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PHM 702: Pulm and ToXXX > not all drugs are good drugs: Pulm > Flashcards

not all drugs are good drugs: Pulm Flashcards

1
Q

Mechanisms of injury: drug induced pulmonary disease

A
  • Oxidant injury
  • Interference with matrix formation
  • Immune compelx mediated
  • Interference with lipid metabolism
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2
Q

Drug induced pulmonary disease: pt related risk factors

A
  • Age (old or young)
  • Respiratory acidosis
  • Pre-existing lung disease
  • Impaired renal or hepatic function
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3
Q

Drug induced pulmonary disease: drug related risk factors

A
  • Dose and cumulative dose
  • Admin rate
  • Treatment duration
  • O2 tehrapy
  • Radiation therapy
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4
Q

drug induced interstitial pneumonitis/fibrosis: S/S

A
  • Non-productive cough
  • Sudden onset dyspnea
  • Fever, rash, eosinophilia
  • Chronic: progressing breathlessness, decreased physical activity
  • Crackles on expiration, clubbing
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5
Q

drug induced interstitial pneumonitis/fibrosis: chest x-ray

A
  • decreased lung volume
  • bilateral diffuse ground-glass opacities
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6
Q

drug induced interstitial pneumonitis/fibrosis: mechanim of tox

A
  • Permanent infalmmation
  • Damage causes
    • Recruitment of fibroblasts
    • Abnormal cellular repair
    • Apoptosis
  • Excess deposition of extracellular matrix
    • Remodeling
    • Honeycombing
    • Fibrosis
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7
Q

drug induced interstitial pneumonitis/fibrosis: causative agents

A
  • amiodarone
  • bleomycin
  • busulfan
  • carmustine
  • cyclophosphamaide
  • gemcitabine
  • leflunomide
  • methotrexate
  • nitrofurantoin
    _
  • immune checkpoint inhibitiors
  • mechanistic target of rapamycin inhibitors (MTORi)
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8
Q

immune checkpoint inhibitor induced interstitial pneumonitis/fibrosis Grade 1 treatment

A

monitor

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9
Q

immune checkpoint inhibitor induced interstitial pneumonitis/fibrosis Grade 2 treatment

A
  • Hold medication OR
  • Treat with prednisone/methylprednisolone 1-2mg/kg/day
    • Treat until improvement to grade 1 then taper off over 4-6 weeks
      • If no improvement in 48-72 hrs, treat as grade 3
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10
Q

immune checkpoint inhibitor induced interstitial pneumonitis/fibrosis Grade 3 treatment

A
  • Permanantely dc OR
  • Treat with methylprednisolone 1-2 mg/kg/day
  • Treat until improvement to grade 1 then taper off over 4-6 weeks
    • If no improvement in 48 hrs, treat with infliximab, IVIG, or MMF(mycophenolate)
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11
Q

immune checkpoint inhibitor induced interstitial pneumonitis/fibrosis Grade 4 treatment

A

Same as grade 3
- Permamently dc OR
- Treat with methylprednisolone 1-2 mg/kg/day
- Treat until improvement to grade 1 then taper off over 4-6 weeks
- If no improvement in 48 hrs, treat with infliximab, IVIG, or MMF

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12
Q

MTORi induced interstitial pneumonitis/fibrosis Grade 1 treatment

A

monitor

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13
Q

MTORi interstitial pneumonitis/fibrosis Grade 2 treatment

A
  • Dose reduce OR
  • Hold medication OR
  • Treat with prednisone 0.75-1 mg/kg/day
    • Treat until improvement to grade 1 then taper off
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14
Q

MTORI pneumonitis/fibrosis Grade 3 treatment

A
  • Hold OR
  • Treat with prednisone 0.75-1 mg/kg/day
    - Treat until improvement to grade 1 then taper off
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15
Q

MTORI induced interstitial pneumonitis/fibrosis Grade 4 treatment

A
  • Permamently discoontinue OR
  • Treat with prednisone 0.75-1 mg/kg/day
    - Treat until improvement to grade 1 then taper off
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16
Q

bleomycin induced interstitial pneumonitis/fibrosis treatment

A

Prednisone 0.75
mg/kg/day for 4 – 6
week

17
Q

carmustine induced interstitial pneumonitis/fibrosis treatment

A
  1. Prednisone 60 mg PO BID
  2. Then 30 mg PO daily
  3. Then 10 mg PO weekly
  4. Then 5 mg PO weekly
18
Q

amiodarone induced interstitial pneumonitis/fibrosis treatment

A
  • Prednisone 0.5 – 1 mg/kg/day
  • Continue for several
    months to one y
19
Q

drug induced bronchiolitis obliterans organizing pneumonia: S/S

A
  • inflammatory response in lungs
  • cough
  • dyspnea
  • b/l crackles
20
Q

drug induced bronchiolitis obliterans organizing pneumonia: chest x-ray

A

b/l patchy infiltrates

21
Q

drug induced bronchiolitis obliterans organizing pneumonia: causative agents

A
  • bleomycin
  • amiodarone
  • CBZ
  • cocaine
22
Q

drug induced bronchiolitis obliterans organizing pneumonia: treatment

A
  • dc med
  • steroids
23
Q

drug induced eosinophilic pneumonia: S/S

A

infiltration of the pulmonary interstitial with eosinophils
- dry cough
- chest pain
- fever

24
Q

drug induced eosinophilic pneumonia: chest x-ray

A

b/l ground glass opacities

25
Q

drug induced eosinophilic pneumonia: causative agents

A
  • daptomycin
  • mesalamine
  • sulfasalazine
26
Q

drug induced eosinophilic pneumonia: treatment

A

steroids

27
Q

drug induced lupus: s/s

A
  • fever
  • myalgaias
  • rash
  • arthralgias
  • arthritis
  • serositis
  • pleuric pain
28
Q

drug induced lupus: chest x-ray

A
  • pleural effusion
  • diffuse interstitial pneumonitis
  • alveolar infiltrates
29
Q

drug induced lupus: causative agents

A
  • procainamide
  • hydralazine
  • isoniazid
  • anti-TNF alfa
30
Q

drug induced lupus: treatment

A

med withdrawal

31
Q

drug induced hypersensitivity pneumonia: s/s

A
  • urticaria
  • angiodema
  • rhinitis
  • dyspnea
32
Q

drug induced hypersensitivity pneumonia: chest x-ray

A

localized or b/l alveolar infiltrates

33
Q

drug induced hypersensitivity pneumonia: causative agents

A
  • NSAIDs
  • methotrexate
34
Q

drug induced hypersensitivity pneumonia: treatment

A
  • dc med
  • antihistamines
  • possible steroids
35
Q

drug induced pulmonary edema: s/s

A
  • cough
  • crepitation on auscultation
  • cyanosis
36
Q

drug induced pulmonary edema: chest x-ray

A

acinar infiltrates with normal heart size

37
Q

drug induced pulmonary edema: causative agents

A
  • Beta mimetics (terbutaline)
  • Chlordiazepoxide
  • Cocaine
  • Cytarabine
  • Gemcitabine
  • HCTZ
  • Mitomycin
  • Narcs → treat with naloxone
  • Phenothiazines
  • Tocolytic agents
  • Tricyclics
  • Vinca alkaloids

PHM 702: Pulm and ToXXX (14 decks)

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