Drug-Induced Pulmonary Disease Flashcards
Mechanisms of Injury
oxidant injury
immune complex-mediated
interference with matrix formation
interference with lipid metabolism
DIPD - Risk Factors (drug-related)
dose
administration route
duration of therapy
oxygen therapy
radiation therapy
cumulative dose
DIPD - Risk Factors (patient-related)
age (extremes)
respiratory acidosis
pre-existing lung disease
impaired renal or hepatic function
Drug-Induced Interstitial Pneumonitis - Symptoms
non-productive cough
sudden-onset dyspnea
fever / rash / eosinophilia
crackles, clubbing
decreased lung volume
bilateral diffuse ground-glass particles
DI Interstitial Pneumonitis - Mechanism
permanent inflammation -> recruitment of fibroblasts -> apoptosis
excess deposition of extracellular matrix -> remodeling -> fibrosis
DI Interstitial Pneumonitis - Drugs
antimicrobials (nitrofurantoin)
anti-rheumatics (leflunomide, methotrexate)
cardio (amiodarone)
antineoplastics (bleomycin, busulfan, cyclophosphamide, gemcitabine)
immune checkpoint inhibitors
mTORIs (sirolimus)
Immune Checkpoint Inhibitors - Treatment
grade 2: hold drug, prednisone or methylprednisolone 1-2 mg/kg/day taper off x 4-6 wks
grade 3: permanent d/c, methylprednisolone 1-2 mg/kg/day
if no improvement in 48 hrs: infliximab, IVIG, mycophenolate
mTORIs - Treatment
grade 2: prednisone 0.75-1 mg/kg/day, decrease dose
grade 3: prednisone 0.75-1 mg/kg/day, hold drug
grade 4: prednisone 0.75-1 mg/kg/day, permanent d/c
Bleomycin - Treatment
prednisone 0.75 mg/kg/day x 4-6 wks
Carmustine - Treatment
prednisone 60 mg BID, taper
Amiodarone - Treatment
prednisone 0.5-1 mg/kg/day x up to 1 year
Pneumonia - Types
Bronchiolitis Obliterans Organizing Pneumonia
Eosinophilic
Hypersensitivity Pneumonia
BOOP - Presentation
cough, dyspnea, bilateral crackles
X-ray: bilateral patchy infiltrates
BOOP - Drugs
bleomycin
amiodarone
carbamazepine
cocaine
BOOP - Treatment
discontinuation
steroids
