tompat
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45 yr old male pt who is being treated for AIDS develop fungal pneumonia.
his past history is singnificant for allegry to sulfa drugs.if u were to treat this infection which drug amongst the current medication u wud like to replace with some other to avoid adverse effects of the the antifungal
A.AZT
B.DDI
C.DDC
D.D4T
E.3TC
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| SILVER
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A. AZT
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| tompat
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hi silver, can u explain why?
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| new_n_lost
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silver wrote:
A. AZT
Agree 
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| new_n_lost
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tompat wrote:
hi silver, can u explain why?
Due to One Reason Only cos AZT is the only Drug with Hepatic Route of Elimination ( CYP3A4 ) along with Renal route while the Rest of the NRTIs have Exclusively Renal Elimination route. Therefore Azole and Protease Inhibitors can both prolong the drug Effects of AZT.
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| new_n_lost
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Take Home Point Azoles and Protease Inhibitors Increase the Plasma Conc of AZT and Rifampin Decreases it.
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| tompat
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ohh, so whats the most common fungal pneumonia in AIDS pt.
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| new_n_lost
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Pneumocystis Jiroveci
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| tompat
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so how wud u treat this yee row vet zee, and how particularly in this pt?
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| new_n_lost
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In Pts with Sulfa Allergy Dapsone will also not work as it is a Sulfone drug Though being the Alternative DOC of PCP infections in AIDS pts. Atovaquone an antimalarial can be used Alongwith Clindamycin.
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| tompat
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why not pentamidin?
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| new_n_lost
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Pentamidine an oxidative phosphorylation blocker and inhibiting protein and phospholipid synthesis has a massive list of SE which i surely wudnt want an already Immunocompromised individual to have eg. Bone Marrow Suppression.
And According to NEJM it shud be the 5th Choice of Drugs in Rx of PCP.
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| tompat
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wow, i just knew tri-sulfa, dapsone n pentamidine. i never came across atovaquinone in books, oh i use lippincotts n k notes.
but thru internet i came to know that in severe PCP atovaquinone is not authorized for treatment.so whats the forth choice NEJM recommends.
any ways as the books mention zalcitabine with pentamidine causes sever pancreatitis, thats what i was thinking.
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| new_n_lost
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Well Buddy its Katzung Actually Which Says that abt Atovaquone and Clindamycin and Primaquinie r used in the Rx of PCP.
NEJM says that in Rx of PCP.
1. TMP-SMX
2. Dapsone w or w/o Prednisone
3. Primaquinine with Clindamycin
4. Atovaquone
5. Pentamidine
http://content.nejm.org/cgi/content/full/339/26/1...
Whether Atovaquone is used in Severe PCP is mentioned by Wikipedia which I dont Consider a reliable source.
2ndly in ur Original Question Antifungals r not used in the Rx of PCP.
3rdly the Zalcitabine and Pentamidine Combo is used in AIDS Rx.
4thly the SE of Pentamidine r not limited to Severe Pancreatitis, it Also Includes
1. Severe Respiratory Depression
2. Marked Hypotension due to Peripheral Vasodilation.
3. Hypoglycemia
4. Anemia
5. Neutropenia
6. Thrombocytopenia
7. Hyperkalemia leading to Cardiac Arrhythmias. << MCC
8. Nephrotoxicity.
Ref. Katzung
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| new_n_lost
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Atovaquone is prefered more due to its better bioavailability and tolerance amongst pts.
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| tompat
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thanks buddy.
by antifungals i meant pentamidine or sulfa-tri, cause here they are acting as anti fungals(pcp is fungus right).
well even though its used why one wud use zalcitabane n pentamidine if we can use other anti retrovirals and take the chances of fatal pancreatitis.cause books mention only the no. of drugs in a combination but not the particular drugs.
any ways i will remember atovaquone n primaquinine
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| new_n_lost
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tompat wrote:
thanks buddy.
by antifungals i meant pentamidine or sulfa-tri, cause here they are acting as anti fungals(pcp is fungus right).
Well PCP though a Fungus doesnt act like fungal agent more like a parasitic agent therefore anti-protozoals can be used alongwith other antibacterials.
tompat wrote:
well even though its used why one wud use zalcitabane n pentamidine if we can use other anti retrovirals and take the chances of fatal pancreatitis.cause books mention only the no. of drugs in a combination but not the particular drugs.
The sentence where u have mentioned abt Zalcitabine and Pentamidine is only mentioned in Lippincott and its used for the Rx of AIDS repeat AIDS not PCP.
Or I think i m still not getting the point u r trying to make ????
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| tompat
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what i m saying is this pt has AIDS but now has got PCP. so if we give him pentamidine , he will bE receiving zalcitabine and pentamidine( CONSIDERING ZAL IS INCLUDED in his anti-retroviral regimen), i dint say this combination is used for the treatment of PCP.
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