Drug-Induced Pulmonary Disease Flashcards

Question

Is the bronchospasm from inhaled medications caused by the medication itself?

Answer 1

No its caused by the other chemicals that are in the drug

Answer 2

``` Stabilizing agent Mechanism Calcium chelation property Benzalkonium chloride Bacteriostatic agent Found in some albuterol nebulization multi-dose vials ``` Mechanism Mast cell degranulation Management Change therapy

Answer 3

Female Asian descent Elderly Heart failure

Answer 4

Cough Tickle to debilitating cough with insomnia and vomiting Dry, nonproductive, hacking cough Patients have normal spirometry and chest xray

Answer 5

``` Not fully known Usually attributed to accumulation of bradykinin and substance P Bradykinin Stimulate cough reflex Substance P Cause bronchoconstriction ```

Answer 6

Cough may resolve within a few weeks Usually stop medication Cough resolves within a few days to a month after discontinuation Usually unresponsive to cough suppressants or bronchodilators

Answer 7

IV formulation Unclear mechanism Associated with young age and absence of smoking History of asthma/COPD not predictive

Answer 8

IV heroin use | Also can be seen with morphine, methadone, meperidine, and propoxyphene

Answer 9

Idiosyncratic reaction Often seen when Moderate and high doses are used Mechanism is unknown

Answer 10

May be comatose with depressed respirations, dyspnea and tachypnea Varies from cough to severe cyanosis and hypoxia Decreased pulmonary function tests Appear within minutes of IV administration up to 2 hours

Answer 11

``` Clinical improvement within 24-48 hours Pulmonary function abnormality may last up to 12 weeks Treatment Naloxone, oxygen, ventilatory support Mortality less than 1% ```

Answer 12

``` Persistent cough Tachypnea Dyspnea Tachycardia Rales on auscultation Hypoxemia Decreased lung compliance ```

Answer 13

``` Hydrochlorothiazide Contrast media IV bleomycin, cyclophosphamide and vinblastine (oncology agents) Terbutaline (used as tocolytic) Salicylate overdose ```

Answer 14

DC medication, supportive care

Answer 15

Nitrofurantoin | Para-aminosalicylic acid (not a drug that you will rx to pts, anti-infective topical)

Answer 16

Fever, nonproductive cough, dyspnea, cyanosis, bilateral pulmonary infiltrates and eosinophilia in blood

Answer 17

Occurs within 1 month of therapy | Complete recovery within 15 days of DC of medication

Answer 18

Chronic pulmonary fibrosis

Answer 19

Restrictive airway disease | Can be fatal if process is not stopped

Answer 20

Idiopathic pulmonary fibrosis is rare Drug induced pulmonary fibrosis ~ 50 causative agents Prevalence increases with increasing cumulative dose

Answer 21

``` Bleomycin Busulfan Carmustine Methotrexate Amiodarone- not chemo but causes pulmonary fibrosis ```

Answer 22

``` Non-productive cough Acute dyspnea Tachypnea Lung crackles PFTs- Initially normally, reduced carbon dioxide diffusing capacity Arterial blood gases- Hypoxemia ```

Answer 23

``` Slow progression Dyspnea on exertion Fatigue Non-productive cough Lung crackles Clubbing ``` PFTs Restrictive disease, decreased vital capacity Reduced carbon monoxide diffusing capacity

Answer 24

Acute sx have been seen after 1st dose of bleomycin | Patients have died up to 15 years after receiving therapy.

Answer 25

Known exposure to causative drug | No known symptoms, physical findings, laboratory tests or histopathologic findings specific to pulmonary fibrosis

Answer 26

Discontinuation of medication | +/- prednisone

Answer 27

Men Increases with age Pre-existing lung disease Dose/duration- Usually >400 mg/day; seen with 200 mg/day for 6-12 months Occurs 4 weeks to 6 years after initiating therapy

Answer 28

Variable- some patients don’t do that bad and some do really bad Progressive dyspnea, malaise, nonproductive cough Rapidly progressive acute respiratory distress syndrome

Answer 29

Accumulation of amiodarone and metabolite in lung tissue Interfere with normal processing of phospholipids Breakdown of phospholipid-laden macrophages results in pulmonary inflammation and fibrosis

Answer 30

Monitor PFTs and CXR at baseline CXR every year PFTs if symptomatic

Answer 31

Majority of patients improve with DC of medication Clinical improvement 1-2 months PFTs and CXR may take up to 18 months +/- corticosteroids

Answer 32

``` Anorexic agents- used for weightloss Fenfluramine and dexfenfluarmine (not on the market) Part of “fen-phen” Phentermine 20% of diagnosed cases Onset between 23 days and 27 years ```

Answer 33

Generally non-specific Exertional dyspnea: most common Chest pain Syncope

Answer 34

DC medication Improvement within 1-3 months 1997: FDA requested withdrawal of fenfluramine and dexfenfluamine (valvular damage) Phentermine Case reports of pulmonary hypertension Association not supported

Answer 35

Cough, chest pain, dyspnea Masked in ventilator dependent patients Lungs become progressively stiffer Ability to oxygenate is compromised

Answer 36

Oxidants are counterbalanced by antioxidant defense system (prevents tissue destruction)

Answer 37

Produces highly reactive, partially reduced oxygen metabolites Superoxide anion, hydrogen peroxide, hydroxyl radical, singlet oxygen, hypochlorous acid Overwhelm antioxidant system

Answer 38

Fraction of inspired oxygen--50-100% | Duration of exposure- Inversely proportional to fraction of inspired oxygen

Answer 39

Acute phase: edema with alveolar hemorrhage | Subacute or chronic phase: collagen and elastin deposition in alveolar walls

Answer 40

Thickening of gas exchange area and fibrosis

Answer 41

+/- improvement in lung function | May see improvement months to years following exposure