1. What is (HIV) human immunodeficiency virus?
    It is a virus that depletes the helper t-lymphocytes (CD4 cells) resulting in continued destruction of the immune system.
  2. What is AIDS?
    HIV with CD4 less than 200 cells or history of opportunistic infection.
  3. When do HIV symptoms start?
    2-4 wks. after exposure
  4. T/F: Testing for HIV is not based on risk factors
  5. What is the initial screening for HIV?
    Enzyme Linked immunosorbent assay (ELISA)
  6. Positive ELISA must be confirmed by what?
    Western Blot
  7. What does viral load measure, assess, and evaluate?
    • 1. measure amount of virus in blood
    • 2. assess disease progression
    • 3. evaluate efficacy of antiretroviral tx.
  8. What does CD4 cell count indicate?
    status of immune system and how much a patient is at risk for developing opportunistic infections
  9. What is normal CD4 cell count?
    800-1200 cells/mm3
  10. When should you initiate antiretroviral treatment (ART)?
    • - history of aids
    • - CD4 <200
    • -CD4 200-350
    • -Pregnant women
    • -pt. with HIV associated nephropathy
    • -pt. co-infected w/ Hep.B.virus when hep.B tx. is indicated
  11. What are the classes of drugs used to treat HIV?
    Nucleoside Reverse Transcriptase Inhibitors (NRTI), non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI), protease inhibitors, entry inhibitors, and integrase inhibitors
  12. What is the recommended initial ART?
    • 2 NRTI and 1 NNRTI (ex. Atripla)
    • 2 NRTI and PI
    • 2 NRTI and integrase inhibitor
    • pregnant women (Combivir plus Kaletra)
  13. What is the MOA of NRTI?
    interfere with HIV viral RNA-dependent DNA, resulting in chain termination and inhibition of viral replication
  14. What NRTI's are based on weight?
    didanosine, stavudine, and lamivudine
  15. What NRTI is affected by food?
  16. Whats the generic name of Combivir (NRTI)
    zidovudine and lamivudine
  17. Whats the generic name of Trizivir? (NRTI)
    zidovudine, lamivudine, and abacavir
  18. Whats the generic name of Truvada? (NRTI)
    tenofovir and emtricitabine
  19. Whats the generic name of Epzicom? (NRTI)
    lamivudine and abacavir
  20. What are the major toxicities with NRTI?
    • lactic acidosis
    • hepatomegaly with steatosis
  21. All the NRTI need to be adjusted for renal impairment except?
    abacavir (Ziagem)
  22. What NRTI should not be used together bc the are chemically similar?
    lamivudine and emtricitabine
  23. What NRTI should not be used together bc of antagonism (both need thymidine for activation)?
    zidovudine and stavudine
  24. Didanosine and stavudine should not be used during pregnancy due to increased risk for?
    lactic acidosis and liver damage
  25. Patients need to be tested for HLA-B 5701 to determnine risk for hypersensitivity reaction to what NRTI?
  26. The 'D' drugs, didanosine and stavudine can cause what? (NRTI) (They are also more associated with lactic acidosis)
    pancreatitis and peripheral neuropathy
  27. What is the brand name of zidovudine (NRTI) and side effect (SE)?
    • Retrovir
    • HA, anemia, neutropenia
  28. What is the brand name of lamivudine (NRTI) and SE?
    • Epivir
    • minimal toxicity
  29. What is the brand name of Abacavir (NRTI) and SE?
    • ziagem
    • hypersensitivity
  30. What is the brand name of didanosine (NRTI) and SE?
    • Videx
    • peripheral neuropathy and pancreatitis
  31. What is the brand name of stavudine (NRTI) and SE?
    • Zerit
    • peripheral neuropathy and pancreatitis
  32. What is the brand name of tenofovir (NRTI) and SE?
    • Viread
    • renal dysfunction
  33. What is the brand name of emtricitabine (NRTI) and SE?
    • Emtriva
    • skin hyperpigmentation
  34. What is tje MOA of NNRTI?
    competitively inhibit reverse transcriptase,thus inhibit HIV replication
  35. What NNRTI need to be avoided in pregnancy?
    efavirenz and atripla (category D)
  36. T/F: All NNRTI need to be adjusted for hepatic impairment?
  37. What are NNRTI toxicities?
    rash and hepatotoxicity
  38. What is the brand name and SE of delaviridine (NNRTI)?
    • rescriptor
    • increase in LFT
  39. What is the brand name and SE of efavirenz (NNRTI)?
    • sustiva
    • CNS (insomnia, weird dreams..)
  40. What is the brand name and SE of Nevirapine (NNRTI)?
    • viramune
    • rash, hepatotoxicity
  41. What is the brand name and SE of etravine (NNRTI)?
    • Intelence
    • rash
  42. What is the generic name for atripla (NNRTI)?
    tenofovir, emtricitabine, and efavirenz
  43. What is the MOA of protease inhibitors (PI)?
    prevent cleavage of newly formed peptide chains into viable HIV
  44. What is the most potent PI?
    ritanovir (usually used to intensify other PI)
  45. What are the PI toxicities?
    • fat maldistribution
    • hyperglycemia
    • hyperlipidemia
    • hypertriglyceridemia
    • possible increase bleeding episodes in pt. with hemophilia
  46. PI monitoring (such as: glucose, LFT, cholesterol, GI effects, fat distribution) should be done when?
    4-6wks. after starting PI, then q3-6months
  47. PI always end in what?
  48. What is the brand name and SE of atazanavir?
    • reyataz
    • indirect hyperbilirubinemia, nephrolithiasis, prolonged PR interval
  49. What is the brand name and SE of darunavir?
    • prezista
    • rash
  50. What is the brand name and SE of fosamprenavir?
    • Lxiva
    • rash, nephrolithiasis
  51. What is the brand name and SE of Indinavir?
    • Crixivan
    • nephrolithiasis
  52. What is the brand name and SE of lopinavir and ritanovir?
    • Kaletra
    • prolong PR or QT interval
  53. What is the brand name and SE of nelfinavir?
    • viracept
    • diarrhea
  54. What is the brand name and SE of ritanovir?
    • norvir
    • parasthesias
  55. what is the brand name and SE of saquinavir?
    • Invirase
    • incerase LFT, nausea
  56. What is the brand name and SE of tipranavir?
    • aptivus
    • increase LFT, rash, intracranial bleeding
  57. What PI are given with ritanovir?
    darunavir, saquinavir, tipranovir
  58. What PI cause nephrolithiasis?
    atazanavir, indinavir, fosamprenavir
  59. (entry (fusion) inhibitor) enfuvirtide (Fuzeon): MOA, SE, and when is it used?
    • inhibit HIV binding to CD4 cell
    • SE: local site reaction
    • SQ injection (not 1st line)
  60. (entry inhibitor) maraviroc (selzentry) MOA and SE?
    • bind to chemokine coreceptor 5 on CD4 cell, thus inhibbit HIV binding and entry into CD4 cell
    • hepatotoxic, infection
  61. (Integrase inhibitor) raltegravir (Isentress) MOA and SE?
    • block integrase enzyme, prevent HIV DNA from meshing with CD4 cell DNA
    • myopathy,creatine phosphokinae elevations
  62. T/F: >95% adherence is necessary to decrease HIV resistance?
  63. When should you start HIV tx. in pregnant women?
    after 1st trimester
  64. What drug can decrease the risk of transmission when taken during preganacy?
  65. What 2 oppotunistic infections require primary prohylaxis? when and what drugs are used?
    • phenocystis jroveci pneumonia (PCP): treat when cd4 fall below 200. Bactrim DS QD (dapsone is allergic)
    • mycobacterium avium complex bactermia (MAC): teat when CD4 fall below 50. tx. with azythromycing 1200mg po every week
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