ISAT I GPM Immunology
Terms
undefined, object
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- CC/HPI
- Subjective
- PMH
- Subjective
- Drug Hx
- Subjective
- Family/Social Hx
- Subjective
- ROS
- Subjective
- Objective data
- Objective
- Problem list
- Assessment
- Assessment of problem
- Assessment
- Therapeutic objective(s)
- Assessment
- Assessment of therapy
- Assessment
- Patient-related variables
- Assessment
- Agent-related variables
- Assessment
- Treatment recommendation
- Plan
- Referral/Triage plan
- Plan
- Monitoring for efficacy
- Plan
- Patient education
- Plan
- Lactic acidosis
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Symptoms:
Fatigue, malaise, weakness
GI complaints
Anorexia, N, V, D
Abdominal pain and distention
Dyspnea
Cardiac arrhythmia
Multi-organ failure
Death
Caused by NRTI's. Abacavir and tenofovir are least likely to cause it. - Pancreatitis
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Risk factors:
Alcoholism
Hypertriglyceridemia
Obesity
Gallstones
Drugs--pentamadine
Caused by NRTI's. Most associated with didanosine and stavudine. - Hepatic Steatosis
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Fatty liver.
Occurs with all NRTI's.
GI: anorexia, N,V, Abd. Pain, ascites
Encephalopathy
Dyspnea
Death
Caused by all NRTI's. - Peripheral neuropathy
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Tx by lowering dose or d/c offending agent
Treat symptoms
NSAIDS, APAP
TCA, gabapentin, lamotrigine
HIV, alcohol, diabetes, nutrition, other drugs may contribute
May take months to resolve
Less common today due to decrease use of offending agents
Caused by NRTI's. Most associated with didanosine and stavudine. - Myopathy
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Fatigue, myalgia, proximal weakness and wasting
Inc. CPK levels
Abnormal mitochondria
Incidence 5-20% assoc with long tx
Zidovudine and other NRTI's
Cardiomyopathy: <1% incidence - Hypersensitivity Reactions (HSR)
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Rash, fever, mayalgia, arthralgia, fatigue, mucosal blistering and ulceration, stevens-johnson syndrome, toxic epidermal necrolysis, hypotension
100x more common in HIV patients
Abacavir, amprenavir, all NNRTIs
Occurs early in tx; about 50% resolve on continuing therapy.
Nevirapine>Efavirenz.
Abacavir: If fever is present, d/c and DO NOT RECHALLENGE (can cause death). - Lipodystrophy
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Syndrome
Fat accumulation: buffalo hump, inc. abdomen, inc. breast size;
Lipoatrophy: facial atrophy,peripheral atrophy; dec. weight, profound buttock wasting; is not muscle wasting
Metabolic changes: glucose intol, inc. LDL,dec.HDL, inc TG
NRTIs mitochondria toxicity(stavudine and didanosine worse); PIs insulin resistance = multi drug etiology
Change medications
Substitute stavudine with zidovudine or abacavir
Plastic surgery--$$$
Antidiabetic therapy
Anabolic steroids; growth hormone
Prevention:vitamins, antioxidants?
Most interventions not proven
Very difficult to treat