Flashcards in Ortoski: High-yield Stuff Deck (98):
1
Geography associated with HIV?
Subsaharan Africa
2
More men or women, which race?
Men more than women, African American predominance
3
Top 3 modes of acquisition of HIV?
1. M to M sexual contact
2. Heterosexual
3. IVDA
4
Around what time was there more treatment, so fewer cases of HIV?
93-94
5
Since HIV causes inflammation, what are 2 areas of issue?
Cardiac and cancer
6
HIV is the BLANK leading cause of death currently
6th- Used to be leading in early 90s in the 25-45 age group
7
Reducing viral load reduces what?
Transmission
8
NRTI
Nucleoside reverse transcriptase inhibitor
9
NNRTI
Non-nucleoside reverse transcriptase inhibitor
10
PI
Protease inhibitor
11
D Drugs
d4t, ddl, ddc, AZT
12
Does AZT have a lot of SE?
YES
13
Nadir CD4
Lowest CD4 count ever
14
Naive
No prior drug exposure
15
Sequestered mutations
Found in minority- not detectable
16
BLD
Below level of detection- less than 20
17
Where is HIV 1 found?
Worldwide
18
Where is HIV 2 found?
Africa- Less easily transmitted
19
Group M
Major group worldwide
20
Group O
Other
21
How many subgroups or clades?
11
22
Group M Subgroup B
Americas, Japan, Austrailia, Carribean, Europe
23
Group M Subgroup C
S. Africa, India
24
Typical transmission modes?
1. Sexual
2. Vertical (mother to child)
3. Transfusion
4. IV drug use
25
If mother's viral load is undetectable, is it less likely to transfer to fetus?
YES
26
Risk factors?
1. 3+ nights in prison
2. Prostitution
3. Other STD
27
What should be emphasize?
Routine voluntary testing
28
What test is the best and confidental?
Serology
29
What is needed for a + result?
2 ELISA screening followed by 1 Western Blot for CONFIRMATION
30
What test is done for infants?
DNA test (newborns have positive antibodies no matter what from mom)
31
When is DNA test done?
After 1 month and after 4 months
32
What does the 4th generation ELISA have?
p24 antigen
33
What is required for an AIDS diagnosis?
Positive serology and a CD count under 200 and/or AIDS defining illness
34
CD4+ Under 200
Prevent PCP pneumonia
35
CD4+ Under 100?
Prevent Toxoplasmosis
36
CD4+ Under 50?
Prevent MAC
37
What is used to test kidney and liver function?
CMP
38
Live Vaccines?
NOOOOOO
39
Dosing for Hep B vaccine?
Give HIV pt. 40mcg (normal is 20mcg)
40
When can you give MMR?
Is CD4 is over 200
41
Phase 1:
Greater than 500 CD4 cells, asymptomatic, acute phase, PHI
42
Phase 2:
CD4- 200-500, Early symptomatic
43
Phase 3:
CD4- 50-200, Late symptomatic, full blown AIDS
44
Phase 4
Fewer than 50 CD4 cells- Advanced AIDS
45
What measures extent of immune system damage?
CD4 count
46
What does viral load measure?
Plasma HIV RNA level...higher means more CD4 destruction
47
What is most popular viral RNA assay?
PCR
48
What test does everyone infected get immediately?
Resistance
49
What % of infections are resistant to at least 1 drug because the index patient was resistant to the drug?
15%
50
What is best bang for buck?
Genotyping (can also use trophile/trophism test)
51
R5 Viruses, CCR5 CoReceptor, Macrophages, Early
M TROPIC
52
X4 Viruses, CXCR4 CoReceptor, T-cells, Late, Faster to AIDS?
T TROPIC
53
M184V mutation
M: AA found in wild tpye
184: AA (codon) position
V: AA substitution/variant
54
We only have drugs that kill what trophism?
R5
55
M184V mutation, what drugs won't work?
Lamivudine and Emtricitabine
56
K103N mutation, what drugs will work?
All of the 1st generation NNRTIs
57
4 types of Anti-retroviral treatment?
1. Reverse Transcriptase Inhibitors: Nucleoside RTI (NRTI), non-Nucleoside RTI (NNRTI), Nucleotides
2. Protease Inhibitors: PI
3. Entry Inhibitors: Attachement inhibitors, chemokine receptor inhibitors, fusion inhibitorsa
4. Integrase inhibitors
58
True or False: ART is recommended for ALL HIV infected persons regardless of CD4 count
TRUE
59
Is monotherapy okay?
NO
60
1 exception to monotherapy?
Pregnant woman that normally will accept no treatment, but is willing to take AZT at the time to prevent the baby from contracting the virus
61
Can you piece drugs together?>
NO...ALL OR NONE
-Start all drugs or stop all drugs at the same time
62
Diagnosis of AIDS?
AIDS defining illness and/or CD4 count below 200
63
All protease inhibitors are taken with what?
Ritonavir
64
What is ritonavir?
A boosting agent for P450... not a viral killer anymore and helps with one-a-day dosing of others
65
HS/HLAB*5701, CAD risk, Danger with Rechallenging?
Ziagen or ABACAVIR
66
Less use with AE, hyperchromic macrocytic anemia
AZT (retrovir)
67
If virus has M184V mutation, what won't work?
Lamivudine and emtricitabine
68
Neurological AE short lived, depression issues, low genetic barrier?
EFAVIRENZ (sustiva)
69
Associated with CAD
Protease Inhibitors
70
RENAL STONES
Reyataz and Crixivan
71
Renal Issues
Viread
72
Entry inhibitors (CCR5)?
Fuzeon
Selzentry
73
Injection SC only, painful, cellulitis?
Fuzeon
74
Use with R5 virus only?
Selzentry
75
Work in nucleus?
Integrase inhibitors
76
Now indicated first line with low AE?
Isentres (integrase inhibitor)
77
Are there dietary restrictions with these drugs?
YES
78
Does adjustments to avoid AE in?
1. ED Medication
2. PPI
3. Statins
4. CCBs
79
Can you use Simvastatin?
NO
80
What 3 combos can be used to initiate?
1. NNRTI and 2 NRTI
2. PI (preferably boosted with ritonavir) and 2 NRTI
3. INSTI and 2 NRTI
(non nuc or PI pr INSTI PLUS 2 NUCs)???
81
What are 2 components of lypodystrophy?
1. Lipohypertropy
2. Lipoatrophy
82
Ring-Enhanced Lesion
Toxoplasmosis brain scan related to an HIV case
-CD4 count under 100 and positive antibodies for Toxo
83
Palmar or plantar rash?
SYPHILLIS
84
What do newborns born to an HIV+ Mom get the first 6 weeks of life?
AZT (zidovudine)
-This is started 8-12 hours after birth and discontinued at 6 weeks (DNA BLD)
85
When is PCP prophylaxis initiated for a baby born to HIV + mom?
At 6 weeks
86
Breast feeding?
NO
87
What is given for pre-exposure prophylaxis for dischordant couples that have an accident?
PrEP- Tanofovir
88
Do all states require pretest counseling or signed release?
NO
89
Anemia?
AZT (Zidovudine)
90
HS
Abacavir (Ziagen)
91
Nightmares
Efavirenz (Sustiva- CNS effects)
92
Kidney Stones
2 protease inhibitors- Reyataz and Crixivan
93
Undetectable mean irradicated
NO
94
What is used to assess efficacy of therapy?
Viral loads
95
Best efficacy is how many drugs?
3
96
Pregnant women should at least take what?
AZT
97
Combo therapy should be started and stopped...
ALL OR NONE
98