Drug Induced Pulmonary Dz

Question 1

what is the most common drug induced respiratory problem?

Answer 1

Bronchospasm

Question 2

Common drugs that can cause anaphylaxis (IgE mediated) (bronchospams)

Answer 2

Penicillins
sulfonamides
Serum
cephalosporins

Question 3

how do aspirin/ NSAIDs induce bonrchospasm

Answer 3

only have leukotrienes which cause bronchospasm due to cyclooxygenase inhibition

Question 4

what are 2 direct airway irritations that cause bronchospams?

Answer 4

Smoke

N-acetylcysteine

Question 5

what can β -adrenergic blockers cause?

Answer 5

bronchospasm

Question 6

what is the aspirin triad?

Answer 6

asthma
nasal polyps
aspirin intolerance

Question 7

preson presents with bronchospasm, rhinorrhea, conjunctivitis, flushing
Urticaria, periorbital edema, abdominal pain
what do you suspect?

Answer 7

Aspirin/ NSAID bronchospasm

Question 8

how do you test to see if someone has aspirin/NSAID induced bronchospasm?

Answer 8

provocation challenge in hospital

Question 9

if patients require aspirin therapy and has a bronchospasm what can you do?

Answer 9

Desensitization, elimination of rxns by slowing increasing doses of oral aspirin

Question 10

therapy options for patients that have the need for pain management but NSAID/aspirin bronchospasm

Answer 10

COX-2 selective (celecoxib)

Acetaminophen

Question 11

Up to 80% of patients with ASA-sensitive patients have an AE to what as well?

Answer 11

Yellow azo dye tartazine (FD&C Yellow No.5)

Question 12

acetaminophen early in life might increase the risk of what ?

Answer 12

asthma and allergic dz

Question 13

is beta blocker induced bronchospasm often seen in people w/o pulmonary dz?

Answer 13

No

Question 14

Patients taking β -blockers without incident for long periods of time _______ experience fatal asthma attacks

Answer 14

may

Question 15

Direct inhibition of β2-receptors may result in ______________________

Answer 15

bronchoconstriction

Question 16

Based on the proposed mechanism of beta blocker induced bronchospasm, which of the following agents could potentially be used for treatment of bronchospasm?

Answer 16

Ipratropium

Question 17

Treatment with beta blockers in patients with __________ may reduce the risk of exacerbations and improve survival

Answer 17

COPD

Question 18

what is a preservation in food and wine and found in injectable epi and isoproternol that can lead to sulfite induced bronchospasm.

Answer 18

sulfite induced bronchospasm

Question 19

Reduced concentration of sulfite oxidase enzyme reported in sulfite-sensitive ______ patients

Answer 19

asthma

Question 20

how do you manage sulfite induced bronchospasm.

Answer 20

avoid it. Not found in asthma drugs.

labeling is found on food projects

Question 21

what are some pretreatment options for individuals with a sulfite induced bronchospasm

Answer 21

Cromolyn
Anticholinergics
Cyanocobalamin

Question 22

what causes mast cell degranulation due to a calcium chelation property?

Answer 22

Ethylenediamine tetraacetic acid (EDTA)
Stabilizing agent (found in inhalers)

Question 23

can cause a dry, non productive cough May begin within days to 12 months after initiating therapy. Patients have normal spirometry and chest xray

Answer 23

ACE inhibitors

Question 24

risk factors for cough due to ACEI

Answer 24

Female
Asian descent
Elderly
Heart failure

Question 25

what is thought to cause cough with ACEI

Answer 25

accumulate bradykinin which stimulates cough reflex and substance P which causes bronchoconstriction

Question 26

how do you manage cough due to ACEI?

Answer 26

discontinue drug and cough will usually resolve if need to stay on ACEI cough suppressants or bronchodilators don't work switch to an ARB

Question 27

what drug in IV formulation can cause cough. Is associated w/ young age and absence of smoking. hx of asthma/ COPD isn't predictive.

Answer 27

fentanyl

Question 28

what is narcotic induced non-cardiogenic pulmonary edema most commonly seen in?

Answer 28

IV heroin use | also seen with morphine, methadone, meperidine, propoxyphene

Question 29

what will a patient with narcotic induced non-cardiogenic pulmonary edema present with?

Answer 29

Comatose, depressed resps can have cyanosis and hypoxia decreased PFTs appear within minutes- hours of administration

Question 30

when do patients with narcotic induced non-cardiogenic pulmonary edema

Answer 30

24-48 hours but PF abnormality may last up to 12 weeks

Question 31

Tx for narcotic induced non-cardiogenic pulmonary edema

Answer 31

naloxone oxygen ventilatory support

Question 32

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

Answer 32

Pulmonary edema

Question 33

when is pulmonary edema seen?

Answer 33

``` HCTZ contrast media IV bleomycin Terbutaline salicylate OD ```

Question 34

what is pulmonary eosinophilia most often due to?

Answer 34

Nitrofuratoin | Para-aminosalicylic acid (topical anti-infective)

Question 35

how does someone with pulmonary eosinophilia present?

Answer 35

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

Question 36

when does pulmonary eosinophilia present with nitrofuratoin?

Answer 36

w/i 1 month of therapy | will recover within 15 days of DC of med

Question 37

Excessive amount of connective tissue in the interstitial spaces of the lung Normal airspaces and blood vessels replaced by fibrotic tissue; lungs become small and stiff Occurs more with higher doses of drugs

Answer 37

Chronic pulmonary fibrosis

Question 38

Drugs that cause pulmonary fibrosis

Answer 38

``` Bleomycin Busulfan Carmustine Methotrexate Amiodarone ```

Question 39

``` Non-productive cough Acute dyspnea Tachypnea Lung crackles PFTs initially normal then reduce CO2 hypoxemia on ABGs ```

Answer 39

pulmonary fibrosis

Question 40

does pulmonary fibrosis happen immediately or a long time after receiving belomycin?

Answer 40

Both

Question 41

what drug can you give to help drug induced pulmonary fibrosis

Answer 41

prednisone

Question 42

risks for amiodarone pulmonary toxicity

Answer 42

men increased age pre-existing lung dz

Question 43

when does amiodarone pulmonary toxicity usually occur?

Answer 43

5 weeks- 6 years after initiating therapy

Question 44

what will amiodarone pulmonary toxicity usually quickly progress to?

Answer 44

ARDS

Question 45

MOA of amiodarone pulmonary toxicity

Answer 45

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

Question 46

what should you do for people on amiodarone?

Answer 46

monitor PFTs and CXR at baseline | CXR every year and PFTs if symptomatic

Question 47

what anorexic agents can cause pulmonary HTN?

Answer 47

Fenfluramine and dexfenfluramien (fen-phen) | phentermine (still on market) onset is 23 days-27 years

Question 48

symptoms of drug induced pulmonary HTN?

Answer 48

non-specific excertional dyspnea: most common chest pain syncope

Question 49

how does oxygen toxicity present?

Answer 49

Cough, chest pain, dyspnea lungs become progressively stiffer

Question 50

who is it difficult to tell oxygen toxicity in?

Answer 50

hard to tell in ventilator dependent patients

Question 51

when do you worry about oxygen toxicity (what percent oxygen)

Answer 51

50-100%

Question 52

what lung damage do you see with oxygen toxicity?

Answer 52

Acute phase edema with alveolar hemorrhage | leads to fibrosis, lack of exchange