Medication Errors Focus on the HIV-Infected Patient
|
|
- Dorthy Oliver
- 6 years ago
- Views:
Transcription
1 Medication Errors Focus on the HIV-Infected Patient Nimish Patel, Pharm.D., Ph.D., AAHIVP Associate Professor Albany College of Pharmacy & Health Sciences
2 I do not have any conflict of interest in relation to this program or presentation.
3 Objectives List common causes of medication errors Describe common examples of medication errors that have occurred in the HIV and non-hiv population List common methods to reduce incidence of medication errors.
4 Medication Errors Medication errors affect over 1.5 million persons in the United States Excess cost of $3.5 billion annually Every hospitalized patient may be subjected to as much as one medication error per day 33,000 trademarked medication names 8,000 nonproprietary medication names Unsurprising that medication names are mixed up
5 Categories of Medication Errors Prescribing error Omission error Wrong time error Unauthorized drug error Improper dose error Wrong dosage form error Wrong drug preparation error Wrong administrationtechnique error Deteriorated drug error Monitoring error Adherence error Other Am J Hosp Pharm. 1993; 50:305 14
6 More Generally Prescribing errors Wrong dose written Drug interactions not accounted for Dispensing errors Wrong drug dispensed Drug interactions not caught Patient errors Patient takes the wrong medications Patient takes meds at the wrong dose or frequency
7 Implications of Errors in HIV Early discontinuation of medications Virologic Failure / Drug Resistance Drug Toxicity Finding the Balance
8 Percent Medication Errors on the Rise Year Clin Infect Dis. 2006; 43:933 8 Ann Pharmacother 2000; 34: Am J Health Syst Pharm 2007; 64: HIV Med 2011; 12:494 9.
9 Contemporary estimate of medication errors Retrospective cohort study Johns Hopkins Hospital HIV Clinic Implemented the Eclipsys Sunrise Clinical Manager CPOE system equipped to Calculate creatinine clearance at time of order entry Alert providers to potential drug-drug interactions Eclipsys does NOT: Flag incomplete antiretroviral regimens Identify ART medication dosing or scheduling errors Yehia BR. Clin Infect Dis May 31. [Epub ahead of print]
10 Contemporary estimate of med errors Collected data on: Demographics Labs Inpatient service utilization Inpatient medication use Medication errors 2 clinical pharmacists reviewed med profiles to identify: ART medication errors Drug interaction errors Yehia BR. Clin Infect Dis May 31. [Epub ahead of print]
11 Contemporary estimate of med errors Errors were classified as: 1. Incomplete ART regimen 2. Incorrect dosage 3. Incorrect schedule 4. Non-recommended drug-drug combinations Per DHHS list of contraindicated or do not coadminister medications Yehia BR. Clin Infect Dis May 31. [Epub ahead of print]
12 Results: 702 hospital admissions 388 HIV-infected patients 188 with ART medications prescribed and 24h admission 145 ART medication errors identified 83 patients (29% of hospital admissions) Nature of the errors: Incomplete regimen: 58% Incorrect dosage: 38% Incorrect schedule: 23% Non-recommended drug combinations: 13% Distribution of errors involving ARTs: PI: 61%, NRTI: 26%, NNRTI: 13% RTV + fluticasone 46% Yehia BR. Clin Infect Dis May 31
13 Medication Errors Study Kaiser Permanente Northern California Study derived from the HIV-infected members of the Kaiser Permanente Northern California Serves 30% of resident population in N. California Approximately 5550 HIV-infected patients received health care at KPNC during the surveillance period of Able to compare written prescriptions with medications dispensed to patients DeLorenze G. et al. Medical Care. 2005;43:63-68
14 Error Categories Explored 1. Co-administration of contraindicated drugs 2. Incorrect dosing Excluded PI s due to multiple dosing options for PIs 3. Co-administration of duplicative medications 4. Sound-alike / Look-alike drug names 5. Antiretroviral Monotherapy DeLorenze G. et al. Medical Care. 2005;43:63-68
15 Error Rates Type of Error Contraindicated Medications No. of potential errors seen No. of errors reviewed No. of errors confirmed Incorrect Dosing Duplicative Medication Sound-alike / Lookalike Antiretroviral Monotherapy Number of errors seen in 5473 HIV-infected patients studied DeLorenze G. et al. Medical Care. 2005;43:63-68
16 Adverse events and catches Type of Error Contraindicated Medications Proportion of confirmed errors associated with adverse events Proportion of confirmed errors identified by clinical staff 10% 8% Incorrect Dosing 0 40% Duplicative Medication Sound Alike / Lookalike Antiretroviral Monotherapy 0 25% DeLorenze G. et al. Medical Care. 2005;43:63-68
17 Case example A patient was recently hospitalized and was discharged and is now returning to your facility. You receive the following medication order Atazanavir 300mg by mouth daily Ritonavir 100mg by mouth daily Abacavir 600mg by mouth daily Any concerns?
18 Simple 3 drug rule For the VAST majority of patients, at least 3 antiretroviral agents should be used at one time For treatment-experienced patients, more than 3 drugs may be used Ritonavir or cobicistat is NOT considered an individual agent and should not be counted as one of the 3 agents
19 Simple 3 drug rule Suggestions: If you see a patient who is prescribed less than 3 antiretroviral agents, question it or look at note (if you have access). Possible consequences detrimental Incomplete virologic suppression ARV resistance
20 Case example 2 A patient was admitted to your facility. The medication reconciliation team provides you with the following: Darunavir 600mg by mouth daily Tenofovir 300mg by mouth daily Emtricitabine 200mg by mouth daily Any concerns?
21 The Boosters Should ritonavir be used in the regimen or perhaps not? Depends upon the protease inhibitor Every protease inhibitor can be boosted EXCEPT for nelfinavir Some can be un-boosted and some always must be boosted Less of an issue as cobicistat slowly replaces ritonavir as the preferred booster and is coformulated with many of the products that it boosts
22 The Ritonavir Rule PIs that can be given without ritonavir: Atazanavir Fosamprenavir Indinavir PIs that MUST be given with ritonavir: Darunavir Saquinavir Lopinavir (built-in) Tipranavir (higher dose) -Cobicistat coformulated with atazanavir (Evotaz) and darunavir (Prezcobix) -Cobicistat also found in Genvoya and Stribild
23 Drug Duplication Order written for: Lopinavir/RTV + zidovudine + Combivir Problem: Combivir contains both zidovudine and lamivudine Overdosage of zidovudine (1200mg per day) Potential adverse effects: risks for anemia, lactic acidosis, neuropathy, etc. **Likely to become a bigger issue as many ART become generic while others remain branded**
24 Therapeutic confusion TWO formulations of tenofovir exist Tenofovir disoproxil fumarate (TDF) ~2001 Tenofovir alafenamide (TAF) ~2015 TAF concentrations are 80-90% higher intracellularly and 90% lower in renal tubules Lower rate of GFR changes
25 Therapeutic confusion Formulations containing TDF Viread Truvada Complera Atripla Stribild Formulations containing TAF Genvoya Odefsey Descovey
26 Antiretroviral Dosing Errors Why is the prescribed dose not matching up with the dose listed in the package insert? Example? Prescription written for etravirine 400mg PO daily FDA approved dose is 200mg PO twice daily You can t get in touch with the presriber
27 Stuck between a rock and a hard place
28 Reasons for different dosing Off-label dosing that has yet to be FDA approved Once daily dosing of twice daily dosed agent Usually done for adherence concerns Renal or hepatic disease Reduced dosing may be recommended certain patients Drug-drug interactions Sometimes may alter dose to overcome drug-drug interactions
29 Drugs currently being dosed off label for some patients Once daily dosed etravirine 400mg PO daily Usually dosed 200mg PO twice daily Once daily dosed raltegravir 800mg PO daily Usually dosed 400mg PO twice daily
30 Dosage Adjustments for Organ Impairment Renal dysfunction: didanosine stavudine zidovudine tenofovir lamivudine emtricitabine Combivir (AZT+3TC) Trizivir (AZT+3TC+ABC) Epzicom (3TC+ABC) Truvada (FTC+TDF) Atripla (TDF + FTC + EFV) Complera (TDF + FTC + RPV) And others Liver dysfunction fosamprenavir indinavir amprenavir abacavir efavirenz DHHS guidelines.
31 Drug interactions and dose adjustments What we know: Drug-drug interactions are common with antiretroviral agents Management consequences: Closer monitoring required Co-administration of agents contraindicated Dose alterations recommended to help normalize drug levels
32 Common Examples Atazanavir + Tenofovir Atazanavir should always be boosted with ritonavir Tenofovir + Didanosine Reduce dose of didanosine 400 to 250mg for patients >=60kg 250 to 200mg for patients <60kg Kaletra (lopinavir/ritonavir) + efavirenz Increase Kaletra dose from 2 tablets to 3 tablets twice daily
33 Examples Raltegravir + rifampin Increase raltegravir dose from 400mg to 800mg BID Protease inhibitors + rifabutin Reduce rifabutin dose to 150mg daily or 3 times weekly Atazanavir and acid suppressants Ensure appropriate spacing of administration times
34 Maraviroc Dosing Concomitant Medications Maraviroc Dosing CYP3A inhibitors (with or without a CYP3A inducer) including: -protease inhibitors Other concomitant medications 150mg twice daily 300mg twice daily CYP3A inducers (without a strong CYP3A inhibitor) including 600mg twice daily
35 Drug Interaction Update Numerous drug interactions exist between antiretroviral agents These interactions increase the risk for: Underdosing Poor efficacy Antiretroviral resistance Overdosing Increase the risk for toxicity and side effects Decrease tolerability
36 Harvoni TDF & boosted PIs In the presences of boosted protease inhibitors: Tenofovir exposures (AUC) are increased ~30% Potential for increase in renal adverse events In HIV/HCV coinfected patients using Harvoni, TDF and PIboosted regimen Even higher increases in tenofovir exposure Potential for renal adverse events Increase renal monitoring Harvoni not an issue with TAF containing products
37 Harvoni Amiodarone In HIV/HCV coinfected patients using amiodarone AVOID HARVONI Life-threatening reports of bradyarrythmias Contraindicated drug-drug interaction
38 Rilpivirine Acid Suppressants Rilpivirine Omeprazole interaction study 40% reduction in rilpivirine concentrations PPI co-administration considered a contraindication with rilpivirine H2 antagonists Use with caution with rilpivirine Administer at least 12 hours before or 4 hours after rilpivirine TMC278 Investigator s Brochure, edition 6. Tibotec Pharmaceuticals Ltd., November Edurant prescribing information. Johnson and Johnson. 2011
39 Salmeterol - Ritonavir Ritonavir shown to cause significant increase in salmeterol concentrations The combination may result in increased risk of cardiovascular adverse events associated with salmeterol, including QT prolongation, palpitations and sinus tachycardia. Combination not recommended Take home message: Additional reasons not to co-prescribe fluticasone-salmeterol (Advair) along with protease inhibitors
40 Antiretroviral Check-List 1. Are they prescribed a complete antiretroviral regimen or does it look like a drug is missing 2. Are duplicate medications present? Look closely at combination products 3. Are the doses appropriate? If they are not using standard doses, are there reasons why? 4. Always consider drug interactions Can they be managed?
41 Example 1 The following prescription comes to your pharmacy: Darunavir 600mg BID Ritonavir 100mg BID Any concerns?
42 Example 1 The following prescription comes to your pharmacy: Darunavir 600mg BID Ritonavir 100mg BID Any concerns? Incomplete regimen Additional agents are necessary
43 Example 2 The following prescription comes your way: Darunavir 600mg BID Ritonavir 100mg BID Abacavir 600mg/d Lamivudine 50mg/d Any concerns?
44 Example 2 The following prescription comes your way: Darunavir 600mg BID Ritonavir 100mg BID Abacavir 600mg/d Lamivudine 50mg/d Any concerns? Lamivudine should be dosed 150mg/d at a CrCL > 40mL/min
45 Example 3 The following prescription comes to your pharmacy: Evotaz 1 tablet daily Ritonavir 100mg daily Truvada 1 tablet daily Any concerns?
46 Example 3 The following prescription comes to your pharmacy: Evotaz 1 tablet daily Ritonavir 100mg daily Truvada 1 tablet daily Any concerns? Booster duplication with ritonavir Evotaz already had cobicistat built into product (atazanavir/cobicistat)
47 Example 4 The following prescription comes your way: Atazanavir 300mg/d Ritonavir 100mg/d Truvada 1 tablet daily Fluticasone 1 inhalation daily Any concerns?
48 Example 4 The following prescription comes your way: Atazanavir 300mg/d Ritonavir 100mg/d Truvada 1 tablet daily Fluticasone 1 inhalation daily Any concerns? Coadministration ritonavir-boosted PIs with fluticasone can cause Cushing s syndrome and is not recommended
49 Thank You!
Antiretroviral Dosing in Renal Impairment
Protease Inhibitors (PIs) Atazanavir Reyataz hard capsules 300 mg once daily taken with ritonavir 100 mg once daily No dosage adjustment is needed for atazanavir in renal impairment Atazanavir use in haemodialysis
More informationHIV MEDICATIONS AT A GLANCE. Atripla 600/200/300 mg tablet tablet daily. Complera 200/25/300 mg tablet tablet daily
HIV MEDICATIONS AT A GLANCE Generic Name Trade Name Strength DIN Usual Dosage Single Tablet Regimen (STR) Products Efavirenz/ Emtricitabine/ rilpivirine/ elvitegravir/ cobicistat/ alafenamide Emtricitabine/
More informationHIV Drugs and the HIV Lifecycle
HIV Drugs and the HIV Lifecycle Together, we can change the course of the HIV epidemic one woman at a time. #onewomanatatime #thewellproject All HIV drugs work by interrupting different steps in HIV's
More informationSimplifying HIV Treatment Now and in the Future
Simplifying HIV Treatment Now and in the Future David M. Hachey, Pharm.D., AAHIVP Professor Idaho State University Department of Family Medicine Nothing Disclosure 1 Objectives List current first line
More informationANTIRETROVIRAL TREATMENTS (Part 1of
CCR5 CO-RECEPTOR ANTAGONISTS maraviroc (MVC) Selzentry 25mg, 75mg, FUSION INHIBITORS 20mg/mL ANTIRETROVIRAL TREATMENTS (Part 1of 5) oral soln enfuvirtide (ENF, T-20) Fuzeon 90mg/mL pwd for SC inj after
More informationCOMPREHENSIVE ANTIRETROVIRAL TABLE: ADULT DOSING, DOSAGE FORM MODIFICATIONS, ADVERSE REACTIONS and INTERACTION POTENTIAL
Generic Name COMPREHENSIVE ANTIRETROVIRAL TABLE: NUCLOESIDE/TIDE REVERSE TRANSCRIPTASE INHIBITORS (N(t)RTIs) Abacavir ABC (Ziagen) Didanosine ddi (Videx EC) Emtricitabine FTC (Emtriva) Lamivudine 3TC (Epivir)
More informationTHE HIV LIFE CYCLE. Understanding How Antiretroviral Medications Work
THE HIV LIFE CYCLE Understanding How Antiretroviral Medications Work DEFINITIONS Host: The animal or cell that another organism lives in. In HIV human CD4 T-cells are the host for HIV. Nucleus: The core
More informationWOMENS INTERAGENCY HIV STUDY ANTIRETROVIRAL DOSAGE FORM SECTION A. GENERAL INFORMATION
WOMENS INTERAGENCY HIV STUDY ANTIRETROVIRAL DOSAGE FORM SECTION A. GENERAL INFORMATION A1. PARTICIPANT ID: ENTER NUMBER HERE - - - ONLY IF ID LABEL IS NOT AVAILABLE A2. VISIT #: A3. VERSION DATE: 1 0 /
More informationSelecting an Initial Antiretroviral Therapy (ART) Regimen
Selecting an Initial Antiretroviral Therapy (ART) Regimen An HIV Diagnosis is a Call to Action In support of the NYSDOH AIDS Institute s January 2018 call to action for patients newly diagnosed with HIV,
More informationCOMPREHENSIVE ANTIRETROVIRAL TABLE: ADULT DOSING**, DOSAGE FORM MODIFICATIONS, ADVERSE REACTIONS and INTERACTION POTENTIAL
COMPREHENSIVE ANTIRETROVIRAL TABLE: NUCLOESIDE/TIDE REVERSE TRANSCRIPTASE INHIBITORS (N(t)RTIs) Abacavir ABC (Ziagen) Didanosine ddi (Videx EC) Emtricitabine FTC (Emtriva) Lamivudine 3TC (Epivir) Stavudine
More informationThe Hospitalized HIV+ Patient
The Hospitalized HIV+ Patient Danny Toub MD dannyt@srheathcenters.org October 8, 2012 Santa Rosa Family Medicine Residency List 3 ways of risk-stratifying known or suspected HIV+ inpatients Perform differential
More informationDaclatasvir (Daklinza ) Drug Interactions with HIV Medications
Daclatasvir/Sofosbuvir (Daklinza /Sovaldi TM ) Drug Interactions A Quick Guide for Clinicians April 2017 John J Faragon, PharmD, BCPS, AAHIVP Mechanism of Action and Route of Metabolism for Daclatasvir
More informationACTHIV 2018: A State-of-the-Science Conference for Frontline Health Professionals
Antiretroviral Medications: What you need to know Jason J. Schafer, PharmD, MPH, BCPS, AAHIVP Associate Professor, Department of Pharmacy Practice Jefferson College of Pharmacy, Thomas Jefferson University
More informationNorthwest AIDS Education and Training Center Educating health care professionals to provide quality HIV care
Northwest AIDS Education and Training Center Educating health care professionals to provide quality HIV care www.nwaetc.org The Northwest AIDS Education and Training Center (NW AETC), located at the University
More informationHIV Management Update 2015
9/30/15 HIV Management Update 2015 Larry Pineda, PharmD, PhC, BCPS Visiting Assistant Professor Pharmacy Practice and Administrative Science ljpineda@salud.unm.edu Pharmacist Learning Objectives Describe
More informationDidactic Series. Switching Regimens in the Setting of Virologic Suppression
Didactic Series Switching Regimens in the Setting of Virologic Suppression Craig Ballard, PharmD, AAHIVP UC San Diego Health Owen Clinic June 14 th, 2018 1 Learning Objectives 1) Describe DHHS guidelines
More informationHuman Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) in the Long Term Care Setting Part 2: HIV Medications
Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) in the Long Term Care Setting Part 2: HIV Medications Carrie Allen PharmD, CGP, BCPS, BCPP, CCHP Overview - Part 2: HIV
More informationWOMEN'S INTERAGENCY HIV STUDY METABOLIC STUDY: MS01 SPECIMEN COLLECTION FORM
WOMEN'S INTERAGENCY HIV STUDY METABOLIC STUDY: MS01 SPECIMEN COLLECTION FORM ID LABEL HERE ---> VERSION DATE 10/01/07 - - - VISIT #: FORM COMPLETED BY: A1. DATE OF BLOOD DRAW: / / M D Y A2. Do you take
More informationFluconazole dimenhydrinate, diphenhydramine. Raltegravir or dolutegravir with antacids
Supportive therapy Summary of interactions Table 1. Summary of potential interactions between antiretroviral agents and supportive therapy Interactions with enzyme inhibitors (protease inhibitors and elvitegravir/cobicistat)
More informationThe ART of Managing Drug-Drug Interactions in Patients with HIV
The ART of Managing Drug-Drug Interactions in Patients with HIV Bradley L. Smith, Pharm.D. smith.bradley1@mayo.edu Pharmacy Grand Rounds December 19, 2017 2017 MFMER slide-1 Presentation Objectives Describe
More informationTomasz Z. Jodlowski, Pharm.D., BCPS (AQ-ID) Clinical Pharmacy Specialist, Infectious Diseases VA North Texas HCS
Tomasz Z. Jodlowski, Pharm.D., BCPS (AQ-ID) Clinical Pharmacy Specialist, Infectious Diseases VA North Texas HCS Tomasz.Jodlowski@va.gov 02/06/2018 Independent contractor. IPRO. IPRO Antibiotic Stewardship
More informationADAP Monitoring Provider Prescribing Patterns. Amanda Bowes, NASTAD Christine Rivera and Dr. Charles Gonzalez, NYS AIDS Institute
ADAP Monitoring Provider Prescribing Patterns Amanda Bowes, NASTAD Christine Rivera and Dr. Charles Gonzalez, NYS AIDS Institute WEBINAR ETIQUETTE All questions or comments can be shared either via the
More informationComprehensive Guideline Summary
Comprehensive Guideline Summary Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents AETC NRC Slide Set Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and
More informationThe use of antiretroviral agents during pregnancy in Canada and compliance with North-American guidelines
The use of antiretroviral agents during pregnancy in Canada and compliance with North-American guidelines I. Boucoiran, T. Lee, K. Tulloch, L. Sauve, L. Samson, J. Brophy, M. Boucher and D. Money For and
More informationIndustry Data Request
Industry Data Request Purpose: reported data will be used internally to populate patient forecasting models that are used for business planning. Business planning includes stock requirement forecasts,
More informationPHARMACOKINETICS OF ANTIRETROVIRAL AND ANTI-HCV AGENTS
8. PHARMACOKINETICS OF ANTIRETROVIRAL AND ANTI-HCV AGENTS David Burger José Moltó Table 8.1a: INFLUENCE OF FOOD ON ABSORPTION (AREA UNDER THE CURVE) OF ANTIRETROVIRAL AGENTS NUCLEOSIDE ANALOGUES NtRTI
More informationSTATEMENT OF DISCLOSURE
STATEMENT OF DISCLOSURE Presenter has no relevant financial relationships with commercial interests pertaining to the contents of this program ARB 2 OBJECTIVES Define medication errors and discuss data
More informationAn HIV Update Jan Clark, PharmD Specialty Practice Pharmacist
An HIV Update - 2019 Jan Clark, PharmD Specialty Practice Pharmacist 2 The goal of this program is to provide a review and update of HIV care and to provide a forum for discussing the current local and
More informationAntiretrovial Crushable/Liquid Formulation Chart
Antiretrovial Crushable/Liquid Formulation Chart Eliza Dollard, PharmD; Nafeesa Chin-Beckford, PharmD; Laura Aragon, PharmD Last Updated: 04/2016 Agent How Supplied Crushable Status **Products listed in
More informationSecond-Line Therapy NORTHWEST AIDS EDUCATION AND TRAINING CENTER
NORTHWEST AIDS EDUCATION AND TRAINING CENTER Second-Line Therapy David Spach, MD Clinical Director, Northwest AETC Professor of Medicine, Division of Infectious Diseases University of Washington Presentation
More informationHIV for the Non-ID Pharmacist
Disclosures HIV for the Non-ID Pharmacist I have nothing to disclose at this time Carmen Faulkner-Fennell, PharmD, BCPS (AQ-ID) Clinical Pharmacy Specialist--Infectious Diseases Greenville Hospital System
More informationHIV Pharmacology 101ish - 202ish: New HIV Clinicians Workshop
HIV Pharmacology 101ish - 202ish: New HIV Clinicians Workshop Parya Saberi, PharmD, MAS The Medical Management of HIV/AIDS December 2012 Objectives What are commonly used ARVs and where do they work in
More informationRisk of HIV-1 low level viremia to treatment. Germany. Nadine Lübke Düsseldorf
Risk of HIV-1 low level viremia to treatment failure in the AREVIR-RESINA cohort in Germany Nadine Lübke Düsseldorf FDA Approval of antiretroviral drugs 1980-84 1985-89 1990-94 1995-99 2000-04 2005-09
More informationExploring HIV in 2017: What a pharmacist needs to know
Exploring HIV in 2017: What a pharmacist needs to know Lifecycle of the HIV virus a. HIV spread through mucous membrane contact, damaged tissue contact, or blood contact with: blood, semen, rectal fluids,
More informationHIV medications HIV medication and schedule plan
Living with HIV (human immunodeficiency virus) It may be scary to find out that you re HIV-positive or have AIDS. Coping with this news may be difficult. Although HIV is a serious infection, people with
More informationContinuing Education for Pharmacy Technicians
Continuing Education for Pharmacy Technicians HIV/AIDS TREATMENT Michael Denaburg, Pharm.D. Birmingham, AL Objectives: 1. Identify drugs and drug classes currently used in the management of HIV infected
More informationAppropriate Use & Safety Edits
Appropriate Use & Safety Edits Envolve Pharmacy Solutions provides a variety of safety edits to promote the use of the right medication, in the right patient, at the right time. These edits are routinely
More informationSculpting a Better Regimen: The ART of HIV Medications
Sculpting a Better Regimen: The ART of HIV Medications Kelly Peddy, PharmD, MPA Clinical Pharmacy Specialist - Ambulatory Care Memorial Hospital of South Bend November 30, 2017 For HealthTrust Members
More informationAntiretroviral Drugs
Antiretroviral Drugs Dr Paddy Mallon UCD HIV Molecular Research Group Associate Dean for Research and Innovation UCD School of Medicine and Medical Science paddy.mallon@ucd.ie UCD School of Medicine &
More informationJULUCA (dolutegravir sodium-rilpivirine hydrochloride) oral tablet
JULUCA (dolutegravir sodium-rilpivirine hydrochloride) oral tablet Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific
More informationPOST-EXPOSURE PROPHYLAXIS, PRE-EXPOSURE PROPHYLAXIS, & TREATMENT OF HIV
POST-EXPOSURE PROPHYLAXIS, PRE-EXPOSURE PROPHYLAXIS, & TREATMENT OF HIV DISCLOSURE Relevant relationships with commercial entities none Potential for conflicts of interest within this presentation none
More information104 MMWR December 17, 2004
104 MMWR December 17, 2004 TABLE 8. Substantial pharmacokinetic drug-drug interactions for drugs used in the treatment of opportunistic Drugs Interacting with Mechanism/effects Recommendations Acyclovir
More informationA Changing Landscape: New and Pipeline HIV Therapies
A Changing Landscape: New and Pipeline HIV Therapies Sarah Turley, PharmD, BCPS PGY2 Internal Medicine Pharmacy Resident Virginia Commonwealth University Health System Financial Disclosure I have no relevant
More informationtreatment passport 1
treatment passport 1 Why keep a treatment history? Keeping a short record of your treatment history can help in many ways. It can help you understand your health and treatment. It can help if your doctor
More informationALABAMA S ADAP FORMULARY OFFERS 117 MEDICATIONS
ALABAMA S ADAP FORMULARY OFFERS 117 MEDICATIONS - 2014 Alabama s ADAP formulary offers a minimum of one medication from each HIV antiretroviral class approved by the U.S. Food and Drug Administration (FDA).
More informationHIV Treatment Update. Objectives. Epidemiology 12/22/2015
HIV Treatment Update Monique Calil, Pharm.D. PGY-1 Resident Broward Health Medical Center Objectives Review antiretroviral therapy (ART) medications used for the treatment of HIV, including new combination
More informationMEDICAL COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 03/07/18 SECTION: DRUGS LAST REVIEW DATE: 02/19/19 LAST CRITERIA REVISION DATE: ARCHIVE DATE:
FUZEON (enfuvirtide) Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs
More informationTreatment and Care: Product portfolio
Treatment and Care: Product portfolio Dr Paula Munderi MRC/UVRI Uganda Research Unit on AIDS EDCTP Stakeholder Meeting on HIV/AIDS 3-4 September 2013 Summary Brief overview HIV Treatment Pipeline Key Questions
More informationThird Agent Advantages Disadvantages. Component Tenofovir/emtricitabine (TDF/FTC) 300/200 mg (coformulated with EFV as Atripla) 1 tab once daily
Table I. Recommended and Alternative Antiretroviral Regimens (DHHS Guidelines, May 1, 2014) Recommended Regimens Nucleoside Analog Reverse Transcriptase Inhibitor (NRTI) Third Agent Advantages Disadvantages
More informationGuidance for Non-HIV-Specialized Providers Caring for Persons with HIV Displaced by Disasters
Guidance for Non-HIV-Specialized Providers Caring for Persons with HIV Displaced by Disasters Visit the AIDSinfo website to access the most up-to-date guideline. Register for e-mail notification of guideline
More informationTORONTO GENERAL HOSPITAL HIV AMBULATORY CARE ROTATION
TGH - ambulatory rotation page 1 of 5 TORONTO GENERAL HOSPITAL HIV AMBULATORY CARE ROTATION SITE: Immunodeficiency Clinic, Toronto General Hospital, University Health Network Location: 13 th floor, Norman
More informationPharmacological considerations on the use of ARVs in pregnancy
Pharmacological considerations on the use of ARVs in pregnancy 11 th Residential Course on Clinical Pharmacology of Antiretrovirals Torino, 20-22 January 2016 Prof. David Burger, PharmD, PhD david.burger@radboudumc.nl
More informationMedscape's Antiretroviral Pocket Guide for the Treatment of HIV Infection
Table 3. Characteristics of Nucleoside Reverse Transcriptase Inhibitors (NRTIs) Generic Name (Abbreviation) / Trade Name Abacavir (ABC) / Ziagen Trizivir with ZDV + 3TC Epzicom with 3TC Didanosine (ddi)
More informationIndustry Request Integrase Inhibitors
Industry Request Integrase Inhibitors The objective of this request is to describe and understand the temporal changes in the prescribing practices of Integrese Inibitors (II) in AHOD cohort between 1/1/
More informationDidactic Series. HIV Drug-Drug Interactions: OTC and non-prescription medications. Kirsten B. Balano, PharmD UCSF School of Pharmacy February 26, 2015
Didactic Series HIV Drug-Drug Interactions: OTC and non-prescription medications Kirsten B. Balano, PharmD UCSF School of Pharmacy February 26, 2015 ACCREDITATION STATEMENT: University of California, San
More informationThe ABCs of ART: Designing Initial Antiretroviral Regimens for Beginners
The ABCs of ART: Designing Initial Antiretroviral Regimens for Beginners Elizabeth Sherman, PharmD, AAHIVP Faculty South Florida, Southeast AETC Clinical Pharmacist, Memorial Healthcare System Assistant
More informationCLINICAL PEARLS OF NEW HIV MEDICATIONS PHARMACIST OBJECTIVES TECHNICIAN OBJECTIVES. At the end of this presentation pharmacists will be able to:
CLINICAL PEARLS OF NEW HIV MEDICATIONS Cindy Lou Zoellner, PharmD, BCPS Added Qualifications in Infectious Diseases Senior Clinical Pharmacy Specialist in HIV Parkland Health & Hospital System Volunteer
More informationRecommended dosing for pediatric patients (6 months to 12 years of age) 1. Dose based on lopinavir component* 1.25 ml ml
Abbott Virology 100 Abbott Park Road Abbott Park, IL 60064 KALETRA 100/25 mg tablets NDC #0074-0522-60 Dear Healthcare Provider: Introducing a new strength of KALETRA (lopinavir/ritonavir): 100/25 mg tablets
More informationABRIDGED ANTIRETROVIRAL TABLE: ADULT DOSING, DOSAGE FORM MODIFICATIONS, ADVERSE REACTIONS and INTERACTION POTENTIAL
NULOESIDE/TIDE REVERSE TRANSRIPTASE INHIBITORS (N(t)RTIs) Abacavir AB (Ziagen) Emtricitabine FT (Emtriva) Lamivudine 3T (Epivir) Tenofovir disoproxil fumarate TDF (Viread) Zidovudine AZT, ZDV (Retrovir)
More informationWhen to Start ART. Reduction in HIV transmission. ? Reduction in HIV-associated inflammation and associated complications» i.e. CV disease, neuro, etc
When to Start ART Exact CD4 count at which to initiate therapy not known, but evidence points to starting at higher counts Current recommendation: ART for all patients with CD4 count of
More informationARVs on an Empty Stomach: Food Interaction Studies in a resource Limited Setting
ARVs on an Empty Stomach: Food Interaction Studies in a resource Limited Setting Dr. Andrew D Kambugu, FRCP (UK) Infectious Diseases Institute, Makerere University Outline of Discussion Key Definitions
More informationPART VI: SUMMARY OF THE RISK MANAGEMENT PLAN
PART VI: SUMMARY OF THE RISK MANAGEMENT PLAN Summary of Risk Management Plan for PREZISTA (Darunavir [TMC114]) This is a summary of the risk management plan (RMP) for PREZISTA. The RMP details important
More informationARVs in Development: Where do they fit?
The picture can't be displayed. ARVs in Development: Where do they fit? Daniel R. Kuritzkes, M.D. Division of Infectious Diseases Brigham and Women s Hospital Harvard Medical School Disclosures The speaker
More informationProduct Monograph. DESCOVY (emtricitabine/tenofovir alafenamide) tablets
INCLUDING PATIENT MEDICATION INFORMATION Pr DESCOVY (emtricitabine/tenofovir alafenamide) tablets 200 mg emtricitabine 10 mg* and 25 mg** tenofovir alafenamide * as 11.2 mg tenofovir alafenamide hemifumarate
More informationHIV Treatment: New and Veteran Drugs Classes
HIV Treatment: New and Veteran Drugs Classes Jonathan M Schapiro, MD National Hemophilia Center Stanford University School of Medicine Rome, March 2013 Overview Many excellent antiretroviral agents are
More informationHIV basics. Katya Calvo Medical Director of Antimicrobial Stewardship
HIV basics Katya Calvo Medical Director of Antimicrobial Stewardship Learning Objectives 1. Review of HIV epidemiology worldwide and locally 2. Review of recommendations on whom to screen 3. Work up of
More informationDistribution and Effectiveness of Antiretrovirals in the Central Nervous System
Distribution and Effectiveness of Antiretrovirals in the Central Nervous System Scott Letendre, MD Associate Professor of Medicine HIV Neurobehavioral Research Center and Antiviral Research Center University
More informationActualización y Futuro en VIH
Actualización y Futuro en VIH Dr. Santiago Moreno Servicio de Enfermedades Infecciosas Hospital U. Ramón y Cajal. Universidad de Alcalá. IRYCIS. Madrid Agenda Control of the HIV-epidemic Coinfections Antiretroviral
More informationDarunavir STADA 400, 600 and 800 mg film-coated tablets , Version 1.1 PUBLIC SUMMARY OF THE RISK MANAGEMENT PLAN
Darunavir STADA 400, 600 and 800 mg film-coated tablets 7.9.2016, Version 1.1 PUBLIC SUMMARY OF THE RISK MANAGEMENT PLAN VI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology Human
More informationPrinciples of Antiretroviral Therapy
Principles of Antiretroviral Therapy Ten Principles of Antiretroviral Therapy Skills Building Workshop: Clinical Management of HIV Infection and Antiretroviral Therapy, 11 th ICAAP, November 21st, 2011,
More informationSummary of treatment benefits
VI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology Human immunodeficiency virus (HIV) attacks the cells of the immune system, the body's natural defense against germs and other
More informationCase # 1. Case #1 (cont d)
Antiretroviral Therapy Management: Expert Panel Discussion George Beatty Susa Coffey Steve O Brien December 3, 2011 Moderated by Annie Luetkemeyer Case # 1 38 y.o. man, CD4 =350, VL=340K, new to your clinic
More informationPaediatric antiretroviral therapy.
Paediatric antiretroviral therapy. Guidelines exist for the choice of first line agents, but do not cover second line agents, other than recommending regimes of adequate potency. We would follow PENTA
More informationHIV Treatment: State of the Art 2013
HIV Treatment: State of the Art 2013 Daniel R. Kuritzkes, MD Chief, Division of Infectious Diseases Brigham and Women s Hospital Professor of Medicine Harvard Medical School Success of current ART Substantial
More informationApproach for the Newly Diagnosed HIV Positive Patient
Approach for the Newly Diagnosed HIV Positive Patient Jason E. Farley, PhD, MPH, ANP-BC, FAAN, AACRN Associate Professor & NP, Johns Hopkins University School of Nursing & Medicine Director, AETC Adult-Gerontology
More informationSingle Pill Combinations Versus Generics: Prescribing Practices in a New Healthcare Era
Activity Code FM285 Single Pill Combinations Versus Generics: Prescribing Practices in a New Healthcare Era Monica Gandhi MD, MPH Clinic Director, Ward 86 HIV Clinic, SFGH/UCSF Learning Objectives Upon
More informationART: The New, The Old and The Ugly
ART: The New, The Old and The Ugly Our Current ARVS The Nucleoside/ Nucleotide Reverse Transcriptase Inhibitors (NRTIs/ NtRTIs) Abacavir Emtricitabine Lamivudine Stavudine Tenofovir Zidovudine The Non-Nucleoside
More informationClinical Commissioning Policy: Use of cobicistat (Tybost ) as a booster in treatment of HIV positive adults and adolescents
Clinical Commissioning Policy: Use of cobicistat (Tybost ) as a booster in treatment of HIV positive adults and adolescents 1 Clinical Commissioning Policy: Use of cobicistat (Tybost ) as a booster in
More informationDisclosures. Goals. US DHHS Guidelines: 1 st Line Therapy. Antiretroviral Therapy Initiation:
Disclosures Antiretroviral Therapy Initiation: From Guidelines to Practice: ART 101 Medical Management of AIDS & Hepatitis December 8, 2017 Research grant support from Gilead Sciences for ongoing work
More informationPage 1 of 5 ENLGLISH / ESPAÑOL / PORTUGUÉS / FRANÇAIS Share 3 Drug Chart for HIV Treatment CURRENT EDITION ABOUT SENSE BACK ISSUES MSMGF HOME CONTACT US There are a number of antiretroviral (ARV) medications
More informationCentral Nervous System Penetration of ARVs: Does it Matter?
NORTHWEST AIDS EDUCATION AND TRAINING CENTER Central Nervous System Penetration of ARVs: Does it Matter? Christina M. Marra, MD Neurology and Medicine (Infectious Diseases) University of Washington 15
More informationProduct Monograph. DESCOVY (emtricitabine/tenofovir alafenamide) tablets
INCLUDING PATIENT MEDICATION INFORMATION Pr DESCOVY (emtricitabine/tenofovir alafenamide) tablets 200 mg emtricitabine 10 mg* and 25 mg** tenofovir alafenamide * as 11.2 mg tenofovir alafenamide hemifumarate
More informationImportant new concerns or changes to the current ones will be included in updates of Symtuza's RMP.
Summary of Risk Management Plan for Symtuza (D/C/F/TAF) This is a summary of the risk management plan (RMP) for Symtuza. The RMP details important risks of Symtuza, how these risks can be minimised, and
More informationProduct Monograph. DESCOVY (emtricitabine/tenofovir alafenamide) tablets
INCLUDING PATIENT MEDICATION INFORMATION Pr DESCOVY (emtricitabine/tenofovir alafenamide) tablets 200 mg emtricitabine 10 mg* and 25 mg** tenofovir alafenamide * as 11.2 mg tenofovir alafenamide hemifumarate
More informationBristol-Myers Squibb and Gilead Sciences, LLC 1
HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use ATRIPLA safely and effectively. See full prescribing information for ATRIPLA. ATRIPLA (efavirenz/emtricitabine/tenofovir
More informationCriteria for Oral PrEP
Oral PrEP New Drugs Roy M. Gulick, MD, MPH Chief, Division of Infectious Diseases Professor of Medicine Weill Medical College of Cornell University New York City Safe Criteria for Oral PrEP Penetrates
More information1/13/16. Updated April 2015
Bernadette Jakeman, PharmD, PhC, BCPS, AAHIVP Assistant Professor UNM College of Pharmacy bjakeman@salud.unm.edu Pharmacist objectives: 1. Summarize key updates to the DHHS treatment guidelines. 2. Identify
More informationOctober 26-28: Training Day 1
Peer Linkage and Re-Engagement of HIV- Positive Women of Color October 26-28: Training Day 1 Peer Linkage and Re -Engagement of HIV - Positive Women of Color Convening Training Trainers Today: Alicia Downes
More informationPharmacology Update Alice Tseng, Pharm.D., FCSHP Vancouver May 11, 2005
Pharmacology Update 2005 Alice Tseng, Pharm.D., FCSHP Vancouver May 11, 2005 I m having a Maalox moment!!! Gastric Hypoacidity in HIV 20% incidence in HIV (unrelated to CD 4 ) Antacids, ddi tablets, H2-blockers
More informationIntegrase Strand Transfer Inhibitors on the Horizon
NORTHWEST AIDS EDUCATION AND TRAINING CENTER Integrase Strand Transfer Inhibitors on the Horizon David Spach, MD Clinical Director, Northwest AETC Professor of Medicine, University of Washington Presentation
More informationHIV Treatment Guidelines
HIV Treatment Guidelines Together, we can change the course of the HIV epidemic one woman at a time. #onewomanatatime #thewellproject What Are Treatment Guidelines? Issued by variety of global and country-based
More informationART and Prevention: What do we know?
ART and Prevention: What do we know? Biomedical Issues Trip Gulick, MD, MPH Chief, Division of Infectious Diseases Professor of Medicine Weill Cornell Medical College New York City ART for Prevention:
More informationHepatitis C Medications Prior Authorization Criteria
Hepatitis C Medications Authorization Criteria Epclusa (/velpatasvir), Harvoni (ledipasvir/), Sovaldi (), Daklinza (daclatasvir), Zepatier (elbasvir/grazoprevir), Olysio (simeprevir), Viekira Pak (ombitasvir/paritaprevir/ritonavir;
More information0.14 ( 0.053%) UNAIDS 10% (94) ( ) (73-94/6 ) 8,920
0.14 UNAIDS 0.053% 2 250 60 10% 94 73 20 73-94/6 8,920 12 43 Public Health Service Task Force Recommendations 5-10% for Use of Antiretroviral Drugs in 10-20% Pregnant HIV-1-Infected Women for Maternal
More informationThe ART of Antiretroviral Therapy in Critically-ill Patients with HIV
The ART of Antiretroviral Therapy in Critically-ill Patients with HIV Tyler Finocchio, PharmD, BCPS PGY2 Critical Care Pharmacy Resident Avera McKennan Hospital & University Health Center February 10 th,
More informationREVIEW No Assessment of safety a. Have all relevant studies on safety been included Yes X No (if no, please provide reference and information)
Expert peer review on application for addition of fixed dose combination formulations of antiretroviral medications in the EML (Adults) REVIEW No. 2 Abacavir + lamivudine (ABC+ 3TC) Tablet (dispersible):
More informationTB Intensive Tyler, Texas December 2-4, Tuberculosis and HIV Co-Infection. Lisa Y. Armitige, MD, PhD. December 4, 2008.
TB Intensive Tyler, Texas December 2-4, 2008 Tuberculosis and HIV Co-Infection Lisa Y. Armitige, MD, Ph.D. December 4, 2008 Tuberculosis and HIV Co Infection Lisa Y. Armitige, MD, PhD Assistant Professor
More informationNON-OCCUPATIONAL POST EXPOSURE PROPHYLAXIS IN HIV PREVENTION. Jason E. Vercher, PA-C, AAHIVM
NON-OCCUPATIONAL POST EXPOSURE PROPHYLAXIS IN HIV PREVENTION Jason E. Vercher, PA-C, AAHIVM Disclosures No disclosures to report Learning Objectives q Identify Individuals who would benefit from non-occupational
More informationTB/HIV Co-Infection. Tuberculosis and HIV
TB Intensive Tyler, Texas June 2-4, 2010 TB/HIV Co-Infection Lisa Y Armitige, MD, PhD June 3, 2010 Tuberculosis and HIV Co-Infection Lisa Y Armitige, MD, PhD Medical Consultant Heartland National TB Center
More informationThis graph displays the natural history of the HIV disease. During acute infection there is high levels of HIV RNA in plasma, and CD4 s counts
1 2 This graph displays the natural history of the HIV disease. During acute infection there is high levels of HIV RNA in plasma, and CD4 s counts decreased. This period of acute infection or serocnversion
More information