Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
41 Cards in this Set
- Front
- Back
do we have the means to suppress the progression of HIV and the transmission? |
yes SE & pill burden has decreased barrier protection exists to minimize transmission HIV no longer primarily a biomedical challenge |
|
how do depression, impulsivity, childhood sexual abuse, and self-efficacy correlate with HIV infection versus non infected? |
depression = increase impulsivity = increase childhood sex abuse = positive correlation self-efficacy = inverse correlation |
|
what percentage of HIV PTs have a suppressed viral load of < 200 copies/mL |
25% |
|
which group is highest risk of HIV dx? |
african american MSM 1 in 2 chance |
|
what is homeostasis versus allostasis, and what is allostatic load? |
homeostasis: stable internal environment allostasis: stability of organism in a changing environment allostatic load: cost to organism over time in terms of wear and tear |
|
how do toxic responses of individuals relate with toxic environments? |
toxic environment produces circumstances in which toxic responses become survival mechanisms |
|
what is structural violence? |
institutional barriers that impair the equal pursuit of human health within and across societies |
|
how do food & housing security correlate with medication adherence? |
reduced food security = reduced med adherence reduced home security = reduced med adherence |
|
what is the difference between stigmatization and shame and how do they relate to their resistance to change? |
stigmatization: social construction based on power structures, resistant to change shame: internalized, painful, response to self-perceived social miscues, may be changeable |
|
what are the factors associated with adult screening of childhood sexual abuse in primary care? |
knowledge of prevalence of CSA confidence in screening for CSA perceived role is to screen for CSA |
|
how does chronic stress affect the immune system, clotting risk, BG related disease, and maladaptive coping behaviors? |
immune system: chronic high adrenaline weakens the immune system clotting: hypercoagulability increases clotting risk BG: inflammation, diabetes, hypercholesterolemia, obesity maladaptive: substance abuse, eating disorders, depression |
|
how does shame relate to chronic stress and HIV outcomes? |
increased shame = increased chronic stress increased shame = CD4 (WBC) decline |
|
how does the ventral vagal complex and DMNX relate to the sympathetic nervous system and stress? |
VVC: engaged at rest; primary control of supradiaphragmatic visceral organs; regulates HR at rest; disengages during periods of stress sympathetic NS: fight-or-flight; engages when VVC disengages during periods of stress DMNX: engages during full panic shutting down consciousness |
|
how do HIV positive PTs relate to sensitivity to facial cues, recognition of sadness/happiness/fear, and amygdala size?? |
HIV+ = deficits in sensitivity to facial cues, slower recognition of emotions, larger amygdala by volume |
|
what is the function of the amygdala and what CNS system is it a part of? |
process memory, make decisions, process emotional reactions part of the limbic system |
|
where do DNA replication, transcription, and translation occur in the cell? |
replication: nucleus transcription: nucleus translation: cytoplasm |
|
is HIV an RNA or DNA virus? |
RNA virus *retrovirus* |
|
what is CD4, what type of WBC is it located on, and what is the function? |
what it is: surface protein Located on: t-helper lymphocytes function: allows them to react to antigen presenting cell |
|
describe the steps of binding, fusion, reverse transcription, integration, translation/transcription, assembly, and release with respect to HIV. |
binding: virus binds to CD4 receptor (& one or two coreceptors CXCR4/CCRS) fusion: virus fuses to host & releases RNA into cell reverse transcription: single strand RNA converted to double strand DNA integration: integrase enzyme inserts viral DNA into cell DNA transcription/translation: viral RNA copied from viral DNA via RNA polymerase and inserted into new viruses or made into HIV proteins assembly: HIV protease cuts long-chain proteins into individual proteins which are assembled with viral RNA release: new viral particles released from host cell within part of the host cell's membrane |
|
which stage of infection is clinical latency, what are the symptoms, and are HIV replication rates high or low in this stage? |
stage: second sx: none rates: low |
|
what is a chancre? |
painless ulcer |
|
what is the correlation between syphilis and HIV? |
syphilis chancres are rich in CD4+ T-lymphocytes open syphilis chancres are open portals for HIV infection behaviors that result in syphilis transmission are same in HIV transmission |
|
during HIV tx what are the lab level goals for CD4 and viral load? |
CD4: > 350 VL: < 20 copies |
|
what is the greatest risk for transmission of HIV in acute care setting? |
accidental blood exposure via sticks and scalpel cuts |
|
what are micron levels, room requirements, door open/closed requirements, and mask requirements for airborne precautions in HIV PTs? |
microns: < 5 microns room: private room door: closed door mask: N-95 fitted mask |
|
what are micron levels, room requirements, door open/closed requirements, and mask requirements for droplet precautions in HIV PTs? |
microns: > 5 microns room: private door: closed optional mask: mask at < 3 ft |
|
what are sx that would indicate screens for HIV, those specific to > 40 yo, what two tests will we order, and what is the home test?? |
acute: acute flu-like illness > 40: weight loss, fatigue, thrush, rashes, psoriasis tests: antibody & viral load home test: Ora-Sure |
|
what sort of education do you want to give immediately after telling pt they are HIV+? |
none bc they're not going to be listening |
|
how many drugs/classes are in highly active antiretroviral therapy cocktails, and how are they dosed? |
drugs/classes: 3 drugs from at least 2 classes dosing: 300 mg BID |
|
how often are the drugs aptripla, complera, and stribild dosed? |
one pill once per day |
|
which patients are not candidates for fixed dosing? |
renal patients |
|
what can result from inaccurate estimation of viral replication when dosing of drugs? |
drug-resistant mutations |
|
how can proofreading, and viral replication/fitness lead to drug resistance? |
proofreading: virus does not have mechanism by which to check for mistakes in DNA replication so it is prone to mutations which can make it resistant to drugs fitness: drug targets one susceptible virus strain leaving non-susceptible strain to duplicate more |
|
what is preexposure prohylaxis and what are the guidelines for it? |
what it is: HIV prophylactic for high-risk populations guidelines: pretest for HIV & HBV, CrCl > 60 mL/min, perform HIV test /2-3 mo, STD check q6mo |
|
what is the effect of antiretrovirals on metabolism of other drugs? |
they can induce or inhibit the metabolism of other drugs interact with drug transporters i.e. P-glycoprotein |
|
what are the associated drugs of HTN & CAD that can interact with protease inhibitors and the antiretroviral Etravirine? |
HTN = increased concentration of Ca++ channel blockers (nondihydropyridines) & beta-blockers with protease inhibitors CAD = Plavix decreased by etravirine |
|
what are the associated drugs of hyperlipidemia that can interact with protease inhibitors and Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)? |
drug: statins protease inhibitor: CYP450 inhibits statin metabolism and protease inhibitors inhibit CYP450 so serum statin levels increase *exception is Pravastatin* NNRTIs: decrease serum statin levels |
|
what are the associated drugs of erectile dysfunction and BPH that can interact with protease inhibitors and Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)? |
drugs: phosphodiesterase inhibitors, alpha-blockers (Alfuzosin) protease inhibitors: increase ED drugs NNRTIs: decrease ED drugs *alpha-blockers contraindicated with retroviral tx* |
|
what are the associated drugs of mental illness and anticonvulsants that can interact with protease inhibitors and Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs), and what are the best benzos & anticonvulsants? |
drugs: benzos, dilantin protease inhibitor: increase benzos, increase dilantin NNRTIs: decrease benzos *benzo = lorazepam, anticonvulsant = Keppra* |
|
What is the indicated course of tx when using hormonal contraceptives and HIV drugs? |
use two methods of contraceptive |
|
what is the risk of using protease inhibitors with steroids (i.e. fluticasone)? |
iatrogenic Cushing's syndrome iatrogenic = of/related to illness caused by medical examination or treatment. |