Drug-Induced Pulm Disease

Question 1

most common drug-induced resp problem

Answer 1

bronchospasm

Question 2

four methods of bronchospasm

Answer 2

Anaphylaxis (IgE)
COX inhibition
Pharmacologic effects
Direct airway irritation (smoke, n-acetylcysteine)

Question 3

Samter’s syndrome

Answer 3

Asthma
nasal polyps
aspirin intolerance

Question 4

aspirin/NSAIDs can cause

Answer 4

bronchospasm

Question 5

what class is used to treat NSAID induced bronchospasm (DOC)

Answer 5

Leukotriene antagonists (Zileutron)

Question 6

therapy options for aspirin/NSAID bronchospasm

Answer 6

COX2 selective NSAIDs

Acetaminophen

Question 7

Cross sensitivity in NSAID induce BS

Answer 7

Ibuprofen/naproxen
yellow dye tartrazine
(colors food, drinks, cosmetics)

Question 8

the use of this drug early in life may increase risk of asthma and allergic disease

Answer 8

Acetaminophen

Question 9

beta blockers can cause

Answer 9

bronchospasm (by directly inhibiting B2 receptors)

Question 10

what could you use to treat b blocker induced bronchospasm

Answer 10

anticholinergics (ipratropium)

Question 11

management options for people with b blocker bronchospasm

Answer 11

inhaled bronchodilator

use selective b blockers, lowest dose possible

Question 12

potassium metabisulfite, a preservative in food and wine and some injectable drugs, can induce what

Answer 12

bronchospasm

Question 13

mechanisms of sulfite induced BS

Answer 13

• sulfite converted to sulfur dioxide (parasymp)
• IgE mediated
• Reduced enzyme sulfite oxidase (which catalyzes sulfITES to sulfATES)

Question 14

pretreatment for sulfite induced BS

Answer 14

cromolyn, anticholinergics, cyanocobalamin

Question 15

inhaled agents can cause

Answer 15

bronchospasm

Question 16

mechanism for inhaled agent BS

Answer 16

EDTA is a stabilizing agent. Has calcium chelation properties and causes buildup of benzalkonium chloride (a bacteriostatic agent) that causes MAST cell degranulaiton

Question 17

ACE inhibitors can cause what

Answer 17

cough

Question 18

ACE-I cough mechanism

Answer 18

attributed to accumul of substance P (bronchoconstriction) and bradykinin (stim cough reflex)

Question 19

management of ACEI cough

Answer 19

stop the medication

switch to an ARB

Question 20

fentanyl can cause

Answer 20

cough

Question 21

Fentanyl causes cough in old smokers mostly. T or F

Answer 21

FALSE. youngs who dont smoke

Question 22

narcotics can induce what

Answer 22

non-cardiogenic pulmonary edema

Question 23

treatment of narcotic induced NCPE

Answer 23

naloxone, O2, ventilatory support

Question 24

pulmonary eosinophilia is associated with what

Answer 24

nitrofurantion

para-aminosalicylic acid

Question 25

Chemotheraputic agents (bleomycin, busulfan, carmustine, methotrexate) can cause

Answer 25

pulmonary fibrosis

Question 26

Amiodarone can cause

Answer 26

pulmonary fibrosis | pulmonary toxicity

Question 27

time of onset PF with bleomycin

Answer 27

after 1st dose to 15 years later

Question 28

management of drug induced PF

Answer 28

DC med | can add prednisone

Question 29

rapidly progressive ARDS

Answer 29

pulmonary toxicity

Question 30

accumulation of this drug in lung tissue interferes with normal processing of phospholipids. Breaking of macrophages results in pulm inflam and fibrosis

Answer 30

Amiodarone

Question 31

monitoring for a pt on amiodarone

Answer 31

PFTs and CXR at baseline CXR every year PFTs if symptomatic

Question 32

treatment of pt with amio induced pulm tox

Answer 32

DC med | can add corticosteroids

Question 33

anorexic agents (fenfluramine and dexfenfluramine and phentermine) can cause

Answer 33

pulmonary HTN

Question 34

most common symptom of pulm HTN

Answer 34

exertional dyspnea

Question 35

management pt with drug induced pulm HTN

Answer 35

DC drug

Question 36

pt on a ventilator presents with cough, chest pain, dyspnea. you see that their fraction of inspired o2 is low. what do you suspect

Answer 36

oxygen toxicity

Question 37

excess oxygen does what

Answer 37

produces highly reactive o2 metabolites that overwhelm the antioxidant system and destroys tissues

Question 38

hyperoxia causes what in the lings

Answer 38

fibrosis