Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
IOS 11 Exam 3
Pharmacotherapy for HIV infection
| Question | Answer |
|---|---|
| Global estimation of population with HIV | 39.4 million |
| Global New cases of HIV in 2004 | 4.9 million |
| Global deaths from HIV in 2004 | 3.1 million |
| Percent of patients with HIV | MSM-57%, Femal-heterosexual 71%, IVDU important in both gendars |
| Trends in HIV death rates | In 1993-95 leading cause of death but1995 decline due to drugs, no others have declined |
| Projection for 2002 HIV life | Estimation that 80% surive 108 months after diagnosis |
| Time life of major HIV interventions 1989 | PCP -bactrium effective in prevention |
| Time life of major HIV interventions 1994 | MAC prophylaxis difficult infection to treat |
| Time life of major HIV interventions 1995 | Prevention of maternal transmission |
| Time life of major HIV interventions 1997-2004 | Multiple antiretroviral therapy |
| Currently there are -classes and- number of agents | 4 classes and 22 agents |
| Survival benefit of AIDS therapy in the US | 3 million years of life saved |
| Greates per person survival gain is with | PCP/MAC/Anritretroviral (4 drugs) increased to 91% |
| Lifecycle of HIV | Absorption, penetration & uncoating, reverse transcription, Integration, Assembly |
| Penetration & uncoating of HIV | Fusion and penetration can only be inhibited by 1 drug-Efuvirtide |
| Reverse transcription of HIV | Can be inhibited by NRTis and Nono-NRTis |
| Integration of HIV | Integration, Transcription-Translation- inhibtitors all investigational |
| On going Replication of HIV | Has primary role in onset and progression of the disease. Halting replication can prevent further progression (for a period of time) |
| 2 surrogate markers of HIV | Plasma HIV RNA(viral load) and CD4 count (normal>750 |
| General principals for monitoring opportunistic infections | Prospective monitoring, primary prophylaxis, treatment and secondary prophylaxis |
| Goals for HIV treatment (5) | Reduce HIV related morbidity& mortality, Improve QALY, restore & preserve immune function, suppress HIV replication, Reduce HIV1 RNA below limit of detection (<50) in 16-24 weeks of therapy for naive patient |
| Predictors of long term success (5) | Potency of drug regimen, adherence, Low basline HIV-RNA, High baseline CD4, Rapid reduction of HIV-RNA with treatment (>1log drop in 1-4 months) |
| When to treat asymptomatic patients | CD4 <350 and and any HIV-RNA if CD4> 350 and HIV-1RNA <100,000 defer |
| Evidence on treating with older therapy | Treating early better but we do not have data with new treatment medications |
| Preferred therapy NNRTI | Efavarinz, or Atazanavir or Fos-ampranivir or Lopinavir/rit + (truvada or Combivir) |
| Alternative to preferred | Atazanavir or fosamprivavir or Fos-amprinavir/rit or Lopinavir/rit + (abacavir + lamovudine) or (didanosine + emtricitabine or lamivudine) |
| Triple NRTI combination considered | Inferior to preferred but aceptable- Abacavir +lamivudine+ zidovudine (Trizivir-BID) |
| Not recommended due to hyperbilirubin | Atazanavir + Indinavir |
| Not recommended due to mitochondria toxcity | Didanosine +stavudine |
| Not recommended due to early virologic failure due to CD4 toxcity | Didanosine + tenofovir |
| Not recommended due to both thymidien analoges | Zidovudine + stavudine |
| Trial PI vs NNRTI regimen result | Same success rates in viral load reduction (<50 HIV RNA) but PI slightly better improving CD4 count |
| Trial Fos-APV/r & LPV/r | No difference in CD4 and HIV RNA, both well tolerated |
| LPV/r BID) + 3TC (lamivudine) +d4T (stavudine) | Potent and durable viral suppression & CD4 cell gain- 98% of subjects able to maintain viral end load when remainin on treatment-response independant of baseline values-No PI resistance |
| Efavarenz + 2 verse 3 drug NRTI- time to virologic failure | 2 NRTis better since the 3rd did not add benefit- Predictor of virologic failure-HCV co-infection, Black patients- Baseline resistance rare-M184 V most common |
| Treatment experienced person virologic failure considered | Viral load >400 after 24 weeks, >50 after 48 weeks or repeated >400 after prior suppression to <400 |
| Managment of experienced patient | Viral Load, evaluate-adherance, tolerance, side effects, Drug resistance testing |
| Darunavir in treatment experienced patients | Activity against treatment resistance PI regimens (BID) |
| Integrase inhibitors when approved | Will be the 5th class - short term trial showed 2 log drop with ritonavir |
| Mitochondrial toxcity- lactic acidosis,hepatomegaly/steatosis | Mitochondrial toxcity is biggest problem with NRTI's (Zalcitabine>Didanosine>Stavudine) |
| CNS Side effect | Efavirenz |
| Fat mal-disstribution | Stavudine |
| Drugs that cause Perpheral neuropathy | Didanosine, Stavudine, Zalcitabine |
| Efavarinz CNS side effect may last | 24 weeks and probably will not go away |
| Atazanavir and Rifampin have | Drug interaction-Efavarinz has interaction and 25% reduction - if patient<65kg of at 600mg but if >65Kg increase to 800mg |
Created by:
liza001
Popular Pharmacology sets