Summer Hehi Exam 3 Hiv

Front 1

do we have the means to suppress the progression of HIV and the transmission?

Back 1

yes

SE & pill burden has decreased

barrier protection exists to minimize transmission

HIV no longer primarily a biomedical challenge

Front 2

how do depression, impulsivity, childhood sexual abuse, and self-efficacy correlate with HIV infection versus non infected?

Back 2

depression = increase

impulsivity = increase

childhood sex abuse = positive correlation

self-efficacy = inverse correlation

Front 3

what percentage of HIV PTs have a suppressed viral load of < 200 copies/mL

Back 3

25%

Front 4

which group is highest risk of HIV dx?

Back 4

african american MSM

1 in 2 chance

Front 5

what is homeostasis versus allostasis, and what is allostatic load?

Back 5

homeostasis: stable internal environment

allostasis: stability of organism in a changing environment

allostatic load: cost to organism over time in terms of wear and tear

Front 6

how do toxic responses of individuals relate with toxic environments?

Back 6

toxic environment produces circumstances in which toxic responses become survival mechanisms

Front 7

what is structural violence?

Back 7

institutional barriers that impair the equal pursuit of human health within and across societies

Front 8

how do food & housing security correlate with medication adherence?

Back 8

reduced food security = reduced med adherence

reduced home security = reduced med adherence

Front 9

what is the difference between stigmatization and shame and how do they relate to their resistance to change?

Back 9

stigmatization: social construction based on power structures, resistant to change

shame: internalized, painful, response to self-perceived social miscues, may be changeable

Front 10

what are the factors associated with adult screening of childhood sexual abuse in primary care?

Back 10

knowledge of prevalence of CSA

confidence in screening for CSA

perceived role is to screen for CSA

Front 11

how does chronic stress affect the immune system, clotting risk, BG related disease, and maladaptive coping behaviors?

Back 11

immune system: chronic high adrenaline weakens the immune system

clotting: hypercoagulability increases clotting risk

BG: inflammation, diabetes, hypercholesterolemia, obesity

maladaptive: substance abuse, eating disorders, depression

Front 12

how does shame relate to chronic stress and HIV outcomes?

Back 12

increased shame = increased chronic stress

increased shame = CD4 (WBC) decline

Front 13

how does the ventral vagal complex and DMNX relate to the sympathetic nervous system and stress?

Back 13

VVC: engaged at rest; primary control of supradiaphragmatic visceral organs; regulates HR at rest; disengages during periods of stress

sympathetic NS: fight-or-flight; engages when VVC disengages during periods of stress

DMNX: engages during full panic shutting down consciousness

Front 14

how do HIV positive PTs relate to sensitivity to facial cues, recognition of sadness/happiness/fear, and amygdala size??

Back 14

HIV+ = deficits in sensitivity to facial cues, slower recognition of emotions, larger amygdala by volume

Front 15

what is the function of the amygdala and what CNS system is it a part of?

Back 15

process memory, make decisions, process emotional reactions

part of the limbic system

Front 16

where do DNA replication, transcription, and translation occur in the cell?

Back 16

replication: nucleus

transcription: nucleus

translation: cytoplasm

Front 17

is HIV an RNA or DNA virus?

Back 17

RNA virus

*retrovirus*

Front 18

what is CD4, what type of WBC is it located on, and what is the function?

Back 18

what it is: surface protein

Located on: t-helper lymphocytes

function: allows them to react to antigen presenting cell

Front 19

describe the steps of binding, fusion, reverse transcription, integration, translation/transcription, assembly, and release with respect to HIV.

Back 19

binding: virus binds to CD4 receptor (& one or two coreceptors CXCR4/CCRS)

fusion: virus fuses to host & releases RNA into cell

reverse transcription: single strand RNA converted to double strand DNA

integration: integrase enzyme inserts viral DNA into cell DNA

transcription/translation: viral RNA copied from viral DNA via RNA polymerase and inserted into new viruses or made into HIV proteins

assembly: HIV protease cuts long-chain proteins into individual proteins which are assembled with viral RNA

release: new viral particles released from host cell within part of the host cell's membrane

Front 20

which stage of infection is clinical latency, what are the symptoms, and are HIV replication rates high or low in this stage?

Back 20

stage: second

sx: none

rates: low

Front 21

what is a chancre?

Back 21

painless ulcer

Front 22

what is the correlation between syphilis and HIV?

Back 22

syphilis chancres are rich in CD4+ T-lymphocytes

open syphilis chancres are open portals for HIV infection

behaviors that result in syphilis transmission are same in HIV transmission

Front 23

during HIV tx what are the lab level goals for CD4 and viral load?

Back 23

CD4: > 350

VL: < 20 copies

Front 24

what is the greatest risk for transmission of HIV in acute care setting?

Back 24

accidental blood exposure via sticks and scalpel cuts

Front 25

what are micron levels, room requirements, door open/closed requirements, and mask requirements for airborne precautions in HIV PTs?

Back 25

microns: < 5 microns

room: private room

door: closed door

mask: N-95 fitted mask

Front 26

what are micron levels, room requirements, door open/closed requirements, and mask requirements for droplet precautions in HIV PTs?

Back 26

microns: > 5 microns

room: private

door: closed optional

mask: mask at < 3 ft

Front 27

what are sx that would indicate screens for HIV, those specific to > 40 yo, what two tests will we order, and what is the home test??

Back 27

acute: acute flu-like illness

> 40: weight loss, fatigue, thrush, rashes, psoriasis

tests: antibody & viral load

home test: Ora-Sure

Front 28

what sort of education do you want to give immediately after telling pt they are HIV+?

Back 28

none bc they're not going to be listening

Front 29

how many drugs/classes are in highly active antiretroviral therapy cocktails, and how are they dosed?

Back 29

drugs/classes: 3 drugs from at least 2 classes

dosing: 300 mg BID

Front 30

how often are the drugs aptripla, complera, and stribild dosed?

Back 30

one pill

once per day

Front 31

which patients are not candidates for fixed dosing?

Back 31

renal patients

Front 32

what can result from inaccurate estimation of viral replication when dosing of drugs?

Back 32

drug-resistant mutations

Front 33

how can proofreading, and viral replication/fitness lead to drug resistance?

Back 33

proofreading: virus does not have mechanism by which to check for mistakes in DNA replication so it is prone to mutations which can make it resistant to drugs

fitness: drug targets one susceptible virus strain leaving non-susceptible strain to duplicate more

Front 34

what is preexposure prohylaxis and what are the guidelines for it?

Back 34

what it is: HIV prophylactic for high-risk populations

guidelines: pretest for HIV & HBV, CrCl > 60 mL/min, perform HIV test /2-3 mo, STD check q6mo

Front 35

what is the effect of antiretrovirals on metabolism of other drugs?

Back 35

they can induce or inhibit the metabolism of other drugs

interact with drug transporters i.e. P-glycoprotein

Front 36

what are the associated drugs of HTN & CAD that can interact with protease inhibitors and the antiretroviral Etravirine?

Back 36

HTN = increased concentration of Ca++ channel blockers (nondihydropyridines) & beta-blockers with protease inhibitors

CAD = Plavix decreased by etravirine

Front 37

what are the associated drugs of hyperlipidemia that can interact with protease inhibitors and Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)?

Back 37

drug: statins

protease inhibitor: CYP450 inhibits statin metabolism and protease inhibitors inhibit CYP450 so serum statin levels increase

*exception is Pravastatin*

NNRTIs: decrease serum statin levels

Front 38

what are the associated drugs of erectile dysfunction and BPH that can interact with protease inhibitors and Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)?

Back 38

drugs: phosphodiesterase inhibitors, alpha-blockers (Alfuzosin)

protease inhibitors: increase ED drugs

NNRTIs: decrease ED drugs

*alpha-blockers contraindicated with retroviral tx*

Front 39

what are the associated drugs of mental illness and anticonvulsants that can interact with protease inhibitors and Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs), and what are the best benzos & anticonvulsants?

Back 39

drugs: benzos, dilantin

protease inhibitor: increase benzos, increase dilantin

NNRTIs: decrease benzos

*benzo = lorazepam, anticonvulsant = Keppra*

Front 40

What is the indicated course of tx when using hormonal contraceptives and HIV drugs?

Back 40

use two methods of contraceptive

Front 41

what is the risk of using protease inhibitors with steroids (i.e. fluticasone)?

Back 41

iatrogenic Cushing's syndrome

iatrogenic = of/related to illness caused by medical examination or treatment.