1. The US Food and Drug Administration (FDA)–approved indication for dolutegravir tablets is:
   1. Monotherapy treatment of HIV-1.
   2. Combination therapy with other antiretroviral agents in the treatment of HIV-1 in patients 12 years of age and older and weighing at least 40 kg.
   3. Combination therapy with other antiretroviral agents in the treatment of HIV-1 in patients 2 years of age and older and weighing at least 12 kg.
   4. Combination therapy with other antiretroviral agents in the treatment of HIV-2 in patients 12 years of age and older and weighing at least 12 kg.
2. Dolutegravir is:
   1. A nucleoside reverse transcriptase inhibitor.
   2. A nonnucleoside reverse transcriptase inhibitor.
   3. An integrase inhibitor.
   4. A protease inhibitor.
3. Dolutegravir plasma concentration increases in a less than dose-proportional manner at doses greater than:
   1. 20 mg.
   2. 35 mg.
   3. 45 mg.
   4. 50 mg.
4. Administration of dolutegravir with food:
   1. Slows the rate and increases the extent of absorption.
   2. Slows the rate and decreases the extent of absorption.
   3. Speeds the rate and decreases the extent of absorption.
   4. Speeds the rate and increases the extent of absorption.
5. Patients at increased risk for development of transaminase elevations with the use of dolutegravir include those with:
   1. High body fat percentage.
   2. Renal impairment.
   3. Underlying hepatitis C infection.
   4. Residual opportunistic infections.
6. During the SPRING-2 study, the incidence of aspartate aminotransferase (AST) elevation was:
   1. Greater with dolutegravir than with raltegravir.
   2. Greater with raltegravir than with dolutegravir.
   3. The same with dolutegravir as with raltegravir.
   4. Not evaluated with either drug.
7. Dolutegravir should not be administered within 2 hours before or 6 hours after:
   1. Proton pump inhibitors such as omeprazole.
   2. Antacids such as magnesium hydroxide.
   3. Daily multivitamins.
   4. Dolutegravir can be administered without regard to other medications.
8. Dolutegravir is associated with which of the following:
   1. Hypertriglyceridemia.
   2. Hypoglycemia.
   3. Immune reconstitution syndrome.
   4. Impaired fertility.
9. Dolutegravir use should be avoided in patients with:
   1. A previous hypersensitivity reaction to raltegravir.
   2. Severe hepatic impairment.
   3. Severe renal impairment.
   4. Hyperglycemia.
10. Dolutegravir is classified in Pregnancy Category:
    1. A.
    2. B.
    3. D.
    4. X.

Case History

R.C. is a 27-year-old woman, weighing 65 kg, with diagnoses of HIV-1 (viral load greater than 100,000 copies/mL), drug-induced diabetes, drug-induced hyperlipidemia, and no history of hepatic or renal failure. Her current medications include tenofovir disoproxil fumarate, emtricitabine, and efavirenz in a single tablet once daily at bedtime, an ethinyl estradiol/norgestimate oral contraceptive daily, daily multivitamin, metformin 1,000 mg twice daily, and simvastatin 10 mg once daily. Prior to her current antiretroviral regimen, she had been treatment naïve. In an effort to reduce her viral load, a regimen including abacavir, lamivudine, and dolutegravir has been recommended to replace her current antiviral regimen.

11. What is the appropriate starting dose of dolutegravir for R.C.?
    1. 50 mg once daily
    2. 100 mg once daily
    3. 50 mg twice daily
    4. 50 mg every other day
12. Which of the following adjustments to R.C.’s therapy may need to be performed after initiating the dolutegravir-containing regimen?
    1. Increase the dose of simvastatin
    2. Decrease the dose of metformin
    3. Increase the dose of ethinyl estradiol/norgestimate
    4. Decrease the dose of tenofovir
13. Two months after initiating the new regimen, R.C. developed an infection at the site of a surgically repaired compound fracture requiring therapy with a fluoroquinolone and rifampin for several months. What dose of dolutegravir should R.C. now receive?
    1. 50 mg once daily
    2. 100 mg once daily
    3. 50 mg twice daily
    4. 50 mg every other day
14. What monitoring should be performed for R.C. before and during treatment with dolutegravir?
    1. HIV-1 RNA and CD4 count
    2. Serum lipase
    3. Slit lamp eye exam
    4. Serum creatinine and BUN
15. The dose of dolutegravir recommended for pediatric patients is:
    1. The same as the adult dose.
    2. Limited to 50 mg once daily.
    3. 50 mg twice daily due to their higher clearance.
    4. Weight-based up to a maximum of 1 mg/kg/day.

This CE activity is co-sponsored by ProCE, Inc. and Hospital Pharmacy. ProCE, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. ACPE Universal Activity Number 0221-9999-14-003-H02-P has been assigned to this knowledge-based home-study CE activity (initial release date 02-01-2014). This CE activity is approved for 1.5 contact hours (0.15 CEUs) in states that recognize ACPE providers. This CE activity is provided at no cost to participants. Statements of credit will be issued online upon completion of the evaluation and the post-test with a score of 70% or higher. No partial credit will be given.

Release Date: February 1, 2014

Expiration Date: February 1, 2016

Continuing Education for this activity is processed through the ProCE online CE Center. To receive CE credit, please go to:

www.ProCE.com/HPJFDR

Click to access the activity page to enroll and complete the Post-Test and Evaluation

With a passing grade of 70% or greater on the Post-Test, you will be able to print your CE statement of credit online.

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Info@ProCE.com.