rifampin?
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-full dose ritonavir
-maraviroc -efavirenz (inc. to 800 mg) |
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What is the interaction between rifabutin and antiretrovirals?
|
-rifabutin decreases ARTs to subtherapeutic levels
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What is the reaction that causes fluticasone to be C/I with ritonavir and many other PIs?
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-severe inhibitor of fluticasone metabolism leading to hyperglycemia and Cushing's disease upon d/c of fluticasone
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What is the brand name and dose of enfuviritide?
|
-Fuzeon
-90 mg (1 ml) injected SC BID |
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What is the brand name and dose of maraviroc?
|
-Selzentry
-150 mg BID OR 300 mg BID OR 600 mg BID |
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What are some substrates of CYP 1A2?
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-haloperidol
-theophylline |
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What are some inducers of CYP 1A2?
|
-Ritonavir
– Phenytoin, phenobarbital, carbamazepine – Cigarette smoke |
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What are some inhibitors of CYP 1A2?
|
– Ciprofloxacin
– Clarithromycin, erythromycin |
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What are some substrates of CYP 2C9?
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– Warfarin
– Voriconazole – Phenytoin |
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What are some inducers of CYP 2C9?
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– Rifampin
– Phenytoin, phenobarbital, carbamazepine |
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What are some inhibitors of CYP 2C9?
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– Ritonavir
– Efavirenz |
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What are some substrates of CYP 2D6?
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– Codeine, methadone, tramadol
– Tricyclic antidepressants – Selective serotonin reuptake inhibitors |
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What are some inducers of CYP 2D6?
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– Rifampin
– Phenytoin, phenobarbital, carbamazepine |
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What are some inhibitors of CYP 2D6?
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– Ritonavir
– Fluoxetine, paroxetine, sertraline |
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What are some substrates of CYP 3A4?
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– PIs, NNRTIs
– Statins – Midazolam, triazolam – Erectile dysfunction agents – Ergot alkaloids – Methadone – Voriconazole – Estrogens – Trazodone – Warfarin |
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What are some inducers of CYP 3A4?
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– Efavirenz, nevirapine
– Ritonavir – Rifampin, rifabutin – Phenytoin, phenobarbital, carbamazepine |
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What are some inhibitors of CYP 3A4?
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– PIs
– Efavirenz, delavirdine – Clarithromycin, erythromycin – Azole antifungal agents – Grapefruit juice |
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What are some class AEs associated with PIs?
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– Class-resistance
– Drug interactions – Metabolic syndrome Insulin resistance/hyperglycemia Increased cholesterol and triglycerides Lipodystrophy/fat redistribution – Heptatotoxicity – GI intolerance – Osteopenia and osteoporosis PIs |
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What is the brand name and dosing of ritonavir?
|
-Norvir
-600 mg BID (NOTE: only available as 100 myg capsules) Take with food to improve tolerability – peanut butter, Nutella Refrigerate capsules – stable at room temperature for 30 days Do NOT refrigerate oral solution |
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What are common AEs of ritonavir?
|
- tolerance issues
– GI upset (NVD) – taste perversion – circumoral tingling |
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What is ritonavirs current purpose in ART therapy?
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used in low doses to boost other PIs
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What is the brand name and dosing for indinavir?
|
Crixivan
– 800 mg PO q8h – 800 mg + RTV 100 mg or 200 mg PO Q12h Take on empty stomach or with nonfat foods – less important when boosted with ritonavir – take with plenty of water at least 1.5 liters per day |
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What are common AEs associated with indinavir?
|
– nephrolithiasis(kidney stones)
– indirect hyperbilirubinemia (jaundice) – headache – dry skin – taste perversion - thrombocytopenia - CNS AEs - worsening of DM - increased bleeding in haemophiliacs - increased sugar and fat content in blood |
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Why is water intake important with indinavir?
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helps to combat kidney stones
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What is the brand name and dosing of nelfinavir?
|
Viracept
– 750 mg PO TID or 1250 mg PO BID - Take with food |
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What AEs are commonly associated with nelfinavir?
|
– diarrhea; rarely used b/c of this AE
|
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What can be done to combat ART induced diarrhea?
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3-4 loose stools per day
loperamide or diphenoxylate/atropine |
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What is the brand name and dosing regimen for saquinavir mesylate (hard gel capsule/tablet?
|
Invirase
-1200 mg po TID OR - 1000 mg po BID with ritonavir – take within 2 hours of food |
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What is important to note about the difference between the hard gel capsules or tablets of saquinavir vs. the soft gel capsule?
|
They are not interchangeable, bioavailability differs.
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What are the common AEs associated with saquinavir?
|
– nausea, vomiting, diarrhea, headache
|
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What is the brand name and dosing regimen for amprenavir?
|
Agenerase
– > 50 kg = 1400 mg solution BID – < 50 kg = 1.5 ml/kg solution BID - Take after meals to decrease GI upset |
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What AEs are commonly associated with amprenavir?
|
– rash (severe with sulfonamide allergy, use caution)
– GI upset – headache, mood changes |
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What is the brand name and dosing regimen for fosamprenavir?
|
Lexiva
– naïve patients or concomitant efavirenz 1400 mg PO BID OR 1400 mg + RTV 200 mg daily OR 700 mg + RTV 100 mg BID – PI-experienced patients 700 mg PO BID + RTV 100 mg BID |
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What AEs are commonly associated with fosamprenavir?
|
– rash (watch sulfonamide allergy)
– GI upset – headache, mood changes |
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What is the dosage regimen for Kaletra?
|
Tx experienced = 2 tablets BID with or without food (400/100 mg)
Tx naive -as above or 4 tablets QD (800/200 mg) |
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What are the common AE associated with Kaletra?
|
– asthenia
– GI upset – taste perversion – circumoral tingling |
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What is the brand name and dosage regment for atazanavir?
|
Reyataz
Tx. exp = 300 mg QD Tx. naive = 400 mg QD Dec. liver fxn = 300 mg QD |
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What common AE are associated with atazanavir?
|
-does not affect lipids!
-hyperbilirubinemia -kidney stones -1st degree AV block |
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What is the brand name and dosage regimen for tipranavir?
|
Aptivus
-500 mg with ritonavir 200 mg BID |
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When is tipranavir used?
|
Tx. experienced patients with resistance
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What commone AEs are associated with tipranavir?
|
-increased risk for intracranial hemorrhage
-hepatotoxic -contain sulfonamide, can cx severe rash |
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What is thebrand name and dosing regimen for Darunavir?
|
Prezista
-600 mg darunavir + 100 mg ritonavir BID with food |
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Who is darunavir reserved for?
|
highly tx experienced patients with resistance
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What AEs are common with darunavir?
|
-contain sulfonamide, can cx severe rash
– GI upset – taste perversion – circumoral tingling |
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What is the common dose of Raltegravir?
|
400 mg BID
|
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What AEs are associated with raletgravir?
|
-diarrhea
-nausea -HA -fever -increased creatinine kinase; monitor muscle breakdown |
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What AEs are associated with maraviroc?
|
-hepatotoxicity
-fever -URI -cough -orthostatic hypotension -abdominal pain |
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What tests must be run before starting maraviroc?
|
-baseline liver enzymes
-CCR5 tropism assay |
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What AEs are commoly associated with efuviritide?
|
skin rxn
-NVD -injection site rxn -fatigue |
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What patient populations are maraviroc and enfuviritide intended for?
|
highly treatment experienced patients
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What is an immune reconstitution reaction?
|
pt. becomes hyperresponsive due to massive cytokine release resulting from reactivation of a severely compromised immune system; can occur with any ART; can be deadly
|
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When are HIV patients at risk for TB infection, what constitutes a positive tuberculin skin test?
|
- pts. at all CD4 counts are at risk
-> 5mm TB skin test is positive |
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What are the doses for primary prophylaxis of INH resistant TB?
|
- INH 300 mg + pyridoxine 50 mg for 9 months (270 doses
OR -INH 900 mg PO + pyridoxine 100 mg BIW BIW X 9 months (76 doses DOT) |
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What is the primary TB prophylaxis regimen for HIV patients exposed to INH resistant straing?
|
RIF 600 mg + PZA 200 mg/kg QD X 2 months
|
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When are HIV patients at risk for candidiasis?
|
CD4 < 200
|
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What is the prophylaxis treatment for candidiasis?
|
- don't prophylaxis b/c of resistance unless pt. has frequent severe recurrences
- fluconazole 100-200 mg QD |
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|
What is the treatment for oropharyngeal candidiasis in HIV patients?
|
fluconazole 100 mg QD X 7-14 days
|
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What is the treatment for esophageal candidiasis in HIV patients?
|
-fluconazole 100-400 mg PO or IV
OR -itraconazole 200 mg PO QD OR -Voriconazole 200 mg PO BID OR -caspofungin 50 mg IV QD all tx. X 14-21 days |
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When are HIV patients at risk for infection by pneumocystis jiroveci pneumonia?
|
CD4 < 200
|
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What is 1st line primary and secondary prophylaxis for PCP?
|
-Bactrim SS or DS tab daily
|
|
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What are alternate prophylaxis options for PCP if pt. can't tolerate bactrim?
|
- dapsone (needs G6PD)
- atovaquone - aerosolized pentamadine - Bactrim 1 DS tab TIW |
|
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What are the 1st line treatment options for PCP?
|
- Bactrim (15-20 mg TMP and 75-100 mg SMX per kg per day IV or PO Q6-8)
OR -Bactrim DS 2 tabs PO TID X 21 days WITH or WITHOUT - Prednisone 40 mg BID days 1-5 then 40 mg QD days 6-10 then 20 mg QD days 11-21 |
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When should prednisone be used in PCP?
|
patients with pO2 < 70
|
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What alternative treatments are available for severe PCP?
|
Pentamadine 4 mg/kg IV QD over at least 1 hour
|
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What alternative therapies are available for mild to moderate PCP?
|
-dapsone 100 mg PO QD + TMP 15 mg/kg/day PO TID
-primaquine 15-30 mg + clindamycin 300-900 mg IV/PO -atovaquone 750 mg BID -trimetrexate + leucovorin Q6 (continue leucovorin for at least 3 days after trimetrexate) |
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When are HIV patients susceptible to toxoplasmosis?
|
-CD4 < 100 and positive IgG antibody to toxoplasma
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|
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What is the first line primary and secondary prophylaxis treatment for toxoplasmosis?
|
-Bactrim 1 DS tab PO QD
|
|
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What are alternative prophylaxis agents for toxoplasmosis?
|
- Bactrim SS
-Dapsone + pyrimethamine + leucovorin -atovaquone +/- pyrimethamine + leucovorin |
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When can primary prophylaxis for toxoplasmosis be stopped?
|
-CD4 > 200 X 3 months and on ART
|
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When can secondary prophylaxis for toxoplasmosis be stopped?
|
-CD4 > 200 X 6 months w/ full course of treatment completed and asymptomatic
-restart if CD4 falls < 200 |
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When should the primary prophylaxis of CDC be stopped?
|
CD4 > 200 X 3 months and on ART
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When should secondary prophylaxis of PCP be stopped?
|
-CD4 > 200 X 3 months and on ART BUT if patient has PCP when CD4 is > 200 then they must remain on lifelong therapy
|
|
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What is the first line therapy for toxoplasmosis?
|
-pyrimethamine 200 mg PO X 1 then 50-75 mg PO QD + sulfadiazine 1000-1500 mg PO Q6 + leucovorin 10-20 mg QD
|
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What alternative therapies are available for toxoplasmosis?
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-5 mg/kg TMP + SMX 25 mg/kg IV or PO BID
-atovaquone 1500 mg PO BID WF + pyremethamine -atovaquone 1500 mg PO BID WF + sulfadiazine 1000-1500 mg PO Q6 -atovaquone 1500 mg PO BID WF - Pyrimethamine + azithromycin 900-1200 mg PO QD |
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When are HIV patients at risk for cryptococcus meningitis?
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CD4 < 50
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What is the primary prophylaxis for cryptococcus meningitis?
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none due to resistance
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What is the 1st line secondary prophylaxis for cryptococcus meningitis?
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fluconazole 200 mg QD
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What are alternative for secondary prophylaxis of cryptococcus meningitis?
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-Amphotericin B 0.6-1 mg/kg IV QW-TIW
-Itraconazole 200 mg PO QD |
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When can secondary prophylaxis of cryptococcus meningitis be stopped?
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never
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What is the treatment for te induction phase of cryptococcus meningitis?
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- Amp B 0.7 mg/kg IV QD (liposomal 4 mg/kg) + flucytosine 25 mg/kg PO QID for 2 weeks
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What is the treatment on cryptococcus meningitis during the consolidation phase?
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Fluconazole 400 mg PO QD X 8 weeks or until CSF cultures clear
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When are HIV patients at risk for MAC infection?
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CD4< 50
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What is first line promary prophylaxis for MAC?
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azithromycin 1200 mg PO QW
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What alternative agents are available for MAC primary prophylaxis?
|
-clarithro 500 mg PO BID + ethambutol
-rifabutin 300 mg PO QD |
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When can MAC primary prophylaxis be d/c?
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CD4 > 100 X 3 months and on ART
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What is the 1st line secondary prophylaxis for MAC?
|
Clarithro 500 mg PO BID + ethambutol 15 mg/kg PO QD +/- rifabutin 300 mg PO QD
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|
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What alternative therapies are available for secondary prohpylaxis of MAC?
|
-azithromycin 500 mg PO QD + ethambutol 15 mg/kg PO QD +/- rifabutin 300 mg QD
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|
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When can secondary prophylaxis of MAC be d/c?
|
-pt. is asymptomatic, has recieved at least 12 months of treatment for MAC, CD4 is > 100 for 6 months and patient is recieving ART
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What is the 1st line tx. regimen for MAC?
|
azithromycin 500 mg + ethambutol 15 mg/kg/day +/- rifabutin 300 mg
-avg duration is 21 months (can sub azithro for clarithro) |
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When are HIV patients at risk for infection with CMV?
|
CD4 < 50 and (+) CMV antibody
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What is the primary prophylaxis for CMV?
|
not recommended
|
|
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What is secondary prophylaxis of CMV?
|
Valgancyclovir 900 mg PO BID for 14 21 days or 900 mg daily with ganciclovir eye insert
|
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When can CMV secondary prophylaxis be d/c?
|
never
|
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What is the therapy for CMV with sight threatening lesions?
|
ganciclovir intraocular implant + valganciclovir 900 mg PO QD
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What is the treatment for CMV with peripheral lesions
|
valganciclovir 900 mg PO BID X 14-21 day then PO QD
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|
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What alternative therapies are available for CMV?
|
-Ganciclovir 7.5-10 mg/kg IV BID-TID for 14-21 days then 5 mg/kg IV QD
-Foscarnet 180 mg/kg/day for 14 days then 90-120 mg/kg/day IV -Cidofovir 5 mg/kg IV QW X 2 weeks then 5 mg/kg QOW + Probenecid |
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What DDIs exist between garlic and PIs?
|
-increase risk of bleeding, garlic should be avoided if on PI
|
|
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What DDI exists between Vitamin C and indinavir?
|
-increased indinavir concentration
-do not take more than 1 gram Vit C per day |
|
|
List the preferred 2 drug PEP regimens
|
-zidovudine + lamivudine (Combivir) BID
-zidovudine + emtricitabine -tenofivir + lamivudine -tenofovir + emtricitabine (Truvada) QD |
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What drug is added to the 2 drug regimen for the standard 3 drug PEP regimen?
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Kaletra (lopinavir/ritonavir)
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What can be considered as an alternative in the expanded PEP regimen if exposeure source is known or suspected to be PI resistant?
|
Efavirenz but use caution in women of childbearing age
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