Drug-Induced Pulm Disease Flashcards
most common drug-induced resp problem
bronchospasm
four methods of bronchospasm
Anaphylaxis (IgE)
COX inhibition
Pharmacologic effects
Direct airway irritation (smoke, n-acetylcysteine)
Samter’s syndrome
Asthma
nasal polyps
aspirin intolerance
aspirin/NSAIDs can cause
bronchospasm
what class is used to treat NSAID induced bronchospasm (DOC)
Leukotriene antagonists (Zileutron)
therapy options for aspirin/NSAID bronchospasm
COX2 selective NSAIDs
Acetaminophen
Cross sensitivity in NSAID induce BS
Ibuprofen/naproxen
yellow dye tartrazine
(colors food, drinks, cosmetics)
the use of this drug early in life may increase risk of asthma and allergic disease
Acetaminophen
beta blockers can cause
bronchospasm (by directly inhibiting B2 receptors)
what could you use to treat b blocker induced bronchospasm
anticholinergics (ipratropium)
management options for people with b blocker bronchospasm
inhaled bronchodilator
use selective b blockers, lowest dose possible
potassium metabisulfite, a preservative in food and wine and some injectable drugs, can induce what
bronchospasm
mechanisms of sulfite induced BS
- sulfite converted to sulfur dioxide (parasymp)
- IgE mediated
- Reduced enzyme sulfite oxidase (which catalyzes sulfITES to sulfATES)
pretreatment for sulfite induced BS
cromolyn, anticholinergics, cyanocobalamin
inhaled agents can cause
bronchospasm
mechanism for inhaled agent BS
EDTA is a stabilizing agent. Has calcium chelation properties and causes buildup of benzalkonium chloride (a bacteriostatic agent) that causes MAST cell degranulaiton
ACE inhibitors can cause what
cough
ACE-I cough mechanism
attributed to accumul of substance P (bronchoconstriction) and bradykinin (stim cough reflex)
management of ACEI cough
stop the medication
switch to an ARB
fentanyl can cause
cough
Fentanyl causes cough in old smokers mostly. T or F
FALSE. youngs who dont smoke
narcotics can induce what
non-cardiogenic pulmonary edema
treatment of narcotic induced NCPE
naloxone, O2, ventilatory support
pulmonary eosinophilia is associated with what
nitrofurantion
para-aminosalicylic acid
Chemotheraputic agents (bleomycin, busulfan, carmustine, methotrexate) can cause
pulmonary fibrosis
Amiodarone can cause
pulmonary fibrosis
pulmonary toxicity
time of onset PF with bleomycin
after 1st dose to 15 years later
management of drug induced PF
DC med
can add prednisone
rapidly progressive ARDS
pulmonary toxicity
accumulation of this drug in lung tissue interferes with normal processing of phospholipids. Breaking of macrophages results in pulm inflam and fibrosis
Amiodarone
monitoring for a pt on amiodarone
PFTs and CXR at baseline
CXR every year
PFTs if symptomatic
treatment of pt with amio induced pulm tox
DC med
can add corticosteroids
anorexic agents (fenfluramine and dexfenfluramine and phentermine) can cause
pulmonary HTN
most common symptom of pulm HTN
exertional dyspnea
management pt with drug induced pulm HTN
DC drug
pt on a ventilator presents with cough, chest pain, dyspnea. you see that their fraction of inspired o2 is low. what do you suspect
oxygen toxicity
excess oxygen does what
produces highly reactive o2 metabolites that overwhelm the antioxidant system and destroys tissues
hyperoxia causes what in the lings
fibrosis
