Drugs for Interstitial Lung Disease and Pulmonary Tuberculosis (Iszard) Flashcards
What is the initial treatment for moderate to severe Interstitial Lung Disease? (P/M/M/A/N)
prednisolone (glucocorticoid) mycophenolate methotrexate azathioprine nintedanib
Prednisolone
What is it, what are what are 3 things it should be cautioned for (HPA/CS/HG), and what are 4 adverse effects of use (FR/AGT/EBP/WG)?
- anti-inflammatory/immunosuppressive agent
caution: can lead to hypothalamic-pituitary-adrenal axis suppression; monitor pts for Cushing’s Syndrome and Hyperglycemia with chronic use
AE: fluid retention, altered glucose tolerance, elevated blood pressure, weight gain
Mycophenolate
What is it and what is it used for, what is it indicated for, and what are its two major contraindications (HS/AP8)?
- immunosuppressive drug given to pts with rheumatoid arthritis and those resistant to methotrexate
I: prophylaxis of organ rejection in allogenic kidney/heart/liver transplants; use in combo with other immunosuppressants
CI: hypersensitivity to drug mycophenolate or MPA, and pts. allergic to Polysorbate 80
Mycophenolate
What are its 3 Black Box Warnings (ET/M/OI) and what are its drug interactions (A/PPI/OC)?
BB: inc. risk of embryofetal toxicity, malignancy (lymphoma or skin), and opportunistic infections
DI: efficacy reduced with antacids and PPIs and can reduce effectiveness of oral contraceptives (use 2 forms of protection)
Methotrexate
What is it, what are its 2 BB warnings, and what are its 3 major indications (ND/P/RA)?
- antimetabolite immunosuppressive
BB: should be used ONLY by physicians with experience due to serious side-effects (fatal) and should ONLY be used in life-threatening neoplastic disease or with disabling disease
I: neoplastic disease, psoriasis, rheumatoid arthritis
Methotrexate
What are its two major contraindications (P/LD), what are its adverse effects related to, and how do NSAIDS, oral Abx, penicillin, and hepatotoxins affect its metabolism?
CI: pregnant women and pts with alcoholism/alcoholic liver disease, or chronic liver disease
AE: related to dose and frequency of administration
NSAIDs: prolong methotrexate lvls
Oral Abx: dec. methotrexate absorption
Penicillin: prolong methotrexate lvls (dec. renal loss)
Hepatotoxins (azathioprine): closely monitor
Azathioprine
What is it, what is it indicated for, what are its 2 contraindications (HS/P), what are its two adverse effects (HT/GIT), and what is its Black Box Warning (M)?
- immunosuppressive antimetabolite (tablet)
I: prevent rejection in renal homotransplantation
CI: drug hypersensitivity and pregnancy (especially those treated previously with alkylating agents)
BB: malignancy if used chronically (purine antimetabolite)
Nintedanib
What is it, what are 5 warnings of use (ELE/ET/AT/B/GIP), and what are its two drug interactions?
- kinase inhibitor for idiopathic pulmonary fibrosis
W: elevated liver enzymes, embryofetal toxicity (no pregnant pts), arterial thromboembolic events, bleeding, gastrointestinal perforation
DI: coadministration with P-gp and CYP3A4 inhibitors may inc. Nintedanib exposure = MONITOR CLOSELY
What are 5 first-line Tuberculosis drugs used to treat active Tuberculosis infection? (R/I/P/E/S)
rifampin, isoniazid, pyrazinamide, ethambutol, streptomycin
presence of drug resistance, contraindication, or intolerance to first-line agents may warrant substitution with one or more second-line agents
What considerations should be taken when patients receive combination antituberculosis therapy?
- measure baseline liver function tests
- test for hepatitis B and C
Rifampin
What is its indication, what are its 3 contraindications (H/RBS/AV), what is its major warning (LD) and precaution (DM), and what drug interactions does it have?
I: tuberculosis and meningococcal carriers
CI: drug hypersensitivity, pts. getting ritonavir-boosted saquinavir (inc. hepatocellular toxicity), and those on antivirals for HIV (can dec. plasma concentrations)
W: can produce liver dysfunction (jaundice fatalities)
P: caution in pts with history of diabetes mellitus
DI: induces certain cytochrome P-450 enzymes (can accelerate other drugs metabolism)
Isoniazid
What is its MOA, what is it indicated for, what are its
2 major contraindication (HS/HT), and what is its major Black Box Warning (H)?
MOA: inhibits synthesis of mycoloic acid (bacterial cell wall component) = bactericidal against active growing M. tuberculosis
I: tablets for all forms of tuberculosis
CI: hypersensitivity and drug-induced hepatic injury
BB: severe or fatal hepatitis can occur and even develop many months after treatment
Isoniazid
What are its two major adverse reactions (N/L) and what are 5 drug interactions it has (F/A/C/V/T)?
AR: nervous system and liver reactions
DI: food, acetaminophen, carbamazepine, valproate, theophylline
Pyrazinamide
What is it indicated for and how should it be used, what are its 3 contraindications (HD/HS/G), and what are its two warnings of use (H/HU)?
Which pt. population should use this drug with caution?
I: used in combination with other drugs to treat active tuberculosis
- first 2 mos: isoniazid, rifampin, pyrazinamide
- nxt 4 mos: isoniazid and rifampin only
CI: hepatic damage, hypersensitivity, acute gout
W: hepatitis (alcohol abusers) and hyperuricemia accompanied by acute gout arthritis
- pts. with history of DIABETES MELLITUS should take caution with use
Ethambutol
What is it, what is it indicated for, what are its 3 contraindications (HS/ON/VC), what is its major warning, and which pt. population should it NOT be used in?
- oral chemotherapeutic agent that is specifically active against actively growing Mycobacterium and should be used with at least one other anti-tuberculous drug (NEVER ALONE)
CI: hypersensitivity, pts. with optic neuritis, pts. with visual side effects or visual changes
W: can dec. visual acuity due to optic neuritis
- NOT recommended for pediatric pts. < 13 yo since safe conditions have NOT been established
