HIV

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Author:
jcu1
ID:
215044
Filename:
HIV
Updated:
2013-04-22 08:08:42
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Shiels
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Description:
Exam 4 ID 2
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  1. What is the detection process for HIV?
    • Screening with ELISA
    • confirmation with Western Blot
  2. What does the ELISA test do?
    detect presence of HIV ab in blood
  3. What to be cautious for when testing for HIV?
    6 mo period
  4. What does the western blot do?
    uses gel electrophoresis to detect specific proteins for HIV ag
  5. preferred way to test for drug resistance and why
    • genotypic assay
    • cheaper, get results faster, better sensitivity
  6. what is the CD4 count a measure of?
    • indicator of immunodeficiency
    • predicts disease progression and survival
  7. when should the CD4 be monitored and what does it determine with therapy?
    • q3-4 months
    • when to start therapy
  8. what is the goal in CD4 monitoring?
    inc of 50-150 cells per year until SS reached
  9. what does the viral load indicate?
    response to antiviral therapy
  10. when is the viral load monitored?
    2-8 wks after the start or change of therapy
  11. what is the viral load treatmetn goal?
    undetectable <50
  12. when is a pt defined as having aids?
    • cd4 <200
    • or an aids defining illness
  13. what are the big AIDS defining illnesses?
    • candidiasis
    • PCP
    • Toxoplasmosis
    • MAC
    • Cytomegalovirus
    • TB
  14. Emtricitabine drug class
    NRTI
  15. lamivudine drug class
    NRTI
  16. tenofovir drug class
    NRTI
  17. stavudine drug class
    NRTI
  18. zidovuidine drug class
    NRTI
  19. abacavir drug class
    NRTI
  20. didanosine drug class
    NRTI
  21. what are the agents active against hep b
    • emtricitabine
    • lamivudine
    • tenofovir
  22. NRTI elimination
    • renal elimination
    • except: abacavir (alcohol dehydrogenase) and zidovudine (glucoronidation)
  23. which NRTIs don't go through renal elimination?
    • abacavir - alcohol dehydrogenase metab
    • zidovudine - glucoronidation
  24. NRTI AEs
    • lactic acidosis
    • hepatic statosis
    • lipodystrophy
  25. what causes bone marrow suppression?
    zidovudine
  26. what causes hypersensitivity?
    abacavir
  27. which drug classes have no cyp drug interactions?
    • NRTI
    • INSTI
  28. etravirine drug class
    NNRTI
  29. NRTI AEs
    • hepatotoxicity
    • hypersensitivity
  30. efavirenz AEs
    • vivd dreams
    • confusion
    • euphoria
  31. efavirenz preg category
    D
  32. NNRTI DDIs
    Cyp 3A4 inducer
  33. atazanivir drug class
    PI
  34. darunavir drug class
    PI
  35. ritonavir drug class
    PI
  36. PI AEs
    • hyperlipidemia
    • insulin resistance, DM
    • lipodystrophy
    • elevated LFTs
    • DIARRHEA
  37. PI DDIs
    CYP 3A4 inhibitors
  38. drugs to avoid with PIs
    • simvastatin
    • lovastatin
    • St. John's Wort
    • Rifampin
  39. which drug should be taken with PPIs
    atazanavir
  40. raltegravir cyp interactions?
    none
  41. enfuviritide drug class
    fusion inhibitor (binds to gp41)
  42. maraviroc drug class
    CCR5 inhibitor
  43. raltegravir drug class
    INSTI
  44. what is the only injectable med?
    enfuviritide
  45. Preferred/alternative NRTI backbone
    • Pre: emtricitabine/tenofovir
    • Alt: lamuvadine/abacavir
  46. pre/alt NNRTI option
    • Pre: efavirenz
    • alt: etravirine
  47. pre/alt PI option
    • pre: atazanavir/ritonavir
    • alt: darunavir/ritonavir
  48. INSTI options
    • pre: raltegravir
    • alt: cobistat/elvitegravir
  49. what is the preferred treatment in pregnancy
    • lopinavir/ritonavir AND
    • zidovudine/lamivudine
  50. pre/alt treatment for thrush
    • primary: clotrimazole, nystatin, fluconazole
    • alt: itraconazole, AmB, caspofungin
  51. thrush proph
    none
  52. Pref/alt proph for PCP
    • pre: bactrim DS
    • alt: pentamidine, dapsone/trimethoprim, atovaquone
  53. when to use proph for PCP
    CD4<200 or thrush
  54. tox proph (pre/alt)
    • pre: bactrim
    • alt: atovaquone, primethamine/leucovorin
  55. MAC proph
    • azithromycin
    • clarithromycin

    alt: rifabutin
  56. when to use proph fro tox
    CD4 <100
  57. when to use proph for MAC
    CD4 <50
  58. when to d/c proph for mac?
    CD4 >100 x 3 mo
  59. when to use proph for TB
    positive test or close contact
  60. pre/alt proph for TB
    • pre: isoniazide/pyridoxine x 9 mo
    • alt: rifampin x 4 mo
  61. indication for cyt proph
    primary proph not indicated, but can use valganciclvir in cd4 <50

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