Drug Induced Pulmonary Diseases Flashcards Preview

PT: Hematology & Pulmonary > Drug Induced Pulmonary Diseases > Flashcards

Flashcards in Drug Induced Pulmonary Diseases Deck (68)
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1
Q

What is the unique thing about lungs?

A

Exposed to the entire circulating blood volume along with outside environment via air

2
Q

What controls breathing?

A

medulla oblongata stimulates respiratory muscles

3
Q

How does breathing happen?

A

Medulla oblongata stimulates diaphragm which decreases intra horacic pressure resulting in external air entrance into pharynx, then trachea, bronchi, bronchioles and alveoli

4
Q

What is the site of carbon dioxide and gas exchange?

A

alveoli exposed to blood capillaries

5
Q

What are two acute life threatening respiratory complications?

A

hypoxic respiratory failure-can’t get oxygen to tissues

-respiratory acidosis-Co2 accumulation

6
Q

What are 3 common drugs that induce pulmonary toxicity and how do they compare in mortality?

A
  • methotraxate- small 1%
  • bleomycin-moderate-25%
  • carmustine induced pulmonary fibrosis=90%
7
Q

What populations are predisposed to drug induced pulmonary problems?

A
  • age
  • also exposure to environmental toxins
  • smoking
  • genetic
  • underlying lung disease
  • inflammatory conditions like RA, IBD
8
Q

How should you go about diagnosing drug induced pulmonary injury?

A
  • clinical suspicion is high
  • obtain medication history
  • pulmonary function tests
  • bronchoscopy and or biopsy
  • typically a diagnosis by exclusion
  • need familiarity with patient and good history
9
Q

What are two ways drugs can induce apnea?

A
  • CNS depression

- respiratory muscle dysfunction

10
Q

What agents can causes CNS depression apnea?

A

narcotic analgestics
benzodiazepines
-high dose antihistamines
-alcohol

11
Q

What can happen if you over oxygenation patients with apnea from CNS depression?

A

IT can be compounded by peristant hypercapnia because the brain isn’t signaling repiratory muscles to breath because it accustomed to high PO2 levels

12
Q

What drugs can cause apnea from respiratory muscle dysnfunction?

A
  • neuromuscular blockers
  • aminoglycosides
  • digitalis
13
Q

What drugs can compound apnea from respiratory muscle dysfunction?

A

myopathy inducing agents

  • corticosteroids
  • high dose (over 2mg/kg/day)
14
Q

What drugs commonly cause a cough?

A

ACE inhibitors

15
Q

Describe an ACE induced cough

A

more common in women

  • non-productive, dry, persistent
  • possible elevated bradykinin
16
Q

What do you do about drug induced cough?

A

no treatment

- need to substitute ACE for alternative medicine

17
Q

What drugs can cause bronchospasms?

A
  • aspirins
  • beta blockers
  • contrast
18
Q

What increases risk for drug induced bronchspasms?

A

underlying asthma or COPD

19
Q

What do you do about drug induced bronchospasms?

A

remove offending agent

-use bronchodilator

20
Q

What is the “aspirin sensitivity triad”?

A

severe asthma, nasal polyps plus aspirin = aspirin induced asthma/bronchospasm
-accompanied by rhinohea, upper extremity flushing and conjunctivitis

21
Q

How do you treat a asprin induced bronchospasm?

A

if they don’t need aspirin, don’t use it (along with other COX inhibitors)
-desensitize by starting at low doses and titrating up in controlled environment

22
Q

What also has cross reactivity for aspirin induced asthmas?

A

other COX inhibitors

-yellow dye

23
Q

Which beta blockers are more likely to induce an asthma attack?

A

non-selective (propranolol)

-choose a beta 1 specific antagonist

24
Q

Which beta blockers are preferred in asthma patients?

A

bisoprolol, atenolol, metoprolol

-they are beta one specific

25
Q

What are common offending agents in drug induced pulmonary edema?

A
  • IV fluids and blood products
  • narcotics
  • beta-adrenergic agonists
  • corticosteroids
  • some chemo agents
26
Q

What does drug induced pulmonary edema present as?

A
  • bilateral, patchy x-ray

- actue dyspnea, alveolar opacities, hypoxia

27
Q

How do you treat drug induced pulmonary edema?

A

remove offending agents

-volume management -can use diuretics

28
Q

Pathological mechanism of drug induced pulmonary edema?

A

capillary leak

29
Q

What is drug induced pulmonary fibrosis (IPF)?

A

replacement of normal lung tissue with fibrous or connective tissue

30
Q

What are common offending agents in IPF?

A
  • amiodarone
  • methotrexate
  • bleomycin
  • carmustine
  • busulifan
  • cyclophosphamide
31
Q

What are predisposing factors for IPF?

A
  • cumulative dose
  • increasing age
  • radiotherapy
  • oxygen therapy
  • concomitant cytotoxic therapy
  • pre-existing pulmonary disease
32
Q

What doses of amiodarone put patients at risk for IPF?

A

over 400mg daily for more than 2 months

33
Q

Clinical findings in amiodarone IPF?

A

exertional dyspnea
nonproductive cough
weight loss
occasional low-grad fever

34
Q

Treatment for IPF from amiodarone?

A

no proven treatment optios

-DC med

35
Q

What is BOOP?

A

bronchiolitis obliterans organizing pneumonia

-a non-infectious pneumonia that causes inflammation of bronchioles and alveolar exudate that can become fibrotic

36
Q

Who is at risk for BOOP?

A
  • underlying inflammatory disease
  • lupus
  • RA
  • schleroderma
37
Q

What do you do about BOOP?

A
  • remove offending agents (amidoraone, amphotericin, bleomycin, cyclophosphamide)
  • administer corticosteroids
38
Q

When is BOOP typically diagnosed?

A

After it is misdiagnosed for pneumonia and the treatment doesn’t work or they patient gets better for a little while but it comes back

39
Q

How long do you need to administer corticosteroids to treat BOOP?

A

usually a 6month-1 year taper

40
Q

What is a diffuse aveolar hemorrhage (DAH)?

A

blood collection with alveoli

  • from damage to small pulmonary vessles
  • causes impaire oxygen exchange
41
Q

DAH presentation

A

hemopytysis, dyspnea, cough, fever

42
Q

How is DAH diagnosed?

A

brochoscopy-can see blood

43
Q

Offending agents for DAH?

A

sirolimus, zathioprine, penicillamine

44
Q

What do you do about DAH?

A

poor prognosis

-no real treatment

45
Q

What medication induced non-lung tissue insults can compromise respiratory status?

A
  • pulmonary embolism caused by BC or hormonal replacement therapy
  • pulmonary hypertension from amphetamines and fenfluramine
  • pulmonary vascular occlusive disease from bleomycin, busfulfan, carmustine
46
Q

What causes drug induced eosinophilic pneumonia?

A

eosinophilic immune response

-lung inflitration

47
Q

What are common offending agents of eosinophilic pneumonia?

A

nitrofurantion, para-aminosalcylic acid

  • amiodarone
  • iodine
  • captpril
  • gold salts
48
Q

How is esoinophilic pneumonia diagnosed?

A

bronchoscopy show esosinphils

49
Q

Can too much oxygen be toxic?

A

Yes, too much free radical production

50
Q

What medications can increase oxidant production?

A

bleomycin, cyclophosphamide, nitrofurantoin, paraquat

51
Q

Should oxygen be used for eosinophilic pneumonia from nitrofurantion?

A

NO, already produces oxidants

52
Q

Should oxygen be used to treat pulmonary problems from bleomycin or cyclophosphamide?

A

NO, already produce oxidants

53
Q

Which drug induced pulmonary disease affect the alvoeli?

A

pulmonary edema
BOOP
diffuse alveolar hemmorhage

54
Q

Which drug induced pulmonary disease affect the pulmonary connective tissue?

A

pulmonary fibrosis

55
Q

Which drug induced pulmonary disease affect the bronchus or large airways?

A

cough and bronchospasm

56
Q

responsibilities of lungs

A
  • phonation
  • foreign matter defense mechanism
  • metabolic functions
57
Q

phonation

A

production of adequate air pass by vocal chords

58
Q

foreign matter defense mechanism of lungs

A

mucociliary defense

alveolar macrophages

59
Q

metabolic functions of lungs

A
  • angiotensin I conversion
  • bradykinin inactivation
  • surfactant release
  • inflammatory mediators
60
Q

Acute life threatening complications of pulmonary compromise

A
  • hypoxic respiratory failure

- respiratory acidosis

61
Q

Prolonged complications of pulmonary compromise

A
  • decreased functional status

- impaired QOL

62
Q

T/f drug initiation should precede symptoms (drug induced pulmonary injury)

A

true

63
Q

Amiodarone can cause

A

BOOP
eosinophilia pneumonia
pulmonary fibrosis

64
Q

Bleomycin can cause

A
  • BOOP
  • pulmonary fibrosis
  • oxygen toxicity
  • pulmonary vascular occlusive disease
65
Q

Methotrexate can cause

A
  • pulmonary fibrosis
66
Q

Carmustine can cause

A
  • pulmonary fibrosis

- pulmonary vascular occlusive disease

67
Q

Cyclophosphamide can cause

A
  • BOOP
  • Pulmonary fibrosis
  • Oxygen toxicity
68
Q

Nitrofurantoin can cause

A
  • eosinophilia pneumonia

- oxygen toxicity