Drug Induced Pulmonary Dz Flashcards
what is the most common drug induced respiratory problem?
Bronchospasm
Common drugs that can cause anaphylaxis (IgE mediated) (bronchospams)
Penicillins
sulfonamides
Serum
cephalosporins
how do aspirin/ NSAIDs induce bonrchospasm
only have leukotrienes which cause bronchospasm due to cyclooxygenase inhibition
what are 2 direct airway irritations that cause bronchospams?
Smoke
N-acetylcysteine
what can β -adrenergic blockers cause?
bronchospasm
what is the aspirin triad?
asthma
nasal polyps
aspirin intolerance
preson presents with bronchospasm, rhinorrhea, conjunctivitis, flushing
Urticaria, periorbital edema, abdominal pain
what do you suspect?
Aspirin/ NSAID bronchospasm
how do you test to see if someone has aspirin/NSAID induced bronchospasm?
provocation challenge in hospital
if patients require aspirin therapy and has a bronchospasm what can you do?
Desensitization, elimination of rxns by slowing increasing doses of oral aspirin
therapy options for patients that have the need for pain management but NSAID/aspirin bronchospasm
COX-2 selective (celecoxib)
Acetaminophen
Up to 80% of patients with ASA-sensitive patients have an AE to what as well?
Yellow azo dye tartazine (FD&C Yellow No.5)
acetaminophen early in life might increase the risk of what ?
asthma and allergic dz
is beta blocker induced bronchospasm often seen in people w/o pulmonary dz?
No
Patients taking β -blockers without incident for long periods of time _______ experience fatal asthma attacks
may
Direct inhibition of β2-receptors may result in ______________________
bronchoconstriction
Based on the proposed mechanism of beta blocker induced bronchospasm, which of the following agents could potentially be used for treatment of bronchospasm?
Ipratropium
Treatment with beta blockers in patients with __________ may reduce the risk of exacerbations and improve survival
COPD
what is a preservation in food and wine and found in injectable epi and isoproternol that can lead to sulfite induced bronchospasm.
sulfite induced bronchospasm
Reduced concentration of sulfite oxidase enzyme reported in sulfite-sensitive ______ patients
asthma
how do you manage sulfite induced bronchospasm.
avoid it. Not found in asthma drugs.
labeling is found on food projects
what are some pretreatment options for individuals with a sulfite induced bronchospasm
Cromolyn
Anticholinergics
Cyanocobalamin
what causes mast cell degranulation due to a calcium chelation property?
Ethylenediamine tetraacetic acid (EDTA) Stabilizing agent (found in inhalers)
can cause a dry, non productive cough May begin within days to 12 months after initiating therapy. Patients have normal spirometry and chest xray
ACE inhibitors
risk factors for cough due to ACEI
Female
Asian descent
Elderly
Heart failure
what is thought to cause cough with ACEI
accumulate bradykinin which stimulates cough reflex and substance P which causes bronchoconstriction
how do you manage cough due to ACEI?
discontinue drug and cough will usually resolve
if need to stay on ACEI cough suppressants or bronchodilators don’t work
switch to an ARB
what drug in IV formulation can cause cough. Is associated w/ young age and absence of smoking. hx of asthma/ COPD isn’t predictive.
fentanyl
what is narcotic induced non-cardiogenic pulmonary edema most commonly seen in?
IV heroin use
also seen with morphine, methadone, meperidine, propoxyphene
what will a patient with narcotic induced non-cardiogenic pulmonary edema present with?
Comatose, depressed resps
can have cyanosis and hypoxia
decreased PFTs
appear within minutes- hours of administration
when do patients with narcotic induced non-cardiogenic pulmonary edema
24-48 hours but PF abnormality may last up to 12 weeks
Tx for narcotic induced non-cardiogenic pulmonary edema
naloxone
oxygen
ventilatory support
Presents with Persistent cough Tachypnea Dyspnea Tachycardia Rales on auscultation Hypoxemia Decreased lung compliance
Pulmonary edema
when is pulmonary edema seen?
HCTZ contrast media IV bleomycin Terbutaline salicylate OD
what is pulmonary eosinophilia most often due to?
Nitrofuratoin
Para-aminosalicylic acid (topical anti-infective)
how does someone with pulmonary eosinophilia present?
Fever, nonproductive cough, dyspnea, , cyanosis, bilateral pulmonary infiltrates and eosinophilia in blood
when does pulmonary eosinophilia present with nitrofuratoin?
w/i 1 month of therapy
will recover within 15 days of DC of med
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
Chronic pulmonary fibrosis
Drugs that cause pulmonary fibrosis
Bleomycin Busulfan Carmustine Methotrexate Amiodarone
Non-productive cough Acute dyspnea Tachypnea Lung crackles PFTs initially normal then reduce CO2 hypoxemia on ABGs
pulmonary fibrosis
does pulmonary fibrosis happen immediately or a long time after receiving belomycin?
Both
what drug can you give to help drug induced pulmonary fibrosis
prednisone
risks for amiodarone pulmonary toxicity
men
increased age
pre-existing lung dz
when does amiodarone pulmonary toxicity usually occur?
5 weeks- 6 years after initiating therapy
what will amiodarone pulmonary toxicity usually quickly progress to?
ARDS
MOA of amiodarone pulmonary toxicity
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
what should you do for people on amiodarone?
monitor PFTs and CXR at baseline
CXR every year and PFTs if symptomatic
what anorexic agents can cause pulmonary HTN?
Fenfluramine and dexfenfluramien (fen-phen)
phentermine (still on market) onset is 23 days-27 years
symptoms of drug induced pulmonary HTN?
non-specific
excertional dyspnea: most common
chest pain
syncope
how does oxygen toxicity present?
Cough, chest pain, dyspnea
lungs become progressively stiffer
who is it difficult to tell oxygen toxicity in?
hard to tell in ventilator dependent patients
when do you worry about oxygen toxicity (what percent oxygen)
50-100%
what lung damage do you see with oxygen toxicity?
Acute phase edema with alveolar hemorrhage
leads to fibrosis, lack of exchange
