Term
|
Definition
- pts. with AIDS-defining illness
- CD4 count of < 200-350 cells/mm3 |
|
|
Term
| HIV initiation regardless of CD4 count |
|
Definition
- preg
- HIV associated nephropathy
- HBV coinfection |
|
|
Term
| Antiretroviral Naive Patients |
|
Definition
1 of 3
INSTI: integrase strand transfer inhibitor
NNRTI: non: non nucleoside reverse transcriptase inhibitor
NRTI: nucleostide reverse transcriptase inhibitor
PI = protease inhibitor
- NNRTI + 2NRTI
- PI (pref w/ ritonavir) + 2 NRTI
- INSTI + 2 NRTI |
|
|
Term
| Preferred Regimens for treatment of naive patients |
|
Definition
Tenofovir + Emtricitabine + Efavirenz
Tenofovir+ Emtricitabine +Atazanavir- Ritonavir
Tenofovir + Emtricitabine + Ritonavir -Darunavir
Tenofovir + Emtricitabine + Raltegravir |
|
|
Term
Non Nucleoside Reverse Transcriptase Inhibitors
(NNRTIS) AEs |
|
Definition
- Fatal hypersensitivity RXN: can genetically screen
- no renal dosage adjustment requirements |
|
|
Term
|
Definition
-Parasthesias
- N/V/D
- lipid/gluc metabolism disturbances
- fat redistribution -> trunk |
|
|
Term
| Fusion/Entry Inhibitors AEs |
|
Definition
- injection site rxn
- hypersensitivity rxn
- > bacterial pneumonia |
|
|
Term
|
Definition
- abd pain
- cough
- dizziness
- MSK sx
- pyrexia
- rash
-URI
- hepatotoxicity
- orthostatic hypertension |
|
|
Term
|
Definition
- N/D
- HA
- Pyrexia
- CPK elevation (muscle weakness and rhabdo) |
|
|
Term
|
Definition
- protease inhibitor
- preferred during preg |
|
|
Term
| HAART therapy response indicator |
|
Definition
- HIV RNA (viral load): most important indicator of response to HAART (Highly active antiretroviral therapy)
- < 40-75; generally acheived in 12-24 wks
- CD4 > 50-150 cells/mm/year
- Q3 month monitoring of immunologic and virologic markers and physical assessments |
|
|
Term
|
Definition
- should be avoided during first trimerster of preg
- HIV infected preg women should receive combos: two NRTIs + a NNRTI or PI - continue post partem |
|
|
Term
|
Definition
| - should be included when antiretroviral therapy is initiated during preg: as a component of antenatal therapy whenever possible |
|
|
Term
|
Definition
| - preferred 2 NRTI in pregnant women |
|
|
Term
| Opportunistic infections in AIDS patients |
|
Definition
- Pneumocytitis Jiroveci (carinii) Pneumonia (PCP)
- CMV |
|
|
Term
|
Definition
- insidious onset: fever, dyspnea, tachypnea, non productive/slightly productive cough, CXR
- possible infiltrates |
|
|
Term
|
Definition
- 1st line: trimethoprim/sulfamethoxazole
- Other: pentamidine |
|
|
Term
|
Definition
| - retinitis, esophagitis, hepatitis, GI, radiculopathy, encephalitis, pneumonitis |
|
|
Term
|
Definition
- Ganciclovir
- optimal duration of therapy is unknown
- some patients may require longterm therapy
- alt tx: Foscarnet |
|
|
Term
|
Definition
- Isoniazid (INH):
- non compliance: larger dose 2x weekly DOT
- Pyroxidine to < CNS effects & peripheral neuropathy esp in preg, alcs and poor diet
- Rifampin
- alt for latent infection if INH faiils or if pt was exposed to INH resistant TB: Non compliance 600 mg 2x weekly DOT |
|
|
Term
|
Definition
- INH & Rifampin: used together for most cases
- best at preventing drug resistance
- Initial Phase 2 months
- INH + RIF + PZA + ETB
DOT regimens available |
|
|
Term
| Pulm TB tx continuation phase |
|
Definition
4-7 months
- INH + RIF daily |
|
|
Term
|
Definition
| RIF + PZA + ETB (+/- FQ) x 6 months |
|
|
Term
|
Definition
- initial phase - INH + RIF + PZA - daily x 2 months
- continuation phase - INH + RIF daily x 6 months
- some use 9-12 months of therapy |
|
|
Term
|
Definition
-initial - INH + RIF + PZA + ETB ( + cycloserine)
- may omit ETB when susceptibility is confirmed
- corticosteroids x 1 month < complications |
|
|
Term
|
Definition
- INH + RIF + ETB x 9 months
- ethambutol & INH are relatively safe
- Rifampin - very rarely causes birth defects, but can be serious ( CNS lesions, limb reduction)
Supplement with pyroxidine while on INH |
|
|
Term
| Drugs to avoid in TB preg women |
|
Definition
- ethionamide: premature delivery, congenital malformations and Downs syndrome
- streptomycin: hearing impairment |
|
|
Term
|
Definition
- severe and sometimes fatal hepatitis
- may occur or develop after many months of tx |
|
|
Term
|
Definition
- CV: HTN, palpitation, tachy, vasculitis
- CNS: lethargy, memory impairment, psychiatric symptoms
- Derm: rash, flushing
- Endocrine: pyridoxine deficiency (peripheral neuropathies)
- > BG
- gynecomastia
- GI: N/V, Abdominal pains
- > LFTs
- hepatitis
- hematologic abnormalities
- MSK: pain/weakness, lupus |
|
|
Term
|
Definition
- CV edema
- flushing
- CNS: ataxia, psychiatric/behavioral changes, cognitive impairment
- endocrine: adrenal insufficiency, menstrual disorders, hematologic abnormalities
Other: acute renal failure, conjunctivitis, hepatitis, red discoloration of body fluids |
|
|
Term
|
Definition
- flu like symptoms (malaise, N/V, arthralgias/myalgias, fever)
- gout
- hepatotoxicity
- photosensitivity
- rash
- hematologic abnormalities |
|
|
Term
|
Definition
- CV/lung: myocarditis, pericarditis, pulm infiltrates - CNS: HA, confusion, psychiatric
- Derm: rash - endocrine: gout
- GI: N/V abdominal pain, hepatitis, > LFTs
- Ocular: optic neuritis, hematologic abnormalities, nephritis |
|
|
Term
| Duration of tx for immunocompromised |
|
Definition
|
|
Term
|
Definition
- INH & Rifampin
- no dosage adjustments required
- pyrazinamide and ethambutol: dosing is typically reduced from daily to 3 x weekly |
|
|
Term
| tx of neurological sx due to INH |
|
Definition
- neurologic symptoms: peripheral neuropathy - pyridoxine supplementation
- CNS symptoms w/ overdose/toxicity: seizures, coma |
|
|
Term
|
Definition
- vasodilators
- CCBs
- prostacyclin analogs
- endothelin antagonist
- phosphdiesterase type 5 inhibitors
- anticoagulants
- drugs to > cardiac output
- drugs to < volume overload
- inotropic agents
- diuretic |
|
|
Term
|
Definition
| involves correction/management of underlying cause |
|
|
Term
|
Definition
| - create interatrial defect by allowing rt to left shunting and > systemic output, lung transplant |
|
|
Term
|
Definition
- afterload reduction
- inotrophics (digoxin)
- diuretics (loop) |
|
|
Term
|
Definition
- pneumococcal vaccine
- flu vaccine
- smoking cessation
- O2 supplementation to sat > 90% at all times
- no cure
- overall prognosis poor |
|
|
Term
|
Definition
- loop diuretics 1st line therapy
- furosemide (lasix)
- give IV despite > incidence of ototoxicity
- metolazone (Zaroxolyn) adjunctive in pts initially refractory to furosemide or in renal dysfunction |
|
|
Term
| Tx of pulm edema: nitrates |
|
Definition
| - < myocardial O2 demand by lowering preload and afterload, SL, nasal spray, IV (for severe signs of HF or pulm edema) |
|
|
Term
| tx of pulm edema: analgesics |
|
Definition
- morphine - anxiolytic effects
- vasodialation (< preload) causes arterial dilation = < systemic vascular resistance & may > CO |
|
|
Term
| tx of pulm edema: inotropes |
|
Definition
- > cardiac contractility and vasodilation
- dobutamine
- norepi: used in protracted hypotension following adequate fluid replacement (perfuse organs)
- dopamine hemodynamic effect based on dose |
|
|
Term
| tx of pulm edema: bronchodilators |
|
Definition
|
|
Term
| tx of pulm edema: anticholinergics |
|
Definition
| - ipratropium, corticosteroids early in tx to accelerate recovery from acute COPD exacerbation and < inflammation in asthma |
|
|
Term
| Indication for drotregcogin alfa (Xigris) |
|
Definition
- inhibition of factors Va and VIIIa limiting thrombotic events
- probable blockade of inflammatory responses infvolved in sepsis |
|
|
Term
| AEs of drotregcogen alfa (Xigris) |
|
Definition
- Bleeding: hemorrhage is possible at any site throughout the body
- Immune rxn (Ab production)
- discontinue antiplatelets, anticoags, thrombolytics |
|
|
Term
|
Definition
- HTN
- HF
- post MI
- recurrent stroke prevention
- diabetic nephropathy |
|
|
Term
|
Definition
(prils)
- dry cough
- hypotension
- hyperkalemia esp when given with NSAIDs, aldo antagonist, < renal fxn)
- angioedema
- renal failure: patients w/ bilateral renal stenosis)
- fever, rash |
|
|
Term
|
Definition
|
|
Term
|
Definition
- Young
- caucasion
- AA w/ loop
- ACS, Post MI, CVD symp or asym vent dysfunction
- DM
- end stage renal failure |
|
|
Term
|
Definition
- artans
- alternative to ACE inhibitors
- HTN
- HF
- prevention of diabetic nephropathy |
|
|
Term
|
Definition
- artan
- similar to ACEI- less risk of cough & angioedma
- teratogenic |
|
|
Term
|
Definition
- artan
- renal disease
- DM
- symptomatic ventricular dysfunction or end stage HD |
|
|
Term
|
Definition
- HTN w/ stable angina
- Post MI
- ACS
- Symptomatic/Asymptomatic ventricular dysfunction
- DM |
|
|
Term
|
Definition
- Bradycardia
- hypotension
- S&S of HF
- CNS: fatigue, nausea
- sexual dysfunction |
|
|
Term
|
Definition
- avoid in Asthma/COPD
- bronchoconstriction
- Unstable HF may cause decompensation
- PVD
- more effective in young, caucasian
- HTN w/ comorbid disease (previous MI, CHF, Migraines, Angina, SVT) |
|
|
Term
|
Definition
- may cause angina
- MI
- sudden death ( patients with ischemic HD) |
|
|
Term
|
Definition
- HTN
- angina
- Supraventricular tachycardia (dihyropyridines) |
|
|
Term
|
Definition
- Constipation (verapamil)
- Dizziness
- HA
- Fatigue
- (-) inotrope |
|
|
Term
|
Definition
- AAs with HTN
- Reduce CVA/ CVD in DM |
|
|
Term
|
Definition
- CHF
- AV block (avoid in combo w/ BB) |
|
|
Term
|
Definition
|
|
Term
|
Definition
- amlodipine/norvasc - ipine
- most useful for hypertension
- less drug interactions w/ other cardiac meds (including warfarin & dig) |
|
|
Term
| Indications for loop diuretics |
|
Definition
- furosemide/lasix
- thiazide alt: for altered renal fxn
- MOST EFFECTIVE
- Used for Edematous conditions: HF, Cirrhosis w/ ascites, RF w/ volume overload |
|
|
Term
|
Definition
- DI wi/ ototoxic meds
- gout meds
- hyperuricemia
- acute hypovolemia/CV
- hypocalcemia
- hypomagnesia |
|
|
Term
| PT type for loop diuretics |
|
Definition
- SVD
- End stage heart disease
- GFR < 50 |
|
|
Term
| Indications for thiazides |
|
Definition
- initial for most HTN patients (mono or combo)
- essential HTN |
|
|
Term
|
Definition
- hypokalemia
- may predispose to digoxin toxicity & arrhythmias
- Hyponatremia
- Hyperuricemia: > serum UA by decreasing filtration of it; gout attacks
- > lipids, > calcium, > gluc
- volume depletions - ortho HTN, dizziness
- skin: photosensitivity, SJS
- hypersensitivity: sulfa - allergics
- rare BM suppression, vasculits, interstitial nephritis, dermatitis |
|
|
Term
| Pt type for loop diuretics |
|
Definition
- HF stage A
- DM
- cerebrovascular disease
- GFR > 50 |
|
|
Term
| Indications for K sparing diuretics |
|
Definition
- aldosterone antagonist; spironolactone
- diuretic |
|
|
Term
| AEs of K sparing diuretics |
|
Definition
- GI upset
- peptic ulcers
- hormonal : gynecomastia, menstrual irregularities, hyperkalemia |
|
|
Term
| DIs of K sparing diuretics |
|
Definition
- other meds that may cause hyperkalemia
- ACEIs, ARBs, NSAIDs, meds w/ hormonal effects |
|
|
Term
| PT type for K sparing diuretics |
|
Definition
- symptomatic ventricular dysfunction or end stage HD
- DM |
|
|
Term
| Indications for vasodilators: hydralizine |
|
Definition
| - hydralizine: HTN, HTN in preg |
|
|
Term
| Indications for Vasodilators |
|
Definition
| Minodixil: severe/refractory HTN, topically to treat male pattern baldness |
|
|
Term
| AEs of vasodilators: Hydralizine |
|
Definition
- HA
- tachycardia
- nausea
- sweating
- arrhythmia
- Lupus like syndrome |
|
|
Term
| AEs of vasodilators: minodixil |
|
Definition
- reflex tachycardia
- fluid retention
- hypertrichosis |
|
|
Term
| indications for alpha blockers |
|
Definition
- Cardura
- HTN
- BPH
- 3rd/4th line for HTN |
|
|
Term
|
Definition
- cardura
- postural hypotension
- tachycardia (reflex)
- edema
- syncope (esp w/ 1st dose)
- tolerance to antihypertensive effects |
|
|
Term
| Pt type for Alpha Blockers |
|
Definition
- Methyldopa (Aldomet)
- used in HTN in pregnancy
- HTN Emerg and urge |
|
|
Term
| Indications of Centrally acting adrenergics |
|
Definition
- Clonidine, Methyldopa
- Used for HTN (2nd line) |
|
|
Term
|
Definition
- clonidine, methyldopa
- dry mouth/nasal mucosa
- sedation
- rebound HTN w/ abrupt withdrawal |
|
|
Term
|
Definition
- BP > 220/10
- reduction of BP of 25% within minutes to hour
- meds: vasodilators (sodium nitroprusside, nicardipine, fenoldapam, labetolol |
|
|
Term
|
Definition
- IV
- causes prompt vasodilation (arterial/venous)
- rapid metabolism (requires continuous infusion to maintain actions) |
|
|
Term
|
Definition
- CCB
- can be given as IV infusion in HTN emergencies |
|
|
Term
|
Definition
-parenteral antihypertensive
- renal insufficiency |
|
|
Term
|
Definition
- alpha and beta non selective beta blockade
- given as IV bolus or IV infusion in hypertensive emergencies
- DO NOT CAUSE REFLEX TACHYCARDIA |
|
|
Term
|
Definition
- relieved w/ rest or nitroglycerin
- SA nitrates are 1st line tx for termination of acute episodes of angina |
|
|
Term
|
Definition
- avoid BBs: may worsen vasospasm due to unopposed a- adrenergic receptor stimulation
- NTG
-CCBs for mono therapy; but keep NTG onhand for short acting |
|
|
Term
|
Definition
- antiplatelets: inhibit cyclooxygenase: < risk of ACV events
- plavix (clopidogrel) - alternative antiplatelet for patients who cannot take ASA
- ACEIs: reduce risk of CV events in pts w/ chronic, stable angina or significant IHD risk factors
- Statins: primary & secondary prevention of CV events |
|
|
Term
|
Definition
- lifestyle modifications
- ACEI or ARB
- BB or CCB for prevention of ischemic events
- Nitrates (SA for acute or prophylaxis and LA for prevention of ischemic episodes)
- Nitrate - free interval to < tolerance
- Statins for cardio prot
- antiplatelets for CV event prophylaxis |
|
|
Term
|
Definition
- SA are 1st line tx for termination of acute episodes of angina
- subligual
- LA PO & transdermal dosage forms
- all are equally effective in prevention of recurrence of angina |
|
|
Term
|
Definition
- SA are 1st line tx for termination of acute episodes of angina
- subligual
- LA PO & transdermal dosage forms
- all are equally effective in prevention of recurrence of angina |
|
|
Term
|
Definition
- tx of angina: 0.3-0.4 mg SL
- repeat every 5 min until sx gone
- unimproved sx after 1-2 doses pt should call for EMS
- prophylaxis: use 5 minutes prior to activity (effective for 30 min) |
|
|
Term
|
Definition
- dizziness
- HA
- hypotension |
|
|
Term
|
Definition
- phosphodiesterase 5 inhibitors: hypotension
- avoid taking 24-48 hrs after nitrates |
|
|
Term
| Tx for secondary prevention following MI |
|
Definition
- ASA 81 mg qd
- clopidogrel 75 mg qd
- BB
- ACEI
- Statins
- +/- aldosterone antagonist
- NTG SL or spray
- smoking cessation
- control HTN
- wt loss
- tight control of DM |
|
|
Term
| Indications of inotropic agents |
|
Definition
- indicated in patient who remain symptomatic despite optimal HF regimen
- After initiation of ACE, BB & diuretic
- HF w/ atrial fibrillation (start slwoly) |
|
|
Term
|
Definition
- Cardiac Effects: slowing of AV conduction (arrythmias)
- GI: anorexia, N/V
- CNS effects: HA, fatigue, confusion, blurred vision, alteration of color perception (red-green or yellow-green vision)
- halos on dark objects |
|
|
Term
| Most common organisms causing endocarditis |
|
Definition
- strep viridans
- staph
- enterococci
- other: gram neg, atypical, fungal organisms |
|
|
Term
| ID common peripheral manifestations of IE |
|
Definition
- dyspnea
- malaise
- murmur
- osler nodes
- Janeway lesions
- splinter hemorrhages
- petechiae
- clubbing
- roth spots
- fever/chills
- night sweats
- weakness |
|
|
Term
| tx for most common causes of IE |
|
Definition
- high dose, bactericidal for extended period
- usually 4-6 wks
- B lactam Abs
- Penicllin G, Ampicillin, Naficillin
- some pathogens require synergistic antimicrobial combinations (like aminoglycosides) |
|
|
Term
| most common Ab used in pt requiring prophylaxis for IE |
|
Definition
- usually amoxicillin
- 2 g PO 1 hr prior to procedure |
|
|
Term
|
Definition
- procainamide: ventricular/supraventricular Tachy
- quinidine: atrial and ventricular tachy |
|
|
Term
|
Definition
| lidocaine IV and phenytoin: ischemic myocardium and ventricular tachy |
|
|
Term
|
Definition
| - flecainide, propafenone: ventricular arrythmias |
|
|
Term
|
Definition
| BBs: used for post MI and reentry arrhythmia |
|
|
Term
|
Definition
- K channel blockers
- amiodarone, ibutilide, dofetilide, sotalol: suppress tachyarrhythmias by re-entry mechanisms |
|
|
Term
|
Definition
- ca channel blockers
- (nondihydropyrimidines)
- Verapimil and Diltilazem: vasodilation, negative inotrope and neg chronotrope, blocks reentry |
|
|
Term
| class 1 a AEs: procainamide |
|
Definition
| - procainamide: Lupus like syndrome, hypotension |
|
|
Term
|
Definition
toxicity-cinchonism
-blurred vision
-tinnitus
- HA
- psychosis
- enhanced digitalis toxicity |
|
|
Term
| class 1a AEs: Dysopyramide |
|
Definition
- Toxicity-cinchonism
- blurred vision
- tinnitus
- HA
- psychosis
- enhanced digitalis toxicity |
|
|
Term
|
Definition
- toxicity
- CNS: seizures, drowsiness
- avoid in high grade heart block suppressed ventricular automaticity may be lethal by preventing alternative rhythms in complete heart block
- phenytoin has less pronounced effects |
|
|
Term
|
Definition
- precipitation of arrhythmias
- CNS stimulation
-CV depression
- allergic reactions
- toxicity is worsened by electrolyte abnormalities |
|
|
Term
| Class 1c: Black Box Warning |
|
Definition
- CAST: Cardiac arrhythmia suppression trial found that treating with class IC drugs for asymptomatic ventricular arrhythmias who had an MI more than 6 days but < 2yrs had an excessive mortality or non fatal cardiac arrest when compared to carefully matched placebo control group
- only reserved for non life threatening arrhythmias |
|
|
Term
|
Definition
LOLS:
arrhythmias
bradycardia
heart failure
hypotension
GI reactions, such as nausea, vomiting, and diarrhea
bronchoconstriction. |
|
|
Term
|
Definition
- similar to IA drugs
- precipitation of arrhythmias: Torsades
- caution w/ other drugs that may cause QT prolongation
- sotalol sinus bradycardia
- AV block
- fatigue
- torsades de pointes |
|
|
Term
|
Definition
- negative inotropic effect
- hypotension
- avoid use w/ class II |
|
|
Term
| hemodynamically unstable AF |
|
Definition
- direct current cardioconversion is recommended
- AMS, hypotension (shock)
- Ventricular rate > 150 bpms
- chest pain suggestive of MI |
|
|
Term
|
Definition
- inhibiting number of impulses conducted from atria to ventricles
- drugs that inhibit AV nodal conduction
- BBs, CCBs-Diltiazem/Verapamil, Digoxin
- IV meds usually work for 1st timers |
|
|
Term
| PSVT: hemodynamically unstable |
|
Definition
|
|
Term
| PSVT: Hemodynamically stable |
|
Definition
| - vagal maneuvers: inhibits AV conduction (parasym) if fails -> adenosine - DOC if unsuccessful tx depends on CV fxn - non pharmacologic - radiofrequency ablation |
|
|
Term
|
Definition
|
|
Term
|
Definition
- tx of hemodynamically unstable V tachy
- DCC and drugs for term of V tach
- Lidocaine
- Procainamide
- amioderone |
|
|
