Friday, June 10, 2016

Step 2 CK: Treatment of Pneumocystis carinii pneumonia (PCP) mnemonic

Hello my old friend!

Today's post is on  Pneumocystis carinii pneumonia (PCP)!

Here are my notes and mnemonics :D

Prophylaxis:

HIV-infected adults should receive chemoprophylaxis against PCP if they have CD4 counts < 200 cells/mm3.

Trimethoprim-sulfamethoxazole (TMP-SMX) is the recommended prophylactic agent.
Mnemonic: PCP Prim Cotrimoxazole Pair (I know Cotrimoxazole is the combination of TMP and SMX but I added it for the mnemonic :P )

For patients who cannot tolerate TMP-SMX, alternative prophylactic regimens include:
Dapsone
Dapsone plus Pyrimethamine plus leucovorin
Aerosolized Pentamidine
Atovaquone
Mnemonic: DAP

Primary Pneumocystis prophylaxis should be discontinued for adult and adolescent patients who have responded to ART with an increase in CD4 counts from < 200 cells/mm3 to ≥ 200 cells/mm3 for > 3 months.

TMP-SMX is the treatment of choice for PCP.

Alternative therapeutic regimens include:
Dapsone and TMP
Primaquine plus Clindamycin (Mnemonic: PC for PCP again!)
(Clindamycin can be given IV, but primaquine is only available orally)
Atovaquone
IV Pentamidine
(Aerosolized pentamidine should not be used to treat PCP because its efficacy is limited and it is associated with more frequent relapse.)

Adverse effects:
TMP-SMX: Rash, Stevens-Johnson syndrome, fever, leukopenia, thrombocytopenia, azotemia, hepatitis and hyperkalemia.
Dapsone or primaquine (especially in those with G6PD deficiency): Methemoglobinemia and hemolysis
Dapsone: Rash and fever with dapsone;
Pentamidine: Azotemia, pancreatitis, hypo- or hyperglycemia, leukopenia, electrolyte abnormalities, and cardiac dysrhythmia.
Primaquine and clindamycin: Anemia, rash, fever, and diarrhea.
Atovaquone: Headache, nausea, diarrhea, rash, and transaminase elevations.

G6PD deficient patients and adverse effects:
Pentamidine is considered when there is documented allergy or intolerance to TMP/SMX. Dapsone/trimethoprim or clindamycin/primaquine are contraindicated in glucose 6-phosphate dehydrogenase (G6PD) deficiency. For this purpose, atovaquone should be used in patients who are deficient in G6PD or who are unable to be on TMP/SMX or pentamidine. (Related post: Drugs causing hemolysis in G6PD deficient patients mnemonic)

That's all!

Quote by Lindsey Stirling: "Any time there is a change to be made, you have to realize that there is somewhere else you want to be and I wanted to be happy." :)

-IkaN

Here's an image on the same :)


Treatment of Pneumocystis carinii pneumonia (PCP) mnemonic

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