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PHM 702- CF, Drug-Induced Pulmonary, Liver, Kidney, and Cardio Disease, > DILD- Pulmonary Fibrosis, Pneumonitis Patho, Drugs, Treatment > Flashcards

DILD- Pulmonary Fibrosis, Pneumonitis Patho, Drugs, Treatment Flashcards

1
Q

Pulmonary fibrosis, pneumonitis pathology

A

Usual or nonspecific interstitial pneumonia, can be drug-induced or idiopathic

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2
Q

Pulmonary fibrosis, pneumonitis: can fibrosis occur with these drugs?

A

Yes, and can be preceded by an acute pneumonitis, fibrosis can lead to pulmonary HTN

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3
Q

Pulmonary fibrosis, pneumonitis: onset

A

acute, subacute, chronic

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4
Q

Pulmonary fibrosis, pneumonitis: symptoms

A

nonproductive cough and sudden onset dyspnea (hours), fever, rash, eosinophilia

chronic Sx: slowly progressing breathlessness, decreased physical activity

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5
Q

Pulmonary fibrosis, pneumonitis chest CT

A

fibrosis- decreased lung volumes, BL diffuse ground-glass opacities

(Diagnosis of exclusion- I don’t think we need to know this)

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6
Q

Pulmonary fibrosis, pneumonitis PE

A

crackles on expiration, clubbing

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7
Q

Pulmonary fibrosis, pneumonitis: purpose of BAL

A

distinguishes between cell differential, rules out malignancy or infection

(Used to rule out other causes- I don’t think we need to know this)

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8
Q

Nitrofurantoin DILD mechanism

A

Imbalance of oxidant/antioxidant

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9
Q

Nitrofurantoin DILD presentation

A

Acute eosinophilic pneumonia
Chronic pulmonary fibrosis: 8 months-16 years

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10
Q

Leflunomide, methotrexate DILD mechanism

A

Hypersensitivity

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11
Q

Leflunomide, methotrexate DILD presentation

A

onset of days-years

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12
Q

Bleomycin DILD mechanism

A

Cytokine, inflammatory cells, free O2 radial induction

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13
Q

Belomycin DILD presentation

A

Weeks-months, can progress to fibrosis

Well known side effect of bleomycin!

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14
Q

Busulfan DILD mechanism

A

Direct alveolar injury

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15
Q

Busulfan DILD presentation

A

4 years after monotherapy or months after a high dose

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16
Q

Carmustine DILD presentation

A

Months-years after initiation
Can progress to fibrosis after years

17
Q

Cyclophosphamide DILD mechanism

A

Direct alveolar injury

18
Q

Cyclophosphamide DILD presentation

A

Months of initiation (early)
Months-years (late)

19
Q

Gemcitabine DILD mechanism

A

Endothelial dysfunction after cytokine release

20
Q

EGFRIs DILD presentation

A

Within 1 month

21
Q

ICPIs DILD presentation

A

Onset within 3 months but may be faster if used in combination with other medications

22
Q

mTORIs DILD mechanism

A

DAD or hypersensitivity

23
Q

mTORIs DILD presentation

A

51-104 days, daily regimens more likely than weekly ones

24
Q

Taxanes DILD mechanism

A

Hypersensitivity, direct toxicity to organ, pneumonia

25
Q

Taxanes DILD presentation

A

During Cycle 2 of treatment or within 18 days after last cycle ends

26
Q

Amiodarone DILD mechanism

A

Direct toxic effect

27
Q

Amiodarone DILD presentation

A

4 weeks-6 years

28
Q

Is amiodarone DILD dose-dependent?

A

YES! Smaller doses over years (>2 years) or larger doses over a shorter period of time (400mg/day for >2 months) are at risk

Patients over 60 have a 3x increased risk of toxicity each subsequent decade

29
Q

Treatment of DIILD: Immunotherapy Check-Point Inhibitors (ICPis), Grade 1 event

A

consider holding meds and reassess in 1-2 weeks

30
Q

Treatment of DIILD: Immunotherapy Check-Point Inhibitors (ICPis), Grade 2 event

A

hold meds, prednisone/methylprednisone 1-2mg/kg/day

if you improve to grade 1, taper over 4-6 weeks, if no improvement in 48-72 hours, treat as grade 3

31
Q

Treatment of DIILD: Immunotherapy Check-Point Inhibitors (ICPis), Grade 3 or 4 event

A

permanent D/C, methylprednisone 1-2mg/kg/day

Taper over 4-6 weeks
no improvement in 48 hours- infliximab, IVIG, MMF

32
Q

Treatment of DIILD: mTORIs, Grade 1 event

A

Nothing, it’s fine

33
Q

Treatment of DIILD: mTORIs, Grade 2 event

A

Dose reduce or hold medication

34
Q

Treatment of DIILD: mTORIs, Grade 3 event

A

hold med

35
Q

Treatment of DIILD: mTORIs, Grade 4 event

A

permanently D/C medication

36
Q

For ALL Grade events (except for 1) of mTORI treatment, what else do you give them?

A

Prednisone 0.75-1mg/kg/day and treat until they’re a Grade 1

37
Q

Bleomycin treatment

A

Prednisone 0.75mg/kg/day for 4-6 days, then taper

38
Q

Carmustine treatmentt

A

Prednisone 60mg PO BID, then 30mg PO QD then tapered by 10mg PO QW, then 5mg PO QW

39
Q

Amiodarone treatment

A

Prednisone 0.5-1mg/kg/day, continue for several months up to 1 year

PHM 702- CF, Drug-Induced Pulmonary, Liver, Kidney, and Cardio Disease, (30 decks)

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