Drug-Induced Lung Diseases Flashcards
drugs that can cause drug-induced lung disease
*oxygen
*bleomycin
*amiodarone
*methotrexate
*nitrofurantoin
*volatile inhalants
*nicotine & tobacco smoke
*vapes & ENDS
*cannabis/marijuana
*cocaine
*heroin
oxygen & drug-induced lung disease - MOA & toxicity
*induces formation of free radicals
*direct injury to endothelial cells & type 1 alveolar cells (results in alveolar-capillary leak)
oxygen & drug-induced lung disease - clinical manifestations
*typical patient: mechanical ventilation with high FiO2
*exudative phase (48-72h after exposure) = interstitial & alveolar edema, alveolar hemorrhage
*proliferative phase (days 4-7) = hyperplasia of type 2 alveolar cells, hyaline membrane deposition; INDISTINGUISHABLE FROM OTHER CAUSES OF ARDS
oxygen & drug-induced lung disease - treatment/prevention
*minimize oxygen exposure (goal FiO2 < 0.60)
bleomycin & drug-induced lung disease - MOA and toxicity
*an antibiotic chemotherapy drug
*20% of patients develop overt pulmonary disease
*cumulative toxicity from direct cytotoxic effects, GENERATION OF FREE RADICALS by binding to Fe2+ and O2
*bleomycin “blasts the lungs”
bleomycin & drug-induced lung disease - clinical manifestations
*ARDS/pulmonary inflammation & PULMONARY FIBROSIS
*CUMULATIVE TOXICITY increases the risk
*oxygen-sensitive toxicity and “radiation recall”
bleomycin & drug-induced lung disease - treatment
*discontinue the drug
*corticosteroids to reduce inflammation
*avoid high FiO2 and radiation during bleomycin treatment
amiodarone & drug-induced lung disease - MOA and toxicity
*iodine-containing antiarrhythmic
*INTERSTITIAL PNEUMONITIS
*dose-related, > 1 month or even for years
amiodarone & drug-induced lung disease - clinical manifestations
*SOB with INTERSTITIAL LUNG CHANGES in patients taking amiodarone
*FOAMY MACROPHAGES in bronchoalveolar lavage fluid only indicates EXPOSURE< not toxicity
*if biopsy done, cellular INTERSTITIAL PNEUMONITIS is seen
amiodarone & drug-induced lung disease - treatment
*discontinue amiodarone
*systemic corticosteroids for 2-6 months to suppress inflammation
*avoid high FiO2
methotrexate & drug-induced lung disease - MOA and toxicity
*antimetabolite that interferes with folic acid metabolism, used in malignancy and in many nonmalignant conditions (psoriasis, RA, sarcoidosis)
*10% of patients develop pulmonary toxicity (rarely fatal)
*poorly understood mechanism, suspected to be a type of hypersensitivity reaction
methotrexate & drug-induced lung disease - clinical manifestations
*dyspnea, nonproductive cough, fever, that occurs a FEW DAYS OR WEEKS after starting MTX
methotrexate & drug-induced lung disease - treatment
*discontinue methotrexate
*corticosteroids not always required
nitrofurantoin & drug-induced lung disease - MOA & toxicity
*an oral antibiotic used frequently for UTI
*mechanism of toxicity is unknown
nitrofurantoin & drug-induced lung disease - clinical manifestations
*typical patient: fever, dyspnea, and dry cough with eosinophilia a few hours to days after starting nitrofurantoin
*one of the most common drug-induced pulmonary diseases
nitrofurantoin & drug-induced lung disease - treatment
*discontinue nitrofurantoin
volatile inhalants & drug-induced lung disease - MOA and toxicity
*volatile liquids become gaseous at room temperature and are inhaled
*multitude of products (paint thinner, gasoline, glue, felt-tip markers)
*nearly all are CNS DEPRESSANTS when abused
volatile inhalants & drug-induced lung disease - clinical manifestations
*typical scenario: a patient with a history of dug abuse found obtunded, with slurred speech, and hypoventilating (respiratory acidosis)
*inhalants will likely be mentioned in vignette
*may also see paint or other stains on face, clothing, or nearby rags
volatile inhalants & drug-induced lung disease - treatment approach
*remove the patient from the source of the exposure
*supportive care for respiratory depression
nicotine/tobacco & drug-induced lung disease - MOA and toxicity
*nicotine: rapidly absorbed and acts on nicotinic cholinergic brain receptors, acting as a stimulant; highly addictive
*combustion of tobacco: several thousand different chemicals, including nicotine, carbon monoxide, acrolein; all can cause illness through systemic absorption and/or local pulmonary oxidative injury
nicotine/tobacco & drug-induced lung disease - clinical manifestations
*acute stimulant effects of nicotine: systemic hypertension, increased heart rate and myocardial work, relative hypoxemia (COHb of 10%)
*long term effects: cardiovascular disease, emphysema, COPD, asthma, CANCER
nicotine/tobacco & drug-induced lung disease - treatment
*smoking cessation (difficult due to chemical + behavioral addiction)
vapes/ENDS & drug-induced lung disease - MOA and toxicity
*use varying strengths of electric current to vaporize liquid; this is NOT water vapor and is NOT smoke
*liquid may contain nicotine, THC, flavorings, etc
*acute inhalation causes increased airway resistance and inflammation
vapes/ENDS & drug-induced lung disease - clinical manifestations
*nicotine/THC effects
*EVALI: e-cigarette and vaping-associated lung injury
vapes/ENDS & drug-induced lung disease - treatment
*cessation strategies as for tobacco/nicotine, marijuana/THC addiction
*not approved for use in tobacco cessation
cannabis/marijuana (THC) & drug-induced lung disease - terminology
*cannabis sativa is the plant
*marijuana refers to the part of the plant with substantial amounts of tetrahydrocannabinol (THC)
*THC is the psychoactive constituent of marijuana
*cannabidiol (CBD) is another biologically active compound in Cannabis
cannabis/marijuana (THC) & drug-induced lung disease - MOA and toxicity
*THC causes direct (sympathomimetic) and indirect (anxiety/hallucination) stress on the cardiovascular system, and varies with the amount inhaled
*COMBUSTION of cannabis results in a similar plume as tobacco containing many of the same carcinogens and toxicants
*method of inhalation for cannabis differs (longer breath holds) resulting in greater CARBOXYHEMOGLOBIN
cannabis/marijuana (THC) & drug-induced lung disease - clinical manifestations
*hyperemesis syndrome
*emphysema, lung cancer risk is likely and yet to be proven
cannabis/marijuana (THC) & drug-induced lung disease - treatment
*avoidance, behavioral cessation strategies
cocaine & drug-induced lung disease - forms
*powdered cocaine
*“crack” freebase cocaine
cocaine & drug-induced lung disease - MOA and toxicity
*SYMPATHOMIMETIC - vasoconstriction, tachycardia, hypertension through stimulation of beta adrenergic receptors
*can be inhaled nasally, injected, or smoked (crack)
cocaine & drug-induced lung disease - clinical manifestations
*hemorrhagic alveolitis
*pulmonary edema
*pulmonary hypertension
cocaine & drug-induced lung disease - treatment
*AVOID BETA BLOCKERS in acute toxicity
*cessation counseling and behavioral strategies
heroin & drug-induced lung disease - MOA and toxicity
*synthetic derivative of morphine, opioid agonist
*direct toxic effect on the alveolar-capillary membrane, possible hypersensitivity reaction
heroin & drug-induced lung disease - clinical manifestations
*HEROIN-INDUCED PULMONARY EDEMA
*obtundation -> hypoventilation -> hypercarbic respiratory failure
*bronchiectasis and necrotizing infection from aspiration
*vascular embolization of talcum or other fill material
heroin & drug-induced lung disease - treatment
*NALOXONE opioid antagonist temporarily counters effects (nasal or IV administration)
*cessation requires intensive behavioral counseling and support
*meds exist to help with cessation (methadone, buprenorphine, naltrexone)
