Term
| what is used to treat chickenpox or disseminated zoster in immunocompromised patients? |
|
Definition
1)acyclovir
2)valacyclovir |
|
|
Term
| how is acyclovir administered in the case of a severe variceela (disseminated, pneumonia, meningitis) infection? |
|
Definition
| IV for 10-14 days, oral once stabilized |
|
|
Term
| how is valacyclovir administered? |
|
Definition
|
|
Term
| what is used to treat Candidiasis? |
|
Definition
|
|
Term
| what can be given to refractory cases of candidiasis that don't respond to flucanazole? |
|
Definition
1) try voriconazole or itraconazole
2)IV echinocandins -caspofungin, micafungin
3)IV amphotericin B – not as tolerated due to kidney toxicity |
|
|
Term
| what is the treatment for penumocystis penumonia in AIDS patients? |
|
Definition
| sulfamethoxazole/trimethoprim |
|
|
Term
| how is Toxoplasma treated in HIV patients? |
|
Definition
| sulfadiazine and pyrimethamine (add leucovorin to prevent marrow toxicity) |
|
|
Term
| when does the opportunistic infection prophylaxis start to be less affective in HIV patients? |
|
Definition
|
|
Term
| what is the treatment for CMV retinitis? |
|
Definition
|
|
Term
| what prophylactic treatments are given when CD4 counts fall below 100? |
|
Definition
1)daily trimethoprim-sulfamethoxazole for pneumocystis penumonia and CNS toxoplamsosis
2) weekly flucanzole for cryptococcal meningitis |
|
|
Term
| what is used for prophylaxis of MAC when CD4 is below 50? |
|
Definition
| macrolides - azithromycin |
|
|
Term
| what can be used for prophylaxis of CMV retinits? |
|
Definition
| valancyclovir - controversial bc of bone marrow toxicity and very expensive |
|
|
Term
| what should be used in addition to pyrimethamine/sulfadiazine when treating Toxoplasmosis if you see a midline shift? |
|
Definition
| adjunct steroids should be given |
|
|
Term
| what is the treatment for cryptococcal meningitis in AIDS patients? |
|
Definition
IV - amphotericin B + flucytosine
may need daily spinal taps to decrease ICP
may change to oral fluconazole AFTER IV therapy for 2-3 weeks |
|
|
Term
| what should be used to maintain suppression of cryptococcal meningitis until HIV therapy can bring immune system back up in HIV patients? |
|
Definition
|
|
Term
| what is the treatment for histoplasmosis that is disseminated or has caused meningitis in a HIV patient? |
|
Definition
IV amphotericin B - 21 days
then switch to oral itraconazole or voriconazole
*Make sure to diff. b/t histo and cryptococcus b/c fluconazole is NOT effective against histoplamosis) |
|
|
Term
| what is the treatment for disseminated coccidiomycosis in HIV? |
|
Definition
| treat with flucanzole - can add amphotericin if get meningitis (treated like crypotcoccus) |
|
|
Term
| what is used to treat legionella in HIV? |
|
Definition
|
|
Term
| what is used to treat disseminated TB in HIV? |
|
Definition
| isoniazid, rifampin, ethambutol, pyrazinamide |
|
|
Term
| what is the drug of choice for an atypical pneumonia caused by strongyloides in HIV? |
|
Definition
|
|
Term
| what is the treament for MAC in HIV? |
|
Definition
3 antimycobacterial drugs + HAART
1)macrolide (azithromycin or clarithromycin)
2)rfiampin or *rifabutin
3)ethambutol |
|
|
Term
| what is the primary goal of treating CMV retinitis? |
|
Definition
|
|
Term
| what is used for the treatment of CMV retinitis in HIV? |
|
Definition
1)IV gancyclovir -induction dose for a few weeks then used for chronic suppression until immune system brought back up
2) oral alternative - valgancyclovir |
|
|
Term
| what is a problmeatic side effect of gancyclovir and valgancyvlovir? |
|
Definition
| bone marrow toxicity- can acuse anemia/ neutropenia |
|
|
Term
| what can be used for salvage or intolerance to valgancyclovir when treating CMV retinitis? |
|
Definition
| vitreal implants filled with CMV drugs |
|
|
Term
| maraviroc blocks what? and is part of what category of drugs? |
|
Definition
| CCR4 and CCR5 and is a fusion inhibitor drug |
|
|
Term
| side effects of AZT (zidovudine)? |
|
Definition
|
|
Term
| side effect of D4T (stavudine)? |
|
Definition
|
|
Term
| side effect of DDI (didanosine)? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| side effect of tenofovir? |
|
Definition
|
|
Term
| side effect of all drugs in NRTI class? |
|
Definition
| lactic acidosis (rare, stop the drugs or pt WILL die) |
|
|
Term
| side effects of stavudine (D4T) + lamivudine? |
|
Definition
1)peripheral neuropathy
2)lipotrophy (haggard face)
3)lactic acidosis |
|
|
Term
| side effects of didanosine (DDI, videx) + lamivudine? |
|
Definition
1)peripheral neuropathy
2)pancreatitis |
|
|
Term
|
Definition
1)nevirapine
2)efavirenz
3)etravirine |
|
|
Term
| side effects of nevirapine? |
|
Definition
| rash, hepatotoxicity, (Do not use in females with CD4 >250, males >400) |
|
|
Term
| side effects of efavirenz? |
|
Definition
| rash, dizziness, drowsiness, very vivid dreams, can have neuropsych effects, teratogenic |
|
|
Term
| ritonavir is not used very often now as a PI for AIDs b/c of what mechanism? |
|
Definition
| very profound P450 inhibition. so its used only in low doses now to boost other PIs |
|
|
Term
| Pro for NNRTIs versus NRTIs ? |
|
Definition
| There is less fat maldistribution |
|
|
Term
| class side effects of protease inhibitors? |
|
Definition
1)lipodystrophy
2)glucose intolerance
3)drug interactions |
|
|
Term
| what are the 5 classes of antiretroviral therapy? |
|
Definition
1)NRTIs (nucleoside analogue reverse transcriptase inhibitors)
2)NNRIs (non-nucleoside analogue reverse transcriptase inhbitors)
3)Pis ( protease inhibtors )
4)FI ( fusion inhibitors )
5)Int I (Integrase inhibitor ) |
|
|
Term
| side effects of indinavir? |
|
Definition
| kidney stones = nephrolithiasis |
|
|
Term
| side effects of nelfinavir? |
|
Definition
|
|
Term
| side effects of lopinavir/norvir? |
|
Definition
| diarrhea, nausea and vomitting |
|
|
Term
| side effects of atazanavir? |
|
Definition
bilirubinemia, headache, GI symptoms
but doesn't have the lipodystrophy like all the other protein inhibitors |
|
|
Term
| what do fusion inhibitors target? |
|
Definition
|
|
Term
| what classes of antiretroviral drugs target reverse transcriptase? |
|
Definition
|
|
Term
|
Definition
| fat maldistribution, dyslipidemia, insulin resistance, drug interactions |
|
|
Term
| cons for use of atazanavir (PI)? |
|
Definition
| bilirubinemia and proton pump inhibitors greatly reduce its absorption |
|
|
Term
| How do protease inhibits work as an antiretroviral? |
|
Definition
| they inhibit the maturation of the virus resulting in production of non viable virus |
|
|
Term
| what is the mechanism of NRTIs (nucleoside analogue reverse transcriptase inhibitors)? |
|
Definition
| they bind DNA chain, thus blocking transcription |
|
|
Term
| what is the machanism of NNRIs (non-nucleoside analogue reverse transcriptase inhbitors)? |
|
Definition
| they bind the enzyme, reverse transcriptase, and prevent transcription |
|
|
Term
| Cons for using enfuvirtide (fusion inhibitor)? |
|
Definition
| PAIN at daily injection sites |
|
|
Term
| what is the critical combination therapy for HAART composed of? |
|
Definition
3 highly active antiretrovirals -
Always critical to have a working backbone of therapy with 2 NRTIs or 1 NRTI + 1 NNRTI plus a third highly active agent |
|
|
Term
| cons for using maravaroc (fusion inhibitor)? |
|
Definition
| targeting of CCR5 often mutates to targeting CCR4 and it no longer works |
|
|
Term
| pros for using raltegravir (integrase inhibitor)? |
|
Definition
| no cross resistance or drug interactions and well tolerated |
|
|
Term
| what is used for prophylaxis of Toxoplasmosis and Pneumocystis jiroveci? |
|
Definition
| trimethoprim/sulfamethoxazole |
|
|
Term
| what are the side effects of Combivir? |
|
Definition
| bone marrow suppression - esp anemia |
|
|
Term
| name the HAART drugs that shouldn't be used in pregnancy (4) |
|
Definition
efavairenz
nelfinivir
didanosine
stavudine |
|
|
