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Naplex
HIV
| Question | Answer |
|---|---|
| Q1. CD4 < 200 cells/mm3 | - Risk of Opportunistic infections - Risk of specific malignancies Kaposi's sarcoma |
| Q2. Risk of Kaposi's sarcoma | CD4 < 200 cells/mm3 |
| Q3. HIV Transmit | Body Fluids: - Blood - Breast milk - Seminal, vaginal, or rectal fluid Direct contact infected fluid and mucous membranes or open wounds |
| Q4. Common Transmission Routes | • Unprotected (eg, condomless) vaginal or rectal sexual intercourse • Sharing injection drug equipment (eg, needles) • Perinatal transmission (mother-to-child) during pregnancy, delivery, or breastfeeding |
| Q5. Symptoms of Acute infection | • Non-specific flu-like symptoms (eg, fever, myalgia, swollen lymph nodes, rash) • Symptoms last a few days to weeks |
| Q6. AIDS-defining condition | • Opportunistic infections (Ols) • Malignancy (eg, Kaposi's sarcoma) • HIV wasting syndrome (lost of of fat tissue, muscle mass, appetite and diarrhea that leads to low body weight) |
| Q7. Treatment of HIV wasting syndrome (lost of appetite, weight, ...) | • Dronabinol (Marinol_capsule CIII, Syndros_PO solution CII) • Megestrol (a progestin) |
| Q8. Testing window: | 4-12 weeks |
| Q9. Over-the-Counter HIV Testing | OraQuick In-Home HIV Test • Detects HIV antibodies from oral swab • Positive result: f/u w a confirmatory test (blood draw) • False-negative: testing < 3 mo post-exposure |
| Q10. HIV Life Cycle ART works on (1) (2) (3) (4) | (1) Attachment: CD4 & Coreceptor (CCR5 or CXCR4) (2) Fusion (3) Reverse Transcription: HIV RNA into HIV DNA (4) Integration: HIV DNA into the host cell DNA (5) Transcription & Translation: protein production (6) Assembly (7) Budding - Maturation |
| Q11. Maraviroc MoA | • Selzentry: Binding & Attachment CCR5 • Tropism • Hepatotoxicity • NOT w St John's Wort |
| Q12. Ibalizumab MoA | - Trogarzo - Binding & Attachment: CD4 |
| Q13. Fostemsavir MoA | • Rukobia: Binding & Attachment GP120 |
| Q14. Enfuvirtide MoA | ,• Fuzeon: Fusion gp41, SQ • NOT re-challenge if systemic reactions • Pneumonia |
| Q15. NRTIs & NNRTIs | Block Reverse Transcription |
| Q16. INSTIs | Integration |
| Q17. Protease inhibitors PI | Maturation |
| Q18. Capsid inhibitors | - Nuclear Import - Budding - Maturation |
| Q19. NRTIs (Z LATTE) | - Zidovudine (Retrovir) - Lamivudine (Epivir) - Abacavir (Ziagen) - Tenofovir disoproxil fumarate, TDF (Viread) - Tenofovir alafenamide, TAF (Vemlidy) - Emtricitabine (Emtriva) |
| Q20. NRTI with NO renal dose adjustment | - Most: QD (except Z: BID both PO and IV) - Abacavir (Ziagen): NO renal dosing, HLA-B 5701 |
| Q21. NRTI oral powder formulation | - TDF oral powder: mix with 2-4 oz of soft food (eg, applesauce, yogurt) to avoid bitter taste |
| Q22. Lamivudine doses for HBV vs HIV | - HBV: lower dose, & should not be used for HIV |
| Q23. NRTI for during labor & delivery for perinatal transmission prophylaxis | Zidovudine: IV during labor & delivery for perinatal transmission prophylaxis |
| Q24. Initial Evaluation & Monitoring of HIV | - CD4 count - Viral load - Resistance testing - CMP, CBC, lipids, UA - Hepatitis B & C (HBV & HCV), STIs - Pregnancy test - Therapy-specific tests (HLA-B*5701 (abacavir), tropism assay (maraviroc) |
| Q25. Abacavir (Ziagen): HLA-B*5701 test to avoid | Life-threatening hypersensitivity reaction |
| Q26. Preferred Initial ART Regimens in Most Treatment-Naive Adults | - Biktarvy - Dovato - Tivicay + Truvada - Tivicay + Descovy |
| Q27. Dovato: Preferred Initial ART Regimens in | - Dolutegravir/lamivudine - Naive Adults Criteria for use - VL < 500,000 copies/mL - NO HBV coinfection & no resistance |
| Q28. Combination of emtricitabine / lamivudine is a common backbone | - NOT combine Emtri and Lamivudine - Chemical structure is nearly identical, and they would compete with each other. |
| Q29. ART in pregnancy - New starts: | - 3 components recommended Dolutegravir or boosted darunavir (DOL-DAR), PLUS • Dual NRTI backbone (eg, emtricitabine/tenofovir) |
| Q30. IRIS stands for: | Immune Reconstitution Inflammatory Syndrome |
| Q31. STOP ART if IRIS happens | FALSE - Continue ART - Treat underlying condition (eg, opportunistic infection) - Provide supportive care (eg, fluids, antipyretics) |
| Q32. What NRTIs NOT interrupted if co-infected HBV | - Lamivudine (Epivir) - Emtricitabine (Emtriva) - Tenofovir (TDF Viread or TAF Vemlidy) |
| Q33. NRTI warnings (L - H - R) | - Lactic acidosis - Hepatomegaly with steatosis (Fatty liver) - Renal dose adj (except Acabavir / Ziagen) |
| Q34. NRTI common SEs | - Nausea - Diarrhea |
| Q35. After hypersensitivity reaction, Rechallenge acabavir / Ziagen is clinically reasonable | NO |
| Q36. NRTI has SE of Hyperpigmentation of palms of hands and soles of feet | - Emtricitabine (Emtriva) - No harm, ctn ART |
| Q37. STOP emtricitabine (Emtriva) if Hyperpigmentation of palms of hands and soles of feet | - FALSE - it's no harm - Ctn ART |
| Q38. NRTI causes osteoporosis | - te N O F ovir (TDF Viread or TAF Vemlidy) |
| Q39. Fanconi syndrome | - Rare renal disorder caused by tenofovir |
| Q40. If switching TDF to TAF, causes | - Lipid abnormalities |
| Q41. What NRTI causes Hematologic toxicity (neutropenia & anemia) | - Zidovudine (Retrovir) |
| Q42. INSTI BC RED: "-tegravir" | - Bictegravir - Cabotegravir (Vocabria: PO for leading/bridging, Apretude: IM for PrEP) - Raltegravir (Isentress BID, Isentress HD) - Elvitegravir - Dolutegravir (Tivicay) |
| Q43. SEs for AIl INSTIs | • Weight gain • Nervous system/psychiatric effects (eg, insomnia, depression) |
| Q44. D/c Bictegravir & dolutegravir SCr increased | • NO • Bictegravir & dolutegravir cause ARTIFICAL Increased SCr (no effect on GFR) |
| Q45. ALL INSTIs cause Increased SCr | • Bictegravir & dolutegravir cause ARTIFICAL Increased SCr (no effect on GFR) |
| Q46. What INSTIs causes Muscle toxicity | • Dolutegravir & raltegravir • Muscle toxicity (increase CPK, myopathy, and/or rhabdomyolysis) |
| Q47. What INSTIs causes Hypersensitivity reactions | • Dolutegravir & raltegravir • Hypersensitivity reactions: rash, fever, allergic reaction symptoms |
| Q48. Beside class SEs, what is the other SEs of Cabotegravir | • Injection site reaction (for IM formula) |
| Q49. What INSTIs causes Hepatotoxicity | • Dolutegravir • Hepatotoxicity (particularly if coinfection with hepatitis B or C) |
| Q49. What INSTIs need a PK booster | • Elvitegravir • Coformulated with cobicistat, a strong CYP3A4 inhibitor • Always watch out for DDI |
| Q50. What INSTIs has Highest risk for myopathy/elevated CPK | • Raltegravir • via UGT metabolize |
| Q51. What INSTIs Class drug interactions | • Separate from polyvalent cations (Al, Mg, Ca, Fe) |
| Q52. What R recall for INSTIs | Raltegravir - R - Rhabdomyolysis. |
| Q53. NNRTIs REDEN: "-vir-" | • Rilpivirine (Component of Complera, Odefsey, Cabenuva & Juluca) • Efavirenz (component of Symfi & Symfi Lo) • Doravirine (Pifeltro) Component of Delstrigo • Etravirine (Intelence) • Nevirapine |
| Q54. What NNRTIs needs to take w FOOD | • Rilpivirine РО: Take with a meal & water • Do not use with PPIs, H2RAs • Depression • ARTIFICAL elevated SCr |
| Q55. What NNRTIs needs to take on EMPTY STOMACH | • Efavirenz • Food INCREASE bioavailability & risk for CNS effects • Take on an empty stomach & at bedtime • ELEVATED total cholesterol & triglycerides |
| Q56. What class SEs for All NNRTIs | • Hepatotoxicity • Severe rash, including SJS/TEN (highest risk with nevirapine) |
| Q57. What NNRTIs drug interactions | • All have risk for CYP450 drug interactions • Avoid strong CYP inducers (with doravirine, rilpivirine) |
| Q58. Cabenuva is for both PrEP and PEP | • Cabenuva is IM formulation (injection site reactions) • Rilpivirine + cabotegravir: QM / Q2M, and for treatment |
| Q59. All INSTIs have DDI with monovalent cations | • NO • DDI with polyvalent cations (Al, Mg, Ca, Fe) • Separate from polyvalent cations: POLY - 6hrs - INSTIs - 2hrs-POLY • Dolutegravir & bictegravir can be taken with calcium- or iron-containing supplements if also taken with food. |
| Q60. Protease Inhibitors? "-navir" DA R | • Darunavir (Prezista), Component of Symtuza & Prezcobix • Atazanavir (Reyataz), Component of Evotaz • Ritonavir • Fosamprenavir • Lopinavir/ritonavir (Kaletra) • Tipranavir (Aptivus) |
| Q61. Similarly to NRTIs, all PI need renal dose adjustment | • NO renal dose adjustment • same with Abacavir (Ziagen) |
| Q62. Darunavir & atazanavir are taken on EMPTY stomach | • NO • Darunavir & atazanavir are taken with food to reduce GI upset • Atazanavir: Needs an acidic gut for absorption |
| Q63. PIs safety concerns (CV risk) | • Diarrhea, nausea • Hyperglycemia/insulin resistance, dyslipidemia, lipodystrophy • Hepatotoxicity (eg, elevated LFTs, hepatitis) • Hypersensitivity reactions (eg, rash, SJS/TEN) • Drug interactions |
| Q64. Atazanavir safety concerns | • Hyperbilirubinemia (reversible): Yellow • Avoid PPIs with unboosted atazanavir • Separate boosted atazanavir: take 12 after PPI (Do not exceed 20 mg omeprazole or equivalent) |
| Q65. Darunavir cautions | • Caution with sulfa allergy |
| Q66. Lopinavir/ritonavir safety concerns | • PO solution: 42% alcohol (disulfiram reaction with metronidazole) |
| Q67. What PIs have the lowest CVD risk | • Darunavir and atazanavir |
| Q68. Cobicistat is taken on Empty stomach | • NO • 150 mg PO daily with FOOD • Can artificially elevated SCr (no effect on GFR) |
| Q69. ART taken on EMPTY stomach | • Efavirenz |
| Q70. ART taken with FOOD | • Cobicistat • Rilpivirine РО: Take with a meal & water • Darunavir & atazanavir • TAF Vemlidy |
| Q71. PEP treatment option | • Start ASAP (≤ 72 hours) after HIV exposure, continue for 28 days • Before starting, Obtain: HIV test, SCr, and hepatitis B serologies Complete HIV regimen: • Truvada (if CrCI ≥ 60 mL/min) PLUS Dolutegravir or raltegravir |
| Q72. TRUE or FALSE: Western Blot test for screening and ELISA test for confirming the diagnosis of HIV | • FALSE • ELISA test (HIV antibodies) for screening and Western Blot test (HIV-1 antibodies) for confirming the diagnosis of HIV |
| Q73. What tests are ordered during the initial visit to an HIV clinic | • CD4 count • HIV RNA count (viral load) • Resistance testing |
| Q74. Mepron | • Atovaquone |
| Q75. Nebupent | • Aerosolized pentamidine |
| Q76. What is recommended for MAC prophylaxis in HIV patients who are not on fully suppressive antiretroviral therapy and have a CD4 cell count below 50 cells/microL? | MAC = Macrolide • Azithromycin 1200 mg PO QW • Azithromycin 600 mg twice weekly • Clarithromycin BID |
| Q77. Dovato | • Dolutegravir/lamivudine • 1st line naive |
| Q78. Triumeq | • Dolutegravir/abacavir/lamivudine • Test for HLA-B*5701 |
| Q79. Juluca | • Dolutegravir/rilpivirine • Replace therapy for undetectable viral load |
| Q80. Cabenuva | • Cabotegravir/rilpivirine • Replace therapy for undetectable viral load • IM administration |
| Q81. Biktarvy | • Bictegravir/emtricitabine/tenofovir alafenamide (TAF) • 1st line naive |
| Q82. Triumeq | • Dolutegravir/abacavir/lamivudine • Test for HLA-B*5701 |
| Q83. Stribild | • Elvitegravir/cobicistat/emtricitabine/tenofovir DF • Take with food (due to cobicistat) |
| Q84. Genvoya | • Elvitegravir/cobicistat/emtricitabine/TAF • Take with food (due to cobicistat) |
| Q85. Odefsey | • Rilpivirine/emtricitabine/TAF • Take with food (2/2 Rilpivirine) |
| Q86. Complera | • Rilpivirine/emtricitabine/tenofovir DF • Take with food (2/2 Rilpivirine) |
| Q87. Symtuza | • Darunavir (PI) /cobicistat/emtricitabine/TAF • Take with food (due to cobicistat) |
| Q88. Truvada | • Emtricitabine/TDF • Dual NRTI |
| Q89. Descovy | • Emtricitabine/TAF • Dual NRTI |
| Q90. Epzicom | • Abacavir/lamivudine • Test for HLA-B*5701 • Dual NRTI |
| Q91. Combivir | • Lamivudine/zidovudine • Dual NRTI |
| Q92. Cimduo | • Lamivudine/TDF • Dual NRTI |
| Q93. Evotaz | • Atazanavir (PI) /cobicistat • Take with food (due to cobicistat) |
| Q94. Prezcobix | • Darunavir (PI) /cobicistat • Take with food (due to cobicistat) |
| Q95. Delstrigo | • Doravirine (NNRTI) /lamivudine/tenofovir DF |
| Q96. Symfi, Symfi Lo | • Efavirenz (NNRTI)/lamivudine/tenofovir DF • Take on an empty stomach (2/2 Efavirenz) |
| Q97. Atripla (still used by some HCPs) | • Efavirenz/emtricitabine/tenofovir DF • Take on an empty stomach (2/2 Efavirenz) |
| Q98. What ART elevates Lipids PAS BLT | • PIs • Antipsychotics • SGLT2 inhibitors • Beta blocker • Loops • Thiazides |
| Q99. PrEP treatment option | • TRUVADA (NOT given if CrCl < 60), for non-vaginal intercourse • DESCOVY (NOT given if CrCl < 30) • Apretude (Cabotegravir) IM Q2M (NOT given if CrCl < 30) |
| Q100. What ART causes ARTIFICAL elevated SCr B C D R | • Bictegravir • Cobicistat • Dolutegravir • Rilpivirine |
| Q101. What are ART taken with food | • Atazanavir • Cobicistat • Darunavir • Rilpivirine • TAF |
| Q102. All single tablet regimens with NRTIs have renal dose adjustments. CrCI cutoffs for initiation : | • < 70 mL/min: Stribild (Elvitegravir / Cobicistate / Emtricitabine / TDF) • < 50 mL/min: TDF-containing products • < 30 mL/min: TAF-containing products |
| Q103. Bactrim for HIV pt | • Treatment / ppx of PCP • Ppx for toxoplasmosis • Alternative for PCP ppx: Dapsone, Mepron, and aerosolized pentamidine • BMS, renal dose adj |
| Q104. Intelence | • Etravirine (ETR) • NNRTI |
| Q105. Sustiva | • Efavirenz, NNRTI, empty stomatch • HA, nightmares, a feeling of being "hung over" aggressive behavior, depression • Avoid: substance abuse • Rash, lipid abnormalities. |
| Q106. Prezista | • Darunavir, PI • Food, sulfa allergy |
| Q107. LEXIVA | • Fosamprenavir • Metabolise abnormal, CVD risk • Hepatic damage • Sulfa allergy • NOT w Red Yeast Rice, St. John's Wort |
| Q108. Vitekta | • Elvitegravir |
| Q109. Didanosine | • Videx, Videx EC, NRTI • Retinal changes, optic neuritis • Pancreatitis: epigastric abdominal pain, elevated lipase / amylase • Peripheral neuropathy |
| Q110. Stavudine | • Zerit • NRTI • Pancreatitis: epigastric abdominal pain, elevated lipase / amylase • Peripheral neuropathy |
| Q111. Norvir | • Ritonavir, PI / booster |
| Q112. Look alike sound alike" Fos_avir" | • FostemSAVIR (Rukobia): Binding & Attachment gp120 • FosampreNAVIR, Lexiva: PI |
| Q113. Aptivus | • Tipranavir, PI • Neuro hemo |
| Q114. ReyATAr | • ATAzanavir, PI |
| Q115. What ART cause rash as a class | • Incl SJS • NNRTI & PI • More w Nevirapine, followed by Efavirenz |
| Q116. Aptivus | • Tipranavir |
| Q117. Crixivan | • Indinavir sulfate • Empty stomatch |
| Q118. Maraviroc DDI w efavirenz, what dose of | • D 600 mg PO BID |
| Q119, Sulfa allery | • Tipranavir • Fosamprenavir • Darunavir |
| Q120. Rescriptor | • Delavirdine, NNRTI |
| Q121. ART prolongs PR interval | • Atazanavir / AV blockers. |
| Q122. SC Yeztugo | • Lenacapavir Q6M • PrEP |
Created by:
dao.vo11017