Drug Induced Pulmonary Diseases Flashcards
What is the unique thing about lungs?
Exposed to the entire circulating blood volume along with outside environment via air
What controls breathing?
medulla oblongata stimulates respiratory muscles
How does breathing happen?
Medulla oblongata stimulates diaphragm which decreases intra horacic pressure resulting in external air entrance into pharynx, then trachea, bronchi, bronchioles and alveoli
What is the site of carbon dioxide and gas exchange?
alveoli exposed to blood capillaries
What are two acute life threatening respiratory complications?
hypoxic respiratory failure-can’t get oxygen to tissues
-respiratory acidosis-Co2 accumulation
What are 3 common drugs that induce pulmonary toxicity and how do they compare in mortality?
- methotraxate- small 1%
- bleomycin-moderate-25%
- carmustine induced pulmonary fibrosis=90%
What populations are predisposed to drug induced pulmonary problems?
- age
- also exposure to environmental toxins
- smoking
- genetic
- underlying lung disease
- inflammatory conditions like RA, IBD
How should you go about diagnosing drug induced pulmonary injury?
- clinical suspicion is high
- obtain medication history
- pulmonary function tests
- bronchoscopy and or biopsy
- typically a diagnosis by exclusion
- need familiarity with patient and good history
What are two ways drugs can induce apnea?
- CNS depression
- respiratory muscle dysfunction
What agents can causes CNS depression apnea?
narcotic analgestics
benzodiazepines
-high dose antihistamines
-alcohol
What can happen if you over oxygenation patients with apnea from CNS depression?
IT can be compounded by peristant hypercapnia because the brain isn’t signaling repiratory muscles to breath because it accustomed to high PO2 levels
What drugs can cause apnea from respiratory muscle dysnfunction?
- neuromuscular blockers
- aminoglycosides
- digitalis
What drugs can compound apnea from respiratory muscle dysfunction?
myopathy inducing agents
- corticosteroids
- high dose (over 2mg/kg/day)
What drugs commonly cause a cough?
ACE inhibitors
Describe an ACE induced cough
more common in women
- non-productive, dry, persistent
- possible elevated bradykinin
What do you do about drug induced cough?
no treatment
- need to substitute ACE for alternative medicine
What drugs can cause bronchospasms?
- aspirins
- beta blockers
- contrast
What increases risk for drug induced bronchspasms?
underlying asthma or COPD
What do you do about drug induced bronchospasms?
remove offending agent
-use bronchodilator
What is the “aspirin sensitivity triad”?
severe asthma, nasal polyps plus aspirin = aspirin induced asthma/bronchospasm
-accompanied by rhinohea, upper extremity flushing and conjunctivitis
How do you treat a asprin induced bronchospasm?
if they don’t need aspirin, don’t use it (along with other COX inhibitors)
-desensitize by starting at low doses and titrating up in controlled environment
What also has cross reactivity for aspirin induced asthmas?
other COX inhibitors
-yellow dye
Which beta blockers are more likely to induce an asthma attack?
non-selective (propranolol)
-choose a beta 1 specific antagonist
Which beta blockers are preferred in asthma patients?
bisoprolol, atenolol, metoprolol
-they are beta one specific
