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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.
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What is AIDS?
HIV with CD4 less than 200 cells or history of opportunistic infection.
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When do HIV symptoms start?
2-4 wks. after exposure
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T/F: Testing for HIV is not based on risk factors
True
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What is the initial screening for HIV?
Enzyme Linked immunosorbent assay (ELISA)
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Positive ELISA must be confirmed by what?
Western Blot
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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.
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What does CD4 cell count indicate?
status of immune system and how much a patient is at risk for developing opportunistic infections
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What is normal CD4 cell count?
800-1200 cells/mm3
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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
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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
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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)
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What is the MOA of NRTI?
interfere with HIV viral RNA-dependent DNA, resulting in chain termination and inhibition of viral replication
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What NRTI's are based on weight?
didanosine, stavudine, and lamivudine
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What NRTI is affected by food?
didanosine
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Whats the generic name of Combivir (NRTI)
zidovudine and lamivudine
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Whats the generic name of Trizivir? (NRTI)
zidovudine, lamivudine, and abacavir
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Whats the generic name of Truvada? (NRTI)
tenofovir and emtricitabine
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Whats the generic name of Epzicom? (NRTI)
lamivudine and abacavir
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What are the major toxicities with NRTI?
- lactic acidosis
- hepatomegaly with steatosis
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All the NRTI need to be adjusted for renal impairment except?
abacavir (Ziagem)
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What NRTI should not be used together bc the are chemically similar?
lamivudine and emtricitabine
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What NRTI should not be used together bc of antagonism (both need thymidine for activation)?
zidovudine and stavudine
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Didanosine and stavudine should not be used during pregnancy due to increased risk for?
lactic acidosis and liver damage
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Patients need to be tested for HLA-B 5701 to determnine risk for hypersensitivity reaction to what NRTI?
Abacavir
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The 'D' drugs, didanosine and stavudine can cause what? (NRTI) (They are also more associated with lactic acidosis)
pancreatitis and peripheral neuropathy
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What is the brand name of zidovudine (NRTI) and side effect (SE)?
- Retrovir
- HA, anemia, neutropenia
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What is the brand name of lamivudine (NRTI) and SE?
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What is the brand name of Abacavir (NRTI) and SE?
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What is the brand name of didanosine (NRTI) and SE?
- Videx
- peripheral neuropathy and pancreatitis
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What is the brand name of stavudine (NRTI) and SE?
- Zerit
- peripheral neuropathy and pancreatitis
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What is the brand name of tenofovir (NRTI) and SE?
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What is the brand name of emtricitabine (NRTI) and SE?
- Emtriva
- skin hyperpigmentation
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What is tje MOA of NNRTI?
competitively inhibit reverse transcriptase,thus inhibit HIV replication
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What NNRTI need to be avoided in pregnancy?
efavirenz and atripla (category D)
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T/F: All NNRTI need to be adjusted for hepatic impairment?
True
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What are NNRTI toxicities?
rash and hepatotoxicity
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What is the brand name and SE of delaviridine (NNRTI)?
- rescriptor
- increase in LFT
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What is the brand name and SE of efavirenz (NNRTI)?
- sustiva
- CNS (insomnia, weird dreams..)
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What is the brand name and SE of Nevirapine (NNRTI)?
- viramune
- rash, hepatotoxicity
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What is the brand name and SE of etravine (NNRTI)?
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What is the generic name for atripla (NNRTI)?
tenofovir, emtricitabine, and efavirenz
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What is the MOA of protease inhibitors (PI)?
prevent cleavage of newly formed peptide chains into viable HIV
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What is the most potent PI?
ritanovir (usually used to intensify other PI)
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What are the PI toxicities?
- fat maldistribution
- hyperglycemia
- hyperlipidemia
- hypertriglyceridemia
- possible increase bleeding episodes in pt. with hemophilia
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PI monitoring (such as: glucose, LFT, cholesterol, GI effects, fat distribution) should be done when?
4-6wks. after starting PI, then q3-6months
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PI always end in what?
NAVIR
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What is the brand name and SE of atazanavir?
- reyataz
- indirect hyperbilirubinemia, nephrolithiasis, prolonged PR interval
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What is the brand name and SE of darunavir?
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What is the brand name and SE of fosamprenavir?
- Lxiva
- rash, nephrolithiasis
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What is the brand name and SE of Indinavir?
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What is the brand name and SE of lopinavir and ritanovir?
- Kaletra
- prolong PR or QT interval
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What is the brand name and SE of nelfinavir?
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What is the brand name and SE of ritanovir?
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what is the brand name and SE of saquinavir?
- Invirase
- incerase LFT, nausea
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What is the brand name and SE of tipranavir?
- aptivus
- increase LFT, rash, intracranial bleeding
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What PI are given with ritanovir?
darunavir, saquinavir, tipranovir
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What PI cause nephrolithiasis?
atazanavir, indinavir, fosamprenavir
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(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)
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(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
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(Integrase inhibitor) raltegravir (Isentress) MOA and SE?
- block integrase enzyme, prevent HIV DNA from meshing with CD4 cell DNA
- myopathy,creatine phosphokinae elevations
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T/F: >95% adherence is necessary to decrease HIV resistance?
true
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When should you start HIV tx. in pregnant women?
after 1st trimester
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What drug can decrease the risk of transmission when taken during preganacy?
zidovudine
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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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