Shared Flashcard Set

Details

HIV
Exam III PT
40
Pharmacology
Graduate
03/17/2012

Additional Pharmacology Flashcards

 


 

Cards

Term
What are the mode of transmission of HIV?
Definition

- Sexual: receptive anal or vaginal intercourse

- Parenteral: IVDU, needlesticks

- Perinatal: in utero, Delivery (vertical transmission), breastfeeding

Term
What are methods for detection of HIV?
Definition

- Enzyme-linked immunosorbent assay (ELISA): detects Ab against HIV-1 (highly sensitive ans specific), false (-) may be due to new infx

 Covenient ELISA methods:

- OraSure: oral collection

- Home access fingerstick

- Calypte: urine test

- OraQuick: rapid (20-40 min), Flexible (clinical & non-clinical settings), Accurate (>99% agreement w/confirmatory western blot)

ELISA repeated, if (+) then confirmatory Western Blot performed ((+) results indicate established HIV infx)

NOTE: is Western Blot intermediate retest after 30 days or perform viral load (VL) assay. 

Term
How is HIV dz characterized?
Definition
By depletion of CD4 cells and development of oportunistic infx and malignancies
Term
What is the major prognostic factor in monitoring HIV dz progression and response to therapy?
Definition
HIV viral load (VL): copies of HIV RNA/mL plasma. It quantify degree of viremia 
Term
Which marker is critical for evaluation of disease progression?
Definition
CD4 Lymphocyte count (T-helper cells)(normal=500-1600 cells/mm^3): strongest predictor of progression and survival 
Term
What is the life cycle of HIV replication?
Definition
Attachement of HIV virion to receptor on host membrane--Fusion/entry--Reverse transcription--integration--transcription--translation--viral assembly--budding and maturation of HIV virion--viral release 
Term
What are the sites for pharmacologic intervention?
Definition

Attachement: entry inhibitors: SCH-C, SCH-D, BMS806

Fusion inhibitors: T-20 

Reverse transcriptase inhibitors: NRTIs, NNRTIs (TMC-125)

Integration inhibitors: S-1360

Buddin/maturation inhibition: protease inhibitors 

Term
What are monitoring parameters for HIV?
Definition

- CD4 count at baseline, Q3-6 mo to monitor clinical response to ART  

- HIV VL testing may be considered for initiation of ART, at or immediately before initiation of tx, ≥2 wks (2wks to mo) after initiation or change in tx, 3-6 mo subsequently 

- Genotype testing preferred for ARV-naive pts upon tx start (repeat testing at ART initiation), when suboptimal VL reduction, & to all pregnant women priot to initiation of tx and those entering pregnancy who hace detectable VL while on ART

- HLA-B*5701 screening: for Abacavir sensitivity reaction 

- Coreceptor Tropism assays TrofileTM, PhenoscriptTM: When maraviroc (CCR5 inhibitor) considered for tx, or ptz experiencing virologic failure on CCR5 inhibitor

 

Term
What are clinical presentation of Primary HIV infection?
Definition

- High VL

- Precipitous drop in CD4

- Latently infected cells established

- Virus disseminates and establishes infection in lymph nodes, gut-associated lymph tissue (GALT)

Term
T/F: Plasma HIV RNA indicates magnitude of HIV replication and CD4 destruction?
Definition
True 
Term
What factors should be considered for tx of HIV?
Definition

- Comorbid conditions

- Adherence and convenience

- ADE

- DI

- Pregnancy/potential pregnancy

- Resistance test results

- HLA-B*5701

Term
When is resistance testing indicated?
Definition

- VL > 1000 copies/mL

- Initial assessment, includin ART-naive pts

- REpeat prior to starting ART

- Following regimen failure (while on therapy)

- Pregnancy (prior to starting ART/entering pregnancy w/ detectable VL) 

Term

 

T/F: immunologic AIDS is defined as CD4 > 200 cells/mm^3?

Definition
False, <200 cells/mm^3
Term
What are AIDS0defining illness?
Definition
Esophageal Candidiasis, Cytomegalovirus (CMV), Lymphoma, Kaposi Sarcoma (KS), Pneumocystis carinii pneumonia (PCP), Mycobacterium avium infx/complex (MAI/MAC), cryptococcosis. 
Term
What are tx recommendation for naive HIV-infected pts?
Definition

- 2 NRTIs + 1 NNRTI

- 2 NTTIs + 1PI or 1PI/RTV (boosted)

- 2NRTIs + INSTI 

Term
Which tx require dose adjustment in renal insufficiency?
Definition

- NRTI--most renally eliminated

 

Term
What to consider w/ NRTIs?
Definition

- ABC (abacavir): Alcohol dehydrogenase

- ZDV (Zidovudine): glucuronidation

- ddI (didanosine) should be taken on empty stomach untless with TDF (tenofovir) (uncommon combination)

Term
ADE of NRTIs?
Definition

- Lactic acidosis w/ hepatic steatosis (rare): S/SX:GI (N/V/D, abdominal distention and pain), myalgia, difficulty breathing 

Risk factors: obesity, prolonged use, females> males 

Term
What are specific ADE of NRTIs?
Definition

- Abacavir: hyepersensitivity rx (HLA-B*5701)-black box warning 

Never rechallenge, DC immediately 

- ddI (didanosine) and d4T (stavudine): peripheral neuropathy, pancreatitis

- TDF (tenofovir): GI upset (mild), flatulence, nephrotoxicity 

- FTC (emtricitabine): hyperpigmentation of plams & soles

- ZDV (zidovudine): Bone marrow suppression (anemia, neutropenia), fatigue, nausea 

Term
What are preferred regimens?
Definition

NNRTI-based regimen:

Preferred: FTC/TDF +EFV

Alt: ABC/3TC + EFV or FTC/TDF + RPV, or ABC/3TC + RPV 

RPV=ripivirine, EFV= efavirenz, 3TC= lamivudine , FTC= emtricitabine, TDF= tenofovir, ABC= abacavir


Term
Which NNRTI is new and marketed for NNRTI-resistant virus?
Definition
Etravirine 
Term
What are ADE of NNRTIs?
Definition

- Rash: self limiting vs. stevens-johnson syndrome

NVP (nevirapine)>EFV (efavirenz)

- hepatic transaminase elevations

- EFV: CNS effects

- Etravirine: GI effects, HA, inability to concentrate Dizziness 

Term
PI based regimen?
Definition

Preferred: FTC/TDF + ATV/r QD, or FTC/TDF + DRV/r QD

Alt: ABC/3TC + ATV/r, or ABC/3TC + DRV/r, or ABC/3TC + FPV/r (QD/BID, or FTC/TDF + FPV/r (QD/BID), or ABC/3TC + LPV/r (QD/BID), or FTC/TDF + LPV/r (QD/BID) 

ATV/r= atazanavir/ritonavir, DRV/r= darunavir/ritonavir, LPV/r= lopinavir/ritonavir

Term
PI ADE?
Definition

- Glucose intolerance

- Lipohypertrophy (neck, back, breast or abdomen)

- Lipoatrophy

- Hyperlipidemia, hypertriglyceridemia 

- Elevated transaminases

- GI upset 

Term
Specific PI ADE?
Definition

- ATV (atazanavir): hyperbilirubinemia

- LPV/r (lopinavir/ritonavir): GI, pancreas

- DRV (darunavir): GI, rash

- TPV (tipranavir): Gi, hepatitis, rash, intracranial hemorrhage (rare)

- APV/FPV (amprenavir/fosamprenavir): GI, rash, oral paresthesias

- IDV (indinavir): hyperbilirubinemia, nephrolithiasis 

- NFV (nelfinavir): diarrhea 

Term
INSTI-based regimen?
Definition

Preferred: FTC/TDF + RAL

Alt: ABC/3TC + RAL

RAL= raltegravir 

 

Term
Which regimen is mainly cleared by liver?
Definition
NNRTI 
Term
Which regimen is hepatically metabolized by CYP3A4?
Definition
PI
Term
Which PI should be taken on empty stomach?
Definition
IDV= indinavir 
Term
Which Drug undergoes UGT1A1- glucuronidation?
Definition
RAL= Raltegravir (BID dosing)
Term
Which drug should not be used during 1st trimester of pregnancy or in women of chilbearing potential?
Definition

EFV= Efavirenz

once daily LPV/r=lopinavir/ritonavir is not recommended in pregnant women 

Term
Which drug should be used in caution in patients w/ renal insufficiency?
Definition
TDF= tenofovir 
Term
Which drug should not be used in patients who require> 20 mg omeprazole equivalent per day?
Definition
ATV/r= Atazanavir/ritonavir 
Term
Use of PI is contraindicated with which drug?
Definition
RPV= rilpivirine 
Term
T/F: use of RPV w/ caution in patients w/ pretreatment HIV RNA> 100,000 copies/mL?
Definition
True 
Term
What is the preferred regimen for pregnant women?
Definition

LPV/r (BID) + ZDV/3TC

ZDV= zidovudine

3TC=lamivudine 

LPV/r= lopinavir/ritonavir 

Term
What are acceptable regimen for HIV?
Definition

- NNRTI: ZDV/3TC +NVP, or FTC/TDF + NVP, or ABC/3TC + NVP, or ZDV/3TC +EFV

- PI: (ABCor ZDV)/3TC + ATV (unboosted), or ZDV/3TC + FPV/r (QD/BID), or ZDV/3TC+ LPV/r (QD/BID), or ZDV/3TC + ATV/r, or ZDV/3TC +DRV/r

- INSTI: ABC or ZDV/3TC + RAL

- CCR5 inihibitor: ZDV/3TC + MVC, or (TDF/FTC) or (ABC/3TC) + MVC

Term
What are ADE of maraviroc (MVC)?
Definition

- Hepatotoxicity (allergic rx: eosinophilia + rash)

- Dizziness

- Increased risk CV events 

Term
What are signs of virologic failure?
Definition

- VL>400 after 24 wks

- VL >50 after 48 wks

- VL>400 after initial suppression

- Immunologic failure

- CD4 increase <25-50 in 1st yr

- CD4 decline below baseline 

Term
What are reasons for treatment failure?
Definition

- Acquired resistance

- DI

- Pharmacokinetic differences/inadequate serum concentrations 

Supporting users have an ad free experience!