AGACNP Final Exam correctly answered 2023/2024 passed

AGACNP Final ExamWho should be screened for HIV? What test do you use? Do you need consent Anyone age 15-65 at least once High risk individuals annually (consider 3-6 months) Always include in prenatal testing and high-risk individuals in 3rd trimester Written consent and prevention counseling is not required This is OPT out Testing Test using 4th generation HIV test The 4th generation HIV test differs from the ELISA/Western Blot how? What about rapid HIV test CDC does not use rapid (Oraquick) test in algorithms The 4th generation HIV test is an antibody and antigen test it looks for P24 antigen and HIV viral load, Qualitative HIV RNA test. Older tests only look for antibodies which sometimes do not develop for 3 months. Brainpower Read More What is considered the most specific HIV test and when do you use this? NAT-Nucleic Acid Test-tests for viral particles. This is very expensive and is done after 4th gen test when first result is positive then the HIV 1 & 2 differentiation are negative for HIV 1 and HIV 2 When would you prescribe ART therapy? How many meds? What is most difficult besides SE of taking ART therapy Start on all HIV positive patients regardless of CD4 count-3 drug regimen. Adherence is the most difficult you have to be 95% adherent in order to prevent resistance. If you transmit HIV you also transmit the resistant HIV Side effects of ART (Initial vs Long term) Initial: n/v/d, fatigue ha, dizzy, poor sleep Initial symptoms worse first 2 weeks then decline over the next month. Long term: Nephropathy, Fat redistribution, liver/kidney toxic, metabolic changes (metabolic syndrome, elevation in triglycerides and cholesterol-high risk for heart disease and DM) Bone-increase risk of osteoporosis and osteopenia-get dexascan The medication is toxic to mitochondria and lactic acidosis Metabolic syndrome is a SE of ART meds what are these s/s Insulin resistance, abdominal obesity, HTN, abnormal lipid panel this leads to increased risk of cardiovascular disease and DM2 What is the difference between primary and secondary immunosuppression Primary-genetic lymphocyte deficiency Secondary-from a disease process or meds Who is at risk for immunocompromise Chronic illness or critical illness DMARDS-anti-Rheumatic meds Chemo High risk behaviors Bone marrow suppression Auto-immune meds Splenectomy Late stage (AIDS) definition CD4 count less than 200 PCP PPX is ________________ what must you test for and when do you give this PCP ppx in immunocompromized patients should be given if CD4 count is less than 200, you can stop treatment when CD4 count is above 200 for 3 months. First line choice is Bactrim (TMP-SMX). You need to test for G6PD deficiency this can cause hemolytic anemia and can be deadly if positive then use Pentamidine or Dapsone/Atovaquone Toxoplasmosis is a protazoa parasite you should consider in immunocompromized patient with acute onset of fever and lymphadenopathy, they can also present with a rash. If you have HIV what is PPX Bactrim for CD4 less than 100 Mycobacterium Avium Complex PPX Azithromyacin 1200mg weekly if CD4 less than 50 Histoplasmosis is a fungi found in bird and bat poop PPX is? Itraconazole 200 mg daily for CD4 less than 100