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Pulm/Tox > Drug-Induced Lung Disease > Flashcards

Drug-Induced Lung Disease Flashcards

1
Q

What are the 4 main mechanisms of lung injury? (How do drugs cause injury?)

A
  1. Oxidant injury
  2. Immune complex-mediated
  3. Interference with Matrix Formation
  4. Interference with lipid metabolism
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2
Q

What are the two usual treatment options for drug/pulmonary toxicity?

A
  1. Stop the offending drug agent
  2. Corticosteroids
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3
Q

What two presentations are indicative of pulmonary toxicity?

A
  1. Respiratory symptoms
  2. Chest X-ray changes
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4
Q

What DRUG-RELATED risk factors are are there for pulmonary toxicity?

A

Dose
Oxygen Therapy
Cumulative dose
Treatment duration
Administration rate
Radiation Therapy

(DOCTAR)

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5
Q

What PATIENT-RELATED risk factors are are there for pulmonary toxicity?

A

Pre-existing lung disease
Age (extremely young/extremely old)
Impaired renal or hepatic function
Respiratory acidosis

(PAIR)

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6
Q

What is the mechanism of drug-induced interstitial pneumonitis/fibrosis?

A

Idiopathic mechanism, but drug is the source of damage
Acute pneumonitis may progress to fibrosis

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7
Q

What are symptoms of drug-induced interstitial pneumonitis/fibrosis? (6)

A

Non-productive cough
Sudden onset dyspnea (hours)
Fever/rash/eosinophilia
Crackles on exhaling, clubbing
CHRONIC SX: progressive SOB, decreased physical activity
CT results: decreased lung volume, bilateral diffuse ground-glass opacities

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8
Q

What are the mechanisms of drug toxicity in the lungs? (3 major)

A
  1. Permanent inflammation
  2. Damages
    - recruit fibroblasts
    - abnormal cellular repair
    - apoptosis
  3. Excess deposition of extracellular matrix
    (Remodeling, honeycombing, fibrosis)
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9
Q

What ANTIMICROBIAL may cause toxicity/Lung disease? Describe mechanism, presentation and onset.

A

NITROFURANTOIN
Mechanism = oxidant injury
Presentation = eosinophilia pneumonia, fibrosis (chronic)
Onset = 8 month - 16 YEARS (long! Often chronic progression)

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10
Q

What ANTI-RHEUMATICS may cause toxicity/lung disease? (2) Describe mechanism and onset.

A

LEFLUNOMIDE
METHOTREXATE (more common)

Mechanism = hypersensitivity
Onset = Days to years (broad window)

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11
Q

What CARDIOLOGY agent may cause toxicity/lung disease? Decribe mechanism, onset, and who is at RISK!

A

AMIODARONE
Mechanism = direct effect, DOSE DEPENDENT
Onset = 4 weeks to 6 years
At-risk patients = >60 years (x3 increased risk)

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12
Q

Which 4 ANTINEOPLASTIC agents may cause toxicity/lung disease?

A

Gemcitabine
Bleomycin
Busulfan
Cyclophosphamide

(Gem BBC)

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13
Q

What is the mechanism of Bleomycin toxicity? (3)

A

Cytokines
Inflammatory cell activation
Free oxygen radical induction

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14
Q

What is the mechanism/onset of Busulfan toxicity? (1)

A

Direct alveolar injury

Onset = 4 years of monotherapy OR months after high dose

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15
Q

What is the mechanism of Cyclophosphamide toxicity? (1)

A

Direct alveolar injury

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16
Q

What is the mechanism of Gemcitabine toxicity? (1)

A

Endothelial dysfunction after cytokine release

17
Q

What are two MAJOR mechanisms of drugs that can cause toxicity that are treated based on GRADE?

A

Immunotherapy Check-Point Inhibitors (ICPis)
Mechanistic Target of Rapamycin Inhibitors (mTORis)
- Diffuse alveolar damage, hypersensitivity

18
Q

How would you treat a GRADE 2 immunotherapy check-point inhibitor DIILD?

A

Hold medication
OR
Give prednisone/Methylprednisolone 1-2 mg/kg/day until Grade 1

19
Q

How would you treat a GRADE 3 or 4 immunotherapy check-point inhibitor DIILD? What if no improvement?

A

Permanent D/C of drug
OR
Methylprednisolone 1-2 mg/kg/day

No improvement in 48 hrs? -> infliximab, IVIG, MMF

20
Q

How would you treat a GRADE 2/3 mTORI DIILD?

A

Dose reduce/hold med
OR
Prednisone 0.75-1 mg/kg/day

21
Q

How would you treat a GRADE 4 mTORI DIILD?

A

Permanently D/C medication
OR
Prednisone 0.75 - 1 mg/kg/day

22
Q

What are the differences between grade 2, 3 or 4 mTORI DIILDs?

A

Grade 2 = Little interference with QoL
Grade 3 = Moderate interference with QoL
Grade 4 = Unable to function normally

23
Q

What is the treatment for BLEOMYCIN DIILDs?

A

Prednisone 0.75 mg/kg/day x 4-6 WEEKS (then taper)

24
Q

What is the treatment for CARMUSTINE DIILDs?

A

Prednisone 60 mg po BID
-> 30 mg mg po QD
-> 10 mg po WEEKLY
-> 5 mg po WEEKLY

25
Q

What is the treatment for AMIODARONE DIILDs?

A

Prednisone 0.5 - 1 mg/kg/day
Use for MONTHS (6 to 12 months!)
(Increased relapses with treatment <6 months)

26
Q

What TWO types of pneumonia can be drug-induced?

A
  1. Bronchial it is Obliterans Organizing Pneumonia (BOOP)
  2. Eosinophilic
27
Q

What drugs may induce BOOP (pneumonia)? What is the treatment?

A

Bleomycin
Amiodarone
Carbamazepine
Cocaine

Treatment = D/C or steroids

28
Q

What drugs may induce eosinophilic pneumonia? What is the treatment?

A

Daptomycin
Mesalamine
Sulfasalazine
(Nitrofurantoin, minocycline)

Treatment = steroids

29
Q

What is the difference between BOOP and eosinophilic pneumonia Chest X-rays?

A

BOOP = Bilateral patchy infiltrates
Eosinophilic = Bilateral ground-glass opacities

30
Q

What are the symptoms of HYPERSENSITIVITY pneumonia? How quick is the onset? What is the Chest X-ray results?

A

Onset = immediate usually, need to determine if chronic
Chest X-ray = localized OR bilateral alveolar infiltrate

Sx = urticaria , angioedema, rhinitis, dyspnea

31
Q

What medications cause Hypersensitivity pneumonia?

A

NSAIDS
Methotrexate

32
Q

What treatment do we use for Hypersensitivity pneumonia?

A

D/C drug
Antihistamines**
Possible steroids

33
Q

What are the symptoms of pulmonary edema (3)? What is the chest x-ray results? Onset?

A

Symtoms = cough, crepitation when exhaling, cyanosis (3 Cs)
Chest X-ray = Acinar infiltrates, NORMAL heart size

Onset = ~2 hours (relatively fast)
- 1-2 days = sx emerge
- 2-5 days = x-ray changes

34
Q

What is the MAIN medication that causes drug-induce pulmonary edema?

A

Narcotics

35
Q

What is the treatment for drug-induced pulmonary edema?

A

Naloxone

36
Q

Drug-induced lung damage often induces/exacerbates LUPUS over years later. What is the mechanism and what are some symptoms?

A

Mechanism = hypersensitivity
Sx = fever, myalgia, rash, arthralgia, arthritis, serositis, pleuritic pain

37
Q

What are the chest x-ray results with Drug-induced LUPUS? (3)

A

Pleural effusion
Diffuse interstitial pneumonitis
Alveolar infiltrates

38
Q

What is the treatment for drug-induced LUPUS? When does recovery occur (timeframe)?

A

Medication withdrawal
Recovery within 6 weeks post-withdrawal

39
Q

What drugs cause drug-induced Lupus? (4)

A

Procainamide
Hydralazine
Isoniazid
Anti-TNF alpha

Pulm/Tox (6 decks)

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