Pharm II Lecture 6 – Flashcards
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Unlock answers-HIV-1: subtype most commonly found in ________ -AIDS: CD4 count less than ____cell/mm3 OR |
-US
-200
-2 |
-What does teh Western blot look for?
-When does seroconversion usually occur?
-A minimally significant change in viral load is considered to be a ____-fold increase or decrease -Lower limits of detection include ____ copies /mL |
-anti-HIV Abs..(gold standard..99% spec/sens)
-3 weeks PI (range 2wks-6mo)
-3-fold
-400 copies/mL (ultrasensitive gets down to 20-50 copies/mL) |
-Those on antivirals should have viral titer loads lower than ___ copies/mL by 6 mo. -when are they monitored? -Normal CD4+ cell counts are ____-____ cell/mm3 |
-Fewer than 50
-every 3-4 months
- 800-1,200
-3-6 months |
-The most common HIV symptom is what?
-2nd most?
-To achieve therapeutic goals what must the compliance rate of HIV pts be to their meds? |
-Fever
-Muscle/joint aches
-95% |
What HIV stage is this: HIV DNA enters the host cell’s nucleus, where an HIV enzyme integrase “hides” the HIV DNA within the host cell’s own DNA.
-Now teh HIV DNA is called a _______. |
-Integration
-provirus |
-What do NUCs (NRTI's) do? ; -What are the class toxicities? ; -What are S/S for lactic acidosis? |
-PREVENTS VIRAL RNA FROM BECOMING DNA; Inhibits viral replication. ; -Lactic Acidosis; severe Hepatomegaly with steatosis (fatty stools) ; -N/V, Abd pain, Wt loss, Malaise |
-Which Entry/Fusion Inhibitor is this?: Fusion Inhibitor ; -What is the other Entry/Fusion Inhibitor? |
; -Enfuvirtide (T20;chemical name) - Fuzeon; ; - Maraviroc (MCV) - Selzentry; |
Which Nuc am I: - Dose: every 12 hours |
; ; ; -AZT or Zidovudine-Retrovir |
Which Nuc am I?; Dose: every 12 or 24 hours, depending on mg. |
; ; -Lamivudine-Epivir (3TC) |
Which Nuc am I: ; Dose: every 24 hours with or without food |
; ; -;;; Emtricitabine-Emtriva-FTC |
Which Nuc am I? Dose: every 12 or 24 hours, depending on mg. |
; ; ;;;; Abacavir-Ziagen-ABC;;; |
; What are these teh risk factors for? Female gender |
; ; ; ;Lactic Acidosis by using NRTI's (Nucs) |
T/F...All NRTI's are prodrugs? ; -What is the good drug resistance strain that can develop in response to certain Nucs? |
-True ; -Strain M184V |
NucleoTIDE reverse transcriptase inhibitor
|
; ; Viread (tenofovir) or TDF |
Which Nuc am I?: ;; Dose: every 12 hours |
; ; ; Stavudine-Zerit-d4T |
-Binds to reverse transcriptase at a different site to inhibit HIV replication -Resistance is an issue Must be dose adjusted in liver impairment Class toxicities: rash and hepatic toxicity Lots of drug interactions;.helps distinguish the individual drugs. |
; ; ; NNRTI's (non-nucleside reverse transcriptase inhibitors) |
Which NNTRI am I?: -Dose: 600mg po every 24 hours (HS) Adverse effects: CNS side effects are unique to EFV (~50%)(ABNORMAL DREAMS) |
Sustiva® (efavirenz or EFV) |
T/F...if one NNRTI develops a resistence...try another?
-T/F...you can use a Nuc and NNRTI together? |
-False...resistent to one=resistence to all.
-True...they work in different places. |
NNRTI:
Dose: every 12 hours; take WITH food! |
Etravirine-Intelence-ETV |
NNRTI: Dose: every 24 hours x 14 days; then increase to every 12 hours |
Nevirapine-Viramune-NVP |
NNRTI: Dose: every 8 hours → prob won’t see this med due to compliance |
⇒ Delavirdine-Rescriptor-DLV |
INTEGRASE INHIBITOR: Dose: every 12 hours |
- Raltegravir-Isentress-RAL (inhibits formation of Provirus) |
-What is the class SE/toxicities of Protease Inhibitors?
-What is teh MOA of Protease Inhibitors? |
-Prevent cleavage of HIV, resulting in immature noninfectious viral particles. |
Which PI am I? Dose: every 12 hours |
Ritonavir-Norvir-RTV |
Which PI am I?
Dose: every 8 hours (TID) → won’t see it much |
Indinavir-Crixivan-IDV |
Which PI am I:?
Dose: every 12 hours WITH food |
Lopinavir/ritonavir-Kaletra-LPV/r |
Which PI am I?
Dose: every 24 hours -Interactions with H2 blockers, PPI's, and CCB's -Decreased hyperlipidemia (use in CAD pts) |
; ; ; ; Atazanavir-Reyataz-ATV |
Which PI am I: ; Doses: depends on na;ve or experienced pt. -Naive pt will get higher doses initially (1400mg po BID) vs. Experienced (700 mb po BID with RTV 100 mcg po bid) |
; ; ; ; Fosamprenavir-Lexiva-f-APV |
Which PI am I? ; Dose: BID w/RTV BID Take with food |
; ; ; Darunavir-Prezista-DRV |
Which PI am I?: Dose: BID w/RTV BID |
; ; ; ; Tipranavir-Aptivus-TPV |
-Preferred Initial Regiments for new HIV pt: PICK ONE OF THESE ; ;;;; _______ + Ritonavir - QD |
-Atazanavir (ATV) ; -Darunavir (DRV) ; -Lopinavir (LPV) ; -Fosamprenavir (f-APV) ; -Efavirenz |
Preferred Initial Regiments: ADD ONE OF THESE ; ;;;; Tenofovir + ________ |
; -Emtricitabine(FTC NRTI) ; -Lamivudine (3TC NRTI) ; -Zidovudine (AZT NRTI) |
HIV regiments to avoid: ;;;; ______therapy |
-monotherapy ; -Two ; -Three ; -Quadruple ; -Efavirenze |
HIV REGIMENS TO AVOID ;;;; Generally not recommended: ___/AZT/3TC -_____urea ; Stavudine + ________ - antagonism ;;;; Stavudine + ________ - toxicities ;;;; Lamivudine + ______ ; similar products |
; -ABC -TDF hydroxyurea -Zidovudine -Didanoside -Emtricitabine |
Which HIV Drug class SE profile am I? Hepatotoxicity Hyperglycemia Hyperlipidemia Triglycerides Increased bleeding in hemophiliacs Lidodystrophy Osteonecrosis |
; ; ; PI's |
When is the only time we should really use the NNRTI Viramune (nevirapine..NVP)? |
-Reserved for use when CD4 count <250 (women) CD4 count <400 (men) |
Which PI am I?: Drug interactions: H2 blockers |
-Reyataz (Atazanavir or ATV) |
-Who has a higher risk for abacavir hypersensitivity reaction (ABC HSR)...whites or blacks?
-THose who usually have a ABC HSR are also positive for what allele? |
-Whites
-HLA-B*5701
|
T/F Nevirapine is a NNRTI that is okay to use on those who have severe hepatic impairment?
-Recommended guidelines for naive retroviral pts: __-NNRTI + __NRTI or __PI (boosted with __) + __NRTI |
-False....DO NOT
- 1-NNRTI + 2-NRTI or 1 PI (boosted with Ritonavir) + 2 NRTI
|
Who can't have Lopinavir/ritonavir BID? ; -Atazanavir + Indinavir are not recommended together b/c they cause? ; -Saquinavir / Darunavir / Tipranavir are all only virologic when used with? |
-Pregnant women. ; -Jaundince and Hyperbillirubinemia ; -Ritonavir (booster PI) |
What happens when we combine the NRTI's Didanosine (ddl)and Stavudine (d4T)?
-NRTI's:; Why shouldn't Lamivudine (3TC) + Emtricitabine (FTC) be used together? |
-High risk of toxicities (esp peripheral neuropathy)
-They have similiar resistence profiles and therefore have little additive benefit when used together. |
What Opportunistic HIV infection am I:? Fever |
-Pneumocystis jiroveci pneumonia (PCP) |
Treatment for PCP?
-Adjunct if PO2 levels are below 70mmHg? -Can Clindamycin also be used as alternative? -If Atovaquone is used as alternative...how often is it dosed? |
-TMP 15mg/kg/day +SMZ 75mg/kg/day po or IV 3-4 divided doses -Prednisone -Yes if used with primaquin...Clindamycin 600 mg IV q8h or 300-450mg po q6h + primaquine 30 mg base po qd |
When do you prophylact for PCP?
-What should you use?
-When do you stop? |
-When CD4 is less than 200
-Bactrim DS...DAILY (3x weekly show to be ineffective)
-When CD4 back over 200 for THREE MONTHS |
Which HIV Opp Dz am I?: Fever Night sweats Weight loss Diarrhea Abdominal pain Positive AFB from blood, liver, bone marrow or lymph nodes (can take 7-21 days) CD4 cell count less than 50/mm3 |
Mycobacterium avium complex (MAC) |
Tx for MAC?
-Stop Tx when? |
Clarithromycin 500 mg po bid + ethambutol 15 mg/kg/d po ± rifabutin 300 mg po qd
-Stop when CD4 count >100/mm3 for 6 months and received 12 months of treatment and asymptomatic |
Primary Prophylaxis for MAC is what?
-Stop when? |
-Azithromycin 1,200 mg po once per week
-Can stop when CD4 cells are greater than 100/mm3 for 3 months |
Which HIV Opp Inf am I: Focal neurologic defect Headache Fever + anti-T. gondii IgG (blood and/or CSF) 2 or more ring enhancing lesions on MRI CD4 cell count less than 100/mm3 |
-Toxoplasma gondii encephalitis |
-Toxo gondi encephalitis Tx: Preferred regimen: treat for at least __ weeks _______ 200 mg loading dose, then 50-75 mg po qd + ______ 10-20 mg po qd + ________ 1-1.5 g po QID |
-6 weeks -Pyrimethamine, leucovorin, sulfadiazine |
Which HIV Opp Inf am I:? Symptoms and Diagnosis |
Cryptococcal meningitis |
Tx for Crypto meng?
-Prophylactic Tx for Crypto meng is?
-Stop when? |
-Ampho B 0.7-1.0 mg/kg/d IV ± flucytosine 100 mg/kg/d po 14 days then fluconazole 200 mg po bid x 8 weeks
-Fluconazole 200 mg daily -Discontinue secondary prophylaxis when CD4 cells are greater than 100-200/mm3 for 6 months, initial therapy is completed, and |
WHich HIV Opp Inf am I?: Fever |
Histoplasmosis (Histo) |
Histo Tx?
-Prophylaxis?
-Stop when?
|
-Preferred regimens:
– itraconazole 200 mg po daily
-Discontinue after |
-Histo: What is a key consideration when deciding whether or not to prophylax for someone with a CD4 count below 100
-Where are CMV infections CD4 counts usually below? |
-Are you in an Endemic area (Southeast/Miss River basin)
-50 |
Decreased visual acuity (floaters, field defects, flashes of light) Funduscopic exam: perivascual yellow-white retinal infiltrates +/- intraretinal hemorrhage (cottage cheese and ketchup) Extraocular CMV: esophagitis colitis pneumonia |
CMV |
-What is main thing to consider when treating CMV?
-Which group gets what? |
-Vision-threatening or not. -Vision threating lesion: |
T/F...Live-Attenuated Vaccines are usually effective with one dose
-T/F...Inactivated vacciens cause fewer site reactions and require only 1 dose? |
-True *except those administered orally (to name some live attenuateds...Yellow Fever, Nasal Flu mist, Zoster, and MMR)
-False, generally 3-5 doses are required |
Polysacchararides are teh preferred Vaccine for those under 2 yo? |
-Less effective for this age group (ex. pneumonococcal, meningicoccal, Salmonella Typhi, and HIb) (IT IS IMPORTANT TO NOTE THAT SOME ARE STILL GIVEN THIS WAY though usually conjugated (examples HiB, mening, pneumococcal) |
What is this describing?: Additional chemical in vaccine that increased the immunogenicity of the antigen Increased antibody production Increases response in poor responders Allows for lower doses Aluminum salts were introduced in 1926 |
-Vaccine Adjuvants (Hib, HPV, PCV7, DTap, and DT all use them) |
-How long should a SubQ needle be? -Where should an IM injection be given on an infant?
-IM needle lengths depend on? |
-5/8 of an inch (inj at 45 degree angle) -Thigh Muscle (Quad area)...Adults get Deltoid of course -Age group (Newborn:5/8 inch
|
When are DTaP boosters to be given? -What does DTaP vaccine cover? -Which is adult strength 'D' or 'd' |
-every 10 years - Diptheria toxin generally given in combination with tetanus toxoid AND acellular pertussis vaccine [DTaP] -'d' |
For those with recent traumatic wounds how do we help them with passive immuninity to Tetanus?
-For which age group is the HIb Vaccine reccommended?
-What type of vaccine is it and what is the most common adverse rxn? |
-T Ig or Tetanus Immunoglobulin
-Those under 5 yo (natural immunity develops from thence on)
- IM conjugate vaccine... Erythema (25%), |
Which Flu virus (A or B) is more prone to mutation?
-Optimal time for Flu vaccine is?
-What age group can have Live Attenuated Flu vaccine? |
-A
-October – mid November
-5-49 (those 5-8 need split doses) |
What does this group of pts represent: Patients >50 |
Flu vaccine (Very high risk populations...they definately need the vaccine) |
Heptavelent vaccine, contains conjugated capsular polysaccharide of 7 serotypes Administration: IM Indicated for children <2 Adverse effects: generally mild, injection site reactions and fever |
Pneumonococcal Conjugated Polysaccharide Vaccine |
-Which Pneumonococcal vaccine covers 23 serotypes of S. pneumo and is recommended for those over 2yo.
-Where should Rabies Ig be administered post exposure?
-What allergy might Rabies vaccine trigger? |
-Unconjugated Pneumonococcal Polysacc Vaccine.
-Around potential infiltrated wound (DONE IM...never IV)
-Thimerosal |
-Which rotavirus vaccine provides teh most protection (against the most Rota strains)
-What allergy shouldn't be given Rubella vaccine |
-Rotateq; (live, oral, pentavalent vaccine)... ; -Neomycin allergic people |
WHo better seroconverts to Varicella vaccine (adults or children)? ; -How must this vaccine be stored? ; -Post-exposure prophylaxis indicated? ; -What allergy is contraindicated? |
-Single dose results in 94% seroconversion in children, but only 80% in adults ; -Frozen ; -Yes 3-5 days Post-Exp ; -Neomycin |
When must Varicella Ig be administered Post-Exp? ; -HPV vaccine: ACIP recommends routine vaccination of females __-__ years of age with __ doses of quadrivalent HPV vaccine ; -Cancerous strains? |
-within 48 hours (may only attenuate infection) ; -11-12 yo with 3 doses (Vaccination is recommended for females 13-26 years of age who have not been previously vaccinated) -16 and 18 |
What preservative is possibly linked to Autism and contains 50% mercury? ; -What is the reporting site should a pt of yours experience a new adverse event due to vaccination? ; -What is imp to document in these events? |
; -Thimersol (DD, TT, Td, and Influ all can have this) ; -VAERS ; Vaccine Adverse Event Reporting System ; -Lot number of the injection |