Which of the following drugs accelerates the p450 metabolic pathway? Indinavir Delavirdine Saquinavir Nevirapine Nelfina - PowerPoint PPT Presentation

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Which of the following drugs accelerates the p450 metabolic pathway? Indinavir Delavirdine Saquinavir Nevirapine Nelfina

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Which of the following drugs accelerates the p450 metabolic pathway? Indinavir Delavirdine Saquinavir Nevirapine Nelfina

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  1. A 40-year-old man with AIDS and a CD4 count of 80/mm3 has a fever and a right lower lobe infiltrate. Which of the following organisms would be considered to be the most likely cause of his pneumonia if recovered from BAL fluid (bronchoalveolar lavage)? • Cytomegalovirus • Herpes simplex • Legionella • Enterobacter cloacea • Candida albicans

  2. A 40-year-old man with AIDS and a CD4 count of 80/mm3 has a fever and a right lower lobe infiltrate. Which of the following organisms would be considered to be the most likely cause of his pneumonia if recovered from BAL fluid (bronchoalveolar lavage)? • Cytomegalovirus • Herpes simplex • Legionella • Enterobacter cloacea • Candida albicans

  3. A 32-year-old man with advanced HIV infection presents with cough and low grade fever of two weeks duration. He has a history of PCP, thrush, ITP, and wasting. Recent medications include ddI, d4T, nelfinavir, dapsone, nystatin, and prednisone. Chest x-ray shows a cavity lesion measuring 4 cm in the right lower lobe. A BAL yields Candida albicans, Nocardia asteroides, P. aeruginosa, and CMV. Which of the following antibiotics should be given? • Ganciclovir • Amphotericin B • Fluconazole • Ceftazidime • Trimethoprim-sulfamethoxazole

  4. A 32-year-old man with advanced HIV infection presents with cough and low grade fever of two weeks duration. He has a history of PCP, thrush, ITP, and wasting. Recent medications include ddI, d4T, nelfinavir, dapsone, nystatin, and prednisone. Chest x-ray shows a cavity lesion measuring 4 cm in the right lower lobe. A BAL yields Candida albicans, Nocardia asteroides, P. aeruginosa, and CMV. Which of the following antibiotics should be given? • Ganciclovir • Amphotericin B • Fluconazole • Ceftazidime • Trimethoprim-sulfamethoxazole

  5. A 25-year-old HIV-infected man presents to your office with severe herpes proctitis. The patient has been treated with acyclovir, 200 mg five times daily for six weeks without improvement in the lesions. On repeat culture of the rectum, herpes simplex virus 2 is again isolated and further testing reveals that this is a thymidine kinase-deficient strain. Which is the preferred treatment option for this condition? • Foscarnet • Vidarabine • Ganciclovir • Valacyclovir • Famciclovir

  6. A 25-year-old HIV-infected man presents to your office with severe herpes proctitis. The patient has been treated with acyclovir, 200 mg five times daily for six weeks without improvement in the lesions. On repeat culture of the rectum, herpes simplex virus 2 is again isolated and further testing reveals that this is a thymidine kinase-deficient strain. Which is the preferred treatment option for this condition? • Foscarnet • Vidarabine • Ganciclovir • Valacyclovir • Famciclovir

  7. A 43-year-old man with AIDS presents with a four-week history of ataxia, progressive right hand weakness, and tremor. Physical examination confirms his symptoms. His CD4 cell count is 56/mm3, and serum antitoxoplasma IgG antibody titer was negative one year ago. An MRI of the head reveals a solitary 2 x 4 cm lesion in the left cerebellar hemisphere which gives a high signal intensity on T2-weighted images but does not enhance with gadolinium. No mass effect is demonstrated. The most likely diagnosis is: • Toxoplasmosis • A fungal abscess • Primary CNS lymphoma • Progressive multifocal leukoencephalopathy (PML) • A mycobacterial abscess

  8. A 43-year-old man with AIDS presents with a four-week history of ataxia, progressive right hand weakness, and tremor. Physical examination confirms his symptoms. His CD4 cell count is 56/mm3, and serum antitoxoplasma IgG antibody titer was negative one year ago. An MRI of the head reveals a solitary 2 x 4 cm lesion in the left cerebellar hemisphere which gives a high signal intensity on T2-weighted images but does not enhance with gadolinium. No mass effect is demonstrated. The most likely diagnosis is: • Toxoplasmosis • A fungal abscess • Primary CNS lymphoma • Progressive multifocal leukoencephalopathy (PML) • A mycobacterial abscess

  9. A 37-year-old man with advanced HIV infection hospitalized with a fever to 40C, BP 80/60, chills, headache, and diarrhea with 3-5 stools/day for two days. He has a history of PCP x 2, CMV retinitis treated with IV ganciclovir, aphthous ulcers in the mouth, and thrush. Current medications include d4T, ddI, ritonavir, Fortovase, ganciclovir, fluconazole, dapsone, Megace, and vitamins. PE shows only fever and thrush; the Hickman catheter site appears clean and fundoscopic exam shows no new CMV lesions. Lab studies show: WBC 4,200/dL, hematocrit 22%; Chemistry panel-normal except for AST 56 U/L, creatinine 130 mmol/L; Clear chest x-ray; Negative CSF analysis (cryptococcal antigen pending); Stool studies including C. difficile toxin assay are pending. After cultures, treatment should begin immediately with which of the following? • Trimethoprim-sulfamethoxazole • Oral vancomycin • Ceftazidime plus vancomycin • Amphotericin B • No antimicrobial treatment pending results of cultures (blood, urine and stool)

  10. A 37-year-old man with advanced HIV infection hospitalized with a fever to 40C, BP 80/60, chills, headache, and diarrhea with 3-5 stools/day for two days. He has a history of PCP x 2, CMV retinitis treated with IV ganciclovir, aphthous ulcers in the mouth, and thrush. Current medications include d4T, ddI, ritonavir, Fortovase, ganciclovir, fluconazole, dapsone, Megace, and vitamins. PE shows only fever and thrush; the Hickman catheter site appears clean and fundoscopic exam shows no new CMV lesions. Lab studies show: WBC 4,200/dL, hematocrit 22%; Chemistry panel- normal except for AST 56 U/L, creatinine 130 mmol/L; Clear chest x-ray; Negative CSF analysis (cryptococcal antigen pending); Stool studies including C. difficile toxin assay are pending. After cultures, treatment should begin immediately with which of the following? • Trimethoprim-sulfamethoxazole • Oral vancomycin • Ceftazidime plus vancomycin • Amphotericin B • No antimicrobial treatment pending results of cultures (blood, urine and stool)

  11. Which of the following drugs accelerates the p450 metabolic pathway? • Indinavir • Delavirdine • Saquinavir • Nevirapine • Nelfinavir

  12. Which of the following drugs accelerates the p450 metabolic pathway? • Indinavir • Delavirdine • Saquinavir • Nevirapine • Nelfinavir

  13. Which of the following shows the best penetration into the central nervous system? • Nevirapine • Indinavir • Nelfinavir • ddI • ddC

  14. Which of the following shows the best penetration into the central nervous system? • Nevirapine • Indinavir • Nelfinavir • ddI • ddC

  15. Which of the following best predicts long-term HIV suppression? • The nadir of plasma HIV RNA levels following treatment • Treatment in relatively early stage disease as indicated by a CD4 count >200/mm3 • A relatively low plasma HIV RNA level at the time antiretroviral therapy is initiated • Absence of an AIDS-defining opportunistic infection • Use of a regimen that contains 2 protease inhibitors

  16. Which of the following best predicts long-term HIV suppression? • The nadir of plasma HIV RNA levels following treatment • Treatment in relatively early stage disease as indicated by a CD4 count >200/mm3 • A relatively low plasma HIV RNA level at the time antiretroviral therapy is initiated • Absence of an AIDS-defining opportunistic infection • Use of a regimen that contains 2 protease inhibitors

  17. Which of the following is least likely to cause peripheral neuropathy? • Lamivudine (3TC) • Stavudine (d4T) • Didanosine (ddI) • Zalcitabine (ddC)

  18. Which of the following is least likely to cause peripheral neuropathy? • Lamivudine (3TC) • Stavudine (d4T) • Didanosine (ddI) • Zalcitabine (ddC)

  19. Which of the following may cause a deceptively high CD4 cell count? • HTLV II co-infection • Splenectomy • Major surgery • Pregnancy • Acute administration of corticosteroids

  20. Which of the following may cause a deceptively high CD4 cell count? • HTLV II co-infection • Splenectomy • Major surgery • Pregnancy • Acute administration of corticosteroids

  21. Antiretroviral Drugs Approved by FDA for HIV Generic Name Class Firm FDA Approval Date zidovudine, AZT NRTI Glaxo Wellcome March 87 didanosine, ddI NRTI Bristol Myers-Squibb October 91 zalcitabine, ddC NRTI Hoffman-La Roche June 92 stavudine, d4T NRTI Bristol Myers-Squibb June 94 lamivudine, 3TC NRTI Glaxo Wellcome November 95 saquinavir, SQV, hgc PI Hoffman-La Roche December 95 ritonavir, RTV PI Abbott Laboratories March 96 indinavir, IDV PI Merck & Co., Inc. March 96 nevirapine, NVP NNRTI Boehringer Ingelheim June 96 nelfinavir, NFV PI Agouron Pharmaceuticals March 97 delavirdine, DLV NNRTI Pharmacia & Upjohn April 97 zidovudine and lamivudine NRTI Glaxo Wellcome September 97 saquinavir, SQV, sgc PI Hoffman-La Roche November 97 efavirenz, EFV NNRTI DuPont Pharmaceuticals September 98 abacavir, ABC NRTI Glaxo Wellcome February 99 amprenavir PI Glaxo Wellcome April 99

  22. Which of the following vaccines is contraindicated in patients with HIV infection due to the potential to cause infection? • Tetanus • Influenza • Varicella • Haemophilus influenzae type B • Hepatitis A virus

  23. Which of the following vaccines is contraindicated in patients with HIV infection due to the potential to cause infection? • Tetanus • Influenza • Varicella • Haemophilus influenzae type B • Hepatitis A virus

  24. Positive serology showing antibody usually indicates which of the following organisms is not present? • Toxoplasma gondii • Cytomegalovirus • Epstein-Barr virus • Hepatitis B virus • Varicella-zoster

  25. Positive serology showing antibody usually indicates which of the following organisms is not present? • Toxoplasma gondii • Cytomegalovirus • Epstein-Barr virus • Hepatitis B virus • Varicella-zoster

  26. Which of the following microbes is most likely to cause a cerebrospinal fluid showing elevated protein and a polymorphonuclear pleocytosis in late-stage HIV infection? a. Toxoplasma gondii b. Cytomegalovirus c. Treponema pallidum d. JC virus (Progressive multifocal leukoencephalopathy)e.Herpes simplex

  27. Which of the following microbes is most likely to cause a cerebrospinal fluid showing elevated protein and a polymorphonuclear pleocytosis in late-stage HIV infection? a. Toxoplasma gondii b. Cytomegalovirus c. Treponema pallidum d. JC virus (Progressive multifocal leukoencephalopathy)e.Herpes simplex

  28. The most common cause of fever of unknown origin with no focal symptoms in a previously untreated patient with a CD4 count of 10/mm3 is: • Disseminated M. avium infection • Disseminated cytomegalovirus • Pneumocystis carinii pneumonia • Toxoplasmosis • Lymphoma

  29. The most common cause of fever of unknown origin with no focal symptoms in a previously untreated patient with a CD4 count of 10/mm3 is: • Disseminated M. avium infection • Disseminated cytomegalovirus • Pneumocystis carinii pneumonia • Toxoplasmosis • Lymphoma

  30. Which of the following fungi is an agent of disseminated infections primarily in southeastern or eastern Asia? • Penicillium marneffei • Coccidioides immitis • Histoplasma capsulatum • Blastomyces dermatitidis • Paracoccidioides brasiliensis

  31. Which of the following fungi is an agent of disseminated infections primarily in southeastern or eastern Asia? • Penicillium marneffei • Coccidioides immitis • Histoplasma capsulatum • Blastomyces dermatitidis • Paracoccidioides brasiliensis

  32. A 45-year-old woman donated blood prior to elective surgery for urinary incontinence. The blood bank reports that the unit is repeatedly reactive in a HIV-1 enzyme immunoassay (EIA), with a negative HIV-1 Western blot. A test done 1 year previously showed the same results. She has no history of blood transfusion or injection drug use, and has been sexually monogamous for ten years with a single partner who has no known HIV risk factors. Your advice is: • Defer surgery until repeat HIV testing can be done at three months • Advise the patient that she has early HIV infection • Perform testing on her sexual partner to determine if he is the source of the infection • Test the patient's sexual partner for HIV • Inform the patient that HIV infection is unlikely given the absence of risk factors and the negative Western blot result

  33. A 45-year-old woman donated blood prior to elective surgery for urinary incontinence. The blood bank reports that the unit is repeatedly reactive in a HIV-1 enzyme immunoassay (EIA), with a negative HIV-1 Western blot. A test done 1 year previously showed the same results. She has no history of blood transfusion or injection drug use, and has been sexually monogamous for ten years with a single partner who has no known HIV risk factors. Your advice is: • Defer surgery until repeat HIV testing can be done at three months • Advise the patient that she has early HIV infection • Perform testing on her sexual partner to determine if he is the source of the infection • Test the patient's sexual partner for HIV • Inform the patient that HIV infection is unlikely given the absence of risk factors and the negative Western blot result

  34. All of the following are correct about hairy leukoplakia except: • It will respond to treatment with acyclovir • It will respond to treatment with ganciclovir • It is a rare complication of diseases other than HIV infection • It is usually not treated • Scrapings of it will show pseudomycelia

  35. All of the following are correct about hairy leukoplakia except: • It will respond to treatment with acyclovir • It will respond to treatment with ganciclovir • It is a rare complication of diseases other than HIV infection • It is usually not treated • Scrapings of it will show pseudomycelia

  36. A 27-year-old intravenous drug abuser is referred to you with positive HIV serology. He is asymptomatic but continues to practice high risk behavior. Past medical history indicates herpes zoster involving the right leg one year ago. Initial evaluation shows the following: WBC 3,400 with 72% PMNs, 5% bands, 15% lymphocytes, 3% monocytes; CD4 count 240/mm3; Chemistry panel normal; Hepatitis serology HBsAg neg and anti-HBs positive; VDRL negative; Chest x-ray negative; PPD negative. Treatment at this time should include which of the following? • Pneumovax • Azithromycin prophylaxis • PCP prophylaxis • Hepatitis B vaccine • Acyclovir

  37. A 27-year-old intravenous drug abuser is referred to you with positive HIV serology. He is asymptomatic but continues to practice high risk behavior. Past medical history indicates herpes zoster involving the right leg one year ago. Initial evaluation shows the following: WBC 3,400 with 72% PMNs, 5% bands, 15% lymphocytes, 3% monocytes; CD4 count 240/mm3; Chemistry panel normal; Hepatitis serology HBsAg neg and anti-HBs positive; VDRL negative; Chest x-ray negative; PPD negative. Treatment at this time should include which of the following? • Pneumovax • Azithromycin prophylaxis • PCP prophylaxis • Hepatitis B vaccine • Acyclovir

  38. Which of the following is correct about Stavudine (d4T)? • The major side effect is peripheral neuropathy. • High level resistance occurs early in treatment when it is given as monotherapy. • It penetrates the blood-brain barrier better than AZT • Tablets should be chewed or dissolved in fluids before swallowing • It commonly causes lactic acidosis

  39. Which of the following is correct about Stavudine (d4T)? • The major side effect is peripheral neuropathy. • High level resistance occurs early in treatment when it is given as monotherapy. • It penetrates the blood-brain barrier better than AZT • Tablets should be chewed or dissolved in fluids before swallowing • It commonly causes lactic acidosis

  40. Which of the following conditions in a person with HIV infection is suggestive of the greatest degree of immunosuppression? • Peripheral generalized lymphadenopathy • Thrush • Pneumonia due to S. pneumoniae • Cavitary pulmonary tuberculosis • Vaginal candidiasis

  41. Which of the following conditions in a person with HIV infection is suggestive of the greatest degree of immunosuppression? • Peripheral generalized lymphadenopathy • Thrush • Pneumonia due to S. pneumoniae • Cavitary pulmonary tuberculosis • Vaginal candidiasis

  42. A HIV-infected patient has cough, fever, and sputum production for 4 days. A chest x-ray shows a left lower lobe infiltrate, the WBC is 4,200/mm3 and a CD4 count is 150/mm3. He takes no medication. The most likely microbial pathogen is: • S. pneumoniae • Mycobacterium tuberculosis • Rhodococcus equii • P. carinii • Cryptococcosis

  43. A HIV-infected patient has cough, fever, and sputum production for 4 days. A chest x-ray shows a left lower lobe infiltrate, the WBC is 4,200/mm3 and a CD4 count is 150/mm3. He takes no medication. The most likely microbial pathogen is: • S. pneumoniae • Mycobacterium tuberculosis • Rhodococcus equii • P. carinii • Cryptococcosis

  44. A HIV-infected woman has headache, fever, and a seizure. The CD4 count is 56/mm3, WBC is 3,200/mm3, and a MRI shows two ring-enhancing lesions. She takes no medicines other than methadone. The most likely diagnosis is: • Lymphoma • Toxoplasmosis • Cryptococcosis • PML • Herpes simplex encephalitis

  45. A HIV-infected woman has headache, fever, and a seizure. The CD4 count is 56/mm3, WBC is 3,200/mm3, and a MRI shows two ring-enhancing lesions. She takes no medicines other than methadone. The most likely diagnosis is: • Lymphoma • Toxoplasmosis • Cryptococcosis • PML • Herpes simplex encephalitis

  46. Which of the following does not have verified benefit in reducing perinatal transmission? • Intrapartum nevirapine • Intrapartum AZT • Intrapartum indinavir • C-section • Reduction in viral load during pregnancy

  47. Which of the following does not have verified benefit in reducing perinatal transmission? • Intrapartum nevirapine • Intrapartum AZT • Intrapartum indinavir • C-section • Reduction in viral load during pregnancy

  48. A 40-year-old gay man with HIV infection complains of intermittent crampy abdominal pain and diarrhea for 2 months. The major concern is 1-3 loose stools daily accompanied by bloating. He took AZT, ddI, and indinavir, but discontinued this when he noted the abdominal symptoms. Nevertheless, there was no improvement. He has been well otherwise and afebrile. He has a CD4 count of 350/mm3. The most likely diagnosis is: • Salmonellosis • C. difficile colitis • Microsporidia • Irritable bowel syndrome • Kaposi's sarcoma of the gut

  49. A 40-year-old gay man with HIV infection complains of intermittent crampy abdominal pain and diarrhea for 2 months. The major concern is 1-3 loose stools daily accompanied by bloating. He took AZT, ddI, and indinavir, but discontinued this when he noted the abdominal symptoms. Nevertheless, there was no improvement. He has been well otherwise and afebrile. He has a CD4 count of 350/mm3. The most likely diagnosis is: • Salmonellosis • C. difficile colitis • Microsporidia • Irritable bowel syndrome • Kaposi's sarcoma of the gut

  50. Which of the following drugs has been associated with serious hypersensitivity reactions characterized by fever, GI distress, and rash? • Efavirenz • Hydroxyurea • Abacavir • Saquinavir • Nelfinavir