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Questions and Answers
Which of the following are potential contraindications for the use of certain medications? (Select all that apply)
Which of the following are potential contraindications for the use of certain medications? (Select all that apply)
What is Ketamine primarily used for?
What is Ketamine primarily used for?
Dissociative anesthetic IV agent
Match the opioid medications with their respective components:
Match the opioid medications with their respective components:
Percocet = Oxycodone 5mg/APAP 325mg Vicodin = Hydrocodone 5mg/APAP 325mg Vicoprofen = Hydrocodone 7.5mg/Ibuprofen 200mg
For patient-controlled analgesia (PCA), patients can self-dose with opioids up to a predetermined _____ interval.
For patient-controlled analgesia (PCA), patients can self-dose with opioids up to a predetermined _____ interval.
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What is the maximum dose of IV APAP based on a 50kg patient?
What is the maximum dose of IV APAP based on a 50kg patient?
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Methylnaltrexone is used to treat opioid-induced constipation.
Methylnaltrexone is used to treat opioid-induced constipation.
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What should be monitored when administering Spironolactone to transgender women?
What should be monitored when administering Spironolactone to transgender women?
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Patients undergoing surgery should receive prophylactic antibiotics like Cefazolin for _____ prior to incision.
Patients undergoing surgery should receive prophylactic antibiotics like Cefazolin for _____ prior to incision.
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Which of the following is true regarding parenteral nutrition?
Which of the following is true regarding parenteral nutrition?
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The central line is preferred for parenteral nutrition due to its capacity to handle _____ mOsm/L.
The central line is preferred for parenteral nutrition due to its capacity to handle _____ mOsm/L.
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What is the primary goal of HIV treatment?
What is the primary goal of HIV treatment?
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What does a CD4 count less than 200 indicate?
What does a CD4 count less than 200 indicate?
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Which of the following is an NRTI?
Which of the following is an NRTI?
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Tenofovir alafenamide (TAF) requires renal adjustment.
Tenofovir alafenamide (TAF) requires renal adjustment.
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Which drug combination should NOT be used together?
Which drug combination should NOT be used together?
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What is the effect of food on the absorption of certain ARVs?
What is the effect of food on the absorption of certain ARVs?
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What should be monitored in patients on PrEP?
What should be monitored in patients on PrEP?
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The viral load target goal is to achieve an undetectable VL, typically within ______ weeks.
The viral load target goal is to achieve an undetectable VL, typically within ______ weeks.
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Which of the following regimens is considered optimal for HIV treatment?
Which of the following regimens is considered optimal for HIV treatment?
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Match the following terms with their definitions:
Match the following terms with their definitions:
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Monotherapy NRTI is a recommended treatment strategy for HIV.
Monotherapy NRTI is a recommended treatment strategy for HIV.
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What is the elimination system credited to in neonates?
What is the elimination system credited to in neonates?
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When does nephrogenesis begin in a fetus?
When does nephrogenesis begin in a fetus?
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What is the Schwartz equation used for?
What is the Schwartz equation used for?
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What is the first-line treatment for ADHD in children older than 6 years?
What is the first-line treatment for ADHD in children older than 6 years?
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Which regimen is recommended for a neonate with suspected sepsis?
Which regimen is recommended for a neonate with suspected sepsis?
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What is the mechanism of action of opioids?
What is the mechanism of action of opioids?
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Clonidine is a first-line treatment for ADHD.
Clonidine is a first-line treatment for ADHD.
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What side effects are associated with the use of Propofol?
What side effects are associated with the use of Propofol?
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What is nirsevimab used for?
What is nirsevimab used for?
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Which of the following medications is classified as an SNRIs used in ADHD treatment?
Which of the following medications is classified as an SNRIs used in ADHD treatment?
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Which parameter indicates the clearance of penicillin and aminoglycosides?
Which parameter indicates the clearance of penicillin and aminoglycosides?
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What is the primary purpose of the use of nitrous oxide in anesthesia?
What is the primary purpose of the use of nitrous oxide in anesthesia?
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Which class of drugs does succinylcholine belong to?
Which class of drugs does succinylcholine belong to?
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Study Notes
HIV Overview
- Viral Load: Represents HIV replication speed; CD4 count <200 indicates progression to AIDS.
- Treatment Goals: Aim to suppress HIV RNA, restore immune function, reduce morbidity, prolong survival, and prevent transmission.
NRTIs (Nucleoside/tide Reverse Transcriptase Inhibitors)
- Examples: FTC/TDF (Truvada), ABC/3TC (Epzicom), FTC/TAF (Descovy) among others.
- Mechanism: Block reverse transcriptase, causing early termination of viral DNA synthesis.
- Key Considerations:
- Renal excretion for most; caution in chronic kidney disease (CKD).
- Combination regimens prolong efficacy; single NRTI use leads to rapid resistance.
NNRTIs (Non-Nucleoside Reverse Transcriptase Inhibitors)
- Examples: EFV/TFV/FTC (Atripla), RPV/TFV/FTC (Complera).
- Mechanism: Bind to reverse transcriptase and alter its shape, inhibiting viral DNA formation.
- Key Concerns:
- CNS effects (e.g., sleep disturbances with EFV).
- Not recommended for patients with high viral loads (>100k).
PIs (Protease Inhibitors)
- Examples: DRV/Cobicistat, ATV/Cobicistat.
- Mechanism: Inhibit HIV protease, preventing viral maturation.
- Safety Profile: Can cause metabolic complications like lipodystrophy; monitor for cardiovascular risks.
INSTIs (Integrase Strand Transfer Inhibitors)
- Examples: EVG/c/FTC/TDF (Stribild), DTG/ABC/3TC (Triumeq).
- Mechanism: Block integrase, preventing viral DNA integration into the host genome.
- High Resistance Barrier: Notable for effectiveness against resistant strains.
Entry/Infusion Inhibitors
- Enfuvirtide (T20) and Maraviroc (MVC): Target viral fusion and coreceptor binding, respectively.
- Side Effects: Injection site reactions for Enfuvirtide, potential hepatotoxicity, and postural hypotension for Maraviroc.
Initial Treatment Regimens for HIV
- Common Combinations: Biktarvy (BIC/TAF/FTC), Tivicay (DTG with TAF/FTC or 3TC).
- Key Guidelines: Use combination therapy to enhance efficacy and reduce resistance; avoid monotherapy.
Treatment Considerations
- Focus on two NRTIs plus an INSTI for optimal antiretroviral therapy (ART).
- Monitor for drug adherence (>95% adherence needed to prevent virologic failure).
- Genetic testing (HLA-B*5701) prior to using Abacavir to minimize hypersensitivity risks.
Opportunistic Infections and Prophylaxis
- Screen for latent TB in all HIV-infected individuals.
- Prophylaxis based on CD4 counts: e.g., PCP prophylaxis when CD4 <200 using Bactrim.
HIV Prophylaxis
- PrEP: HIV-negative individuals use medications like Truvada for prevention.
- PEP: Post-exposure protocols consist of NRTIs and INSTIs for occupational or non-occupational exposure.
Pediatric Considerations
- Age-related absorption and distribution differences; juvenile patients require tailored dosing.
- Monitor growth, nutritional intake, and adjust treatment for developmental stages.
Changing Treatment
- Adjustments should be based on intolerable side effects or new resistance profiling; maintain regimen efficacy.
Monitoring Guidelines
- Regular measurements of viral load and CD4 counts are critical to track treatment success.
- Utilize resistance testing if treatment failure occurs or if viral load remains high.
Drug Interactions
- Monitor CYP450 interactions especially with PIs; adjust or select medications accordingly to avoid adverse effects.
Special Cases
- Vaccination policies for HIV patients, especially avoiding live vaccines if CD4 <200.
- Pregnancy: ART regimens should be optimized, considering specific safety profiles for mother and child.### Meningitis and Anesthesia Overview
- Nirsevimab (Beyfortus) is an IgG1 monoclonal antibody used for passive immunization against RSV in pediatrics, associated with hypersensitivity reactions.
Guedel's Classification of Anesthesia Stages
- Stage I: Analgesia without amnesia; patient is conscious and comfortable.
- Stage II: Excitement; patient may vocalize, but awareness is absent.
- Stage III: Surgical anesthesia; characterized by reduced respiratory and heart rates.
- Stage IV: Medullary depression; requires support for respiration and circulation.
General Anesthesia Awareness
- Midazolam induces amnesia, preventing memory formation during sedation.
- Inhaled anesthesia induction can be monitored using bispectral index (BIS) < 60 or a depth > 0.7 MAC.
Inhaled Anesthesia Details
- Administered as volatile or gaseous agents; rapid onset due to gas exchange in alveoli.
- Volatile agents (e.g., halothane, isoflurane) require vaporizers, while gases (e.g., nitrous oxide) are liquid at room temperature.
IV Procedural Anesthesia
- Propofol provides rapid induction, crosses the blood-brain barrier quickly, and is commonly used in ICU settings; requires caution in patients with egg or soybean allergies.
- Etomidate is used for rapid sequence intubation; causes minimal cardiovascular effects but can lead to myoclonus and adrenal suppression.
- Benzodiazepines like midazolam facilitate sedation; accumulation can prolong effects.
Neuromuscular Blocking Agents (NMBA)
- Succinylcholine is a depolarizing NMBA causing transient fasciculations leading to paralysis; contraindicated in patients with a history of malignant hyperthermia.
- Non-depolarizing agents (e.g., rocuronium, vecuronium) used for prolonged paralysis; monitoring via train of four response is essential.
Opioids and Their Pharmacology
- Fentanyl and hydromorphone are rapid-onset opioids; morphine has a longer duration of action.
- Opioids act on μ, δ, κ receptors affecting pain and excitability mechanisms.
Pain Management
- Acetaminophen (APAP) and NSAIDs are first-line for nociceptive pain, while antidepressants and anticonvulsants are preferred for neuropathic pain.
- Persistent pain may require opioids despite low addiction risks.
Acute Pain Classification
- Mild pain: managed with APAP or NSAIDs.
- Moderate pain: treated with scheduled NSAIDs and short-term opioid use.
- Severe pain: necessitates high-dose opioids for significant surgeries.
Acute Perioperative Pain Management
- IV acetaminophen and liposomal bupivacaine are effective for surgical pain.
- Opioids can be administered via various routes including IV and transdermal; caution with side effects like respiratory depression.
Antidotes in Emergency Medicine
- N-Acetylcysteine for APAP overdose; naloxone for opioid overdose; atropine for organophosphate poisoning.
Fluid Management in Surgery
- Isotonic solutions like 0.9% NS or LR are crucial for resuscitation.
- Preoperative nutritional support via parenteral nutrition advised for malnourished patients.
Sodium Management
- Tolvaptan and conivaptan used in cases of symptomatic hyponatremia.
- Rapid correction of hypernatremia should be avoided to prevent complications.
Surgery and Infection Prevention
- Cefazolin is first-line for preventing surgical site infections; vancomycin added if MRSA risk is high.
- Wound classification determines the use of antibiotics based on the degree of contamination.
These notes encapsulate key facts relevant to pharmacology, anesthesia, pain management, and emergency care necessary for an effective study guide.### Pharmacology Overview
- Furosemide, diazepam, digoxin, and etoposide are key medications in clinical practice.
- Iron dextran can destabilize lipid emulsion in 3-in-1 parenteral nutrition due to trivalent cations.
Monitoring Parameters
- Monitor for signs of infection and peripheral vein complications like thrombophlebitis and infiltration.
- Fluid status and nutritional status should be regularly assessed using prealbumin levels (normal: 16-40, moderate malnutrition: 11-16).
- Electrolyte and acid-base imbalances need to be closely monitored.
Acid-Base Disorders
- Metabolic alkalosis is treated with sodium and potassium chloride salts.
- Metabolic acidosis can be treated with sodium and potassium as acetate to bicarbonate salts.
- Respiratory acid-base disorders require addressing the underlying cause or adjustments to ventilator settings.
Enteral Nutrition via G/J Tube
- Indicated for hemodynamically stable patients at risk of malnutrition with anticipated inability to consume orally for 1-2 weeks.
- Contraindications include complete intestinal obstruction, high-output GI fistulas (>500 mL/d), extreme short bowel syndrome, severe vomiting/diarrhea, hemodynamic instability, and intestinal ischemia.
- Orogastric tubes are not recommended for patients with nasal/facial trauma or sinusitis.
NG Tube Placement and Use
- Most common for short-term enteral access and stomach decompression.
- Long-term use can lead to sinusitis and ulceration; gastric ileus contraindicates NG use due to aspiration risk.
Benefits of Enteral Nutrition
- Decreases infection risk and maintains GI mucosal integrity.
- Prevents bacterial translocation from gut bacteria across a compromised intestinal barrier.
Complications and Management
- Risks include improper tube placement or displacement.
- Clogs can be mitigated by flushing with warm water or other specified solutions.
- Aspiration pneumonia prevention involves elevating the head of the bed to 30-45° and monitoring gastric residuals.
Administration of Drugs via Feeding Tube
- Liquids should be diluted with 2-3 times the medication volume.
- Crushed tablets/capsules should be mixed with 10-15 mL sterile water and administered separately.
- Do not crush sustained-release or enteric-coated medications for administration.
- To enhance bioavailability, withhold tube feeds before and after drug administration and consider tube placement for drug absorption.
Transgender Medicine
- Spironolactone is commonly prescribed for transgender women; potassium monitoring is important due to hyperkalemia risk.
- Estrogen therapy requires monitoring of estradiol (E2) levels.
- Testosterone therapy for transgender men involves monitoring serum testosterone levels.
Initial Steps for Gender-Affirming Hormone Therapy (GAHT)
- Confirmation of age of consent and clearance from a mental health provider or psychologist is necessary.
- Patients must understand the consequences and risks associated with hormone therapy.
- An affidavit affirming preferred name and gender is optional, but recommended robust real-life experience (>3 months) may assist in verification.
- Pre-treatment assessment includes physical examination and laboratory tests for baseline health.
Additional Recommendations
- Counsel patients on maintaining a healthy lifestyle, including body weight management and avoiding substance abuse.
- Address any co-existing conditions like hypertension and diabetes.
- Discuss options for cryopreservation of oocytes and embryos.
- Discourage self-medication practices and ensure informed consent for GAHT, including potential risks and benefits.
Puberty Suppression
- Utilize GnRH analogs, antiandrogens, antiestrogens, and medroxyprogesterone acetate as part of gender-affirming hormone therapy and puberty suppression strategies.
Hospice Care
- Intended for patients with end-stage illnesses, emphasizing comfort and quality of life.
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Description
Prepare for your Pharm III final exam with this quiz focused on HIV treatment and management. Key topics include understanding viral load, treatment goals, and the implications of CD4 counts. Test your knowledge on how to effectively manage and treat HIV to prolong patient life and improve immunologic function.
