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54 Cards in this Set
- Front
- Back
what is the adherence rate in order for ART to be effective in long run
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95%
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at what CD4 count should ART be started
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all HIV infected people should be on it (not really, maybe, possibly, wtf?)
best recc is cd4 <350 start |
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whats preferred NNRTI based regimen
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efavirenz, tenofovir, emtricitabine
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preferred PI combo?
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(Ataz + Ritonavir) + tenofovir/emtrictitabine
(Darunavir + Ritonavir) + tenofovir/emtricitabine |
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preferred regiment for preg
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lopinavir + ritonavir + zidovudine/lamivudine
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alternative INSTI based regimen
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raltagreavir + abacavir/lamivudine
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what is IRIS
How to tx? |
immune recon inflame syndrome
happens when you start ART in pt with low CD4 tx underlying disease and continue ART |
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general SE/BBW for NRTIs
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BBW- lactic acidosis, hepatic steatosis,
sometimes fatal- stavudine, didanosine, zidovudine |
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abacavir
brand name? BBW? |
Ziagen
BBW- hypersens skin rxn - test 1st with HLA-B5701 |
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what are meds in trizivir?
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lamivudine/zidovudine/ abacavir
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Didanosine
Brand? BBW? SE? |
Videx
BBW-Pancreatitis (fatal) SE- peripheral neuropathy, NVD! |
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Should Videx EC be taken on an empty stomach or with food?
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take on an empty stomach 1 H before
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Emtrictiabine
Brand? BBW? SE? |
Emtriva
BBW- exacerbates HepB if med D/Ced SE-hyperpigmentation of palms and soles |
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what are meds in Truvada
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Emtricitabine + tenofovir
"Truth is ten's are tricky" to get in bed |
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meds in Atripla
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Emtrictabine + tenofovir + efavirenz
3somes are a favorite, but tricky with tens |
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Lamivudine
Brand? BBW? |
Epivir
do NOT use Epiivir-HBV for HIV (lower dose) exacerbates HepB if D/Ced |
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Stavudine
Brand? BBW? |
Zerit
Pancreatitis |
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whats in Epzicom
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Lamivudine + abacavir
Ep + zia |
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whats in combivir
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zidovudine + lamivudine
Z combs lams |
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Zidovudine
brand? BBW? |
Retrovir
BBW- bone marrow sup (neutropenia + anemia) |
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Tenofovir
brand? BBW? SE |
Viread
BBW- may develop HepB, if D/Ced or HBV resistance can develop SE- fanconi syndrome, renal insuff, osteomalacia + dec in bone density |
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General stuff of Nukes
metabolism how? avoid which 2 NRTIs in combo |
not hepatically- so few interactions
emtrictiabine + lamivudine (no benefit) |
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NNRTIs
class SE |
rash, increase LFTs
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Efavirnez
Brands? how to take? SE? C/I? |
Sustiva
Take on an empty stomach at bedtime SE- CNS (impaired conc, vivid dreams, psych symptoms Preg Cat D-Avoid |
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Etravirine
brand? |
Intelence
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Nevirapine
Brand? dosing how? BBW? |
Viramune
need 14 day leading period - 200 daily, then 200 BID BBW- severe hepatotoxicity-highest in 1st 6 wks life threatening SJS, TENs |
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rilpivirine
brand? dosing? |
Edurant
take with a meal |
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NNRTI metabolized how?
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hepatically CYP, many interactions
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how do protease inhib work
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prevent HIV from reaching mature phase by inhibiting the enzyme that cleaves gag-poly protein
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PI's
class SE |
hyperglycemia/insulin resistance
lipodystrophy/ loss of fat in face, buttocks, legs buffalo hump dyslipidemia hepatitis IRIS |
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Atazanavir
Brand? SE Dosing |
Reyataz
SE- PR interval prolong, indirect hyperbillirubinemia nephrolithiasis (tk with 48 oz H20 to dec risk) Take with food, 10 H after H2A, or 1H after antacids |
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Darunavir
Brand? SE Dosing cautions |
Prezista
severe NVD, rash (SJS) take with food, swallow whole caution in sulfa allergy pt's |
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Fosamprenavir
brand |
lexiva
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Indinavir
brand? SE dispensing note |
Crixivan
Nausea, nephrolithiasis must dispense in original container-has desiccant-protects from moisture |
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Nelfanavir
brand note |
Viracept
diarrhea contains phenylalanine |
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Ritonavir
brand? Dosing? SE? NOTES soln has how much alcohol? |
Norvir
take with food SE-NVD, paresthesis,"", altered taste, PR prolong caps-need refrigeration, can be room temp x 30 D Tabs-store room temp soln-contains 43% alcohol |
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whats in kaletra
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lopinavir + ritonavir
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Saquinavir
brand? CI |
Invirase
QT prolong-monitor with ECG |
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Tipranaivr
brand bbw caps stored soln stored |
aptivus
BBW-intracranial hemorrhage, hepatitis caps-refrigerate, can be out for 60 D soln-room temp |
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how do fusion inhibitors work
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block attachment of HIV to CD4 cell-cause change in gp41
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enfuvirtide
brand SE place in tx |
fuzeon
SE-given SC, so local injection rxn in 100%-pain, redness salvage tx |
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CCR5 Antagonist work how
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bind go CCR5 co receptor on CD4 prevent HIV entry
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maraviroc
brand? BBW SE Monitorijg |
selzentry
BBW-hepatotoxicity SE-rash, SJS monitor crcl <30 ml/min only works in ccr5 tropic HIV- so do tropism test before starting |
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how do integrase inhibitors work
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blocks enzyme needed for viral DNA to enter cell nucleus
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raltegravir
brand monitor |
isentress
cpk if using with ripamin, use high dose 800 mg BID |
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what is PrEP
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pre-exposure prophylaxis
truvada given to patients w/o HIV, but have risk of developing HIV |
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occupational PREP
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basically if less than 1500 viral load do:
combivir or truvada x 28 days if >1500 viral load do: (combivir or truvada) + kaletra x 28 days |
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how to use Oraquick
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do not eat or brush teeth 20 mins before
HIV test-open test stick + swab upper gums and lower gums, pop off test tube and put stick into soln and wait 20 mins. IF line at C and no line at F= negative IF line at C and F=******, positive If no C line, test is invalid need to do western blot to confirm |
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whats dumb about Oraquick
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need to wait 3 months from exposure to test, cause this tests for HIV antigens
hopefully ppl don't use few days after and think they are clean |
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if CD4 <200 what OI need to worry about
how to tx |
PCP Pneumocystis Pneumonia
use bactrm DS, OR dapsone if sulfa allergy |
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CD4 <100 what OI need to be careful of
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toxoplasma Gondi
Bactrim DS or Dapsone + leucovorin + pyrimethamine |
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cd4 <50 OI
tx? |
MAC
use a mac-azithromycin 1200 mg Weekly |
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what 3 meds need to be careful using if HepB
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lamivudine, emtricitabine, tenofovir
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HIV replication steps
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1) HIV fuzes to CD4
3) Viral RNA, and its enzymes enter cell 3) virus uncoats and RNA turns into DNA via revertranscriptase 4) Viral DNA joins nucleus and integrates with cell DNA 5) New viral RNA made 6) viral RNA + proteins move to cell surface and form new HIV 7) virus matures by protease, releasing individual HIV proteins |