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Pharm II > Drug Induced Pulmonary Dz > Flashcards

Drug Induced Pulmonary Dz Flashcards

1
Q

what is the most common drug induced respiratory problem?

A

Bronchospasm

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2
Q

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

A

Penicillins
sulfonamides
Serum
cephalosporins

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3
Q

how do aspirin/ NSAIDs induce bonrchospasm

A

only have leukotrienes which cause bronchospasm due to cyclooxygenase inhibition

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4
Q

what are 2 direct airway irritations that cause bronchospams?

A

Smoke

N-acetylcysteine

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5
Q

what can β -adrenergic blockers cause?

A

bronchospasm

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6
Q

what is the aspirin triad?

A

asthma
nasal polyps
aspirin intolerance

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7
Q

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

A

Aspirin/ NSAID bronchospasm

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8
Q

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

A

provocation challenge in hospital

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9
Q

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

A

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

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10
Q

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

A

COX-2 selective (celecoxib)

Acetaminophen

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11
Q

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

A

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

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12
Q

acetaminophen early in life might increase the risk of what ?

A

asthma and allergic dz

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13
Q

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

A

No

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14
Q

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

A

may

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15
Q

Direct inhibition of β2-receptors may result in ______________________

A

bronchoconstriction

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16
Q

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

A

Ipratropium

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17
Q

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

A

COPD

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18
Q

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

A

sulfite induced bronchospasm

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19
Q

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

A

asthma

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20
Q

how do you manage sulfite induced bronchospasm.

A

avoid it. Not found in asthma drugs.

labeling is found on food projects

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21
Q

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

A

Cromolyn
Anticholinergics
Cyanocobalamin

22
Q

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

A 
Ethylenediamine tetraacetic acid (EDTA)
Stabilizing agent (found in inhalers)
23
Q

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

A

ACE inhibitors

24
Q

risk factors for cough due to ACEI

A

Female
Asian descent
Elderly
Heart failure

25
Q

what is thought to cause cough with ACEI

A

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

26
Q

how do you manage cough due to ACEI?

A

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

27
Q

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

A

fentanyl

28
Q

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

A

IV heroin use

also seen with morphine, methadone, meperidine, propoxyphene

29
Q

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

A

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

30
Q

when do patients with narcotic induced non-cardiogenic pulmonary edema

A

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

31
Q

Tx for narcotic induced non-cardiogenic pulmonary edema

A

naloxone
oxygen
ventilatory support

32
Q 
Presents with 
Persistent cough
Tachypnea
Dyspnea
Tachycardia
Rales on auscultation
Hypoxemia
Decreased lung compliance
A

Pulmonary edema

33
Q

when is pulmonary edema seen?

A 
HCTZ
contrast media
IV bleomycin
Terbutaline
salicylate OD
34
Q

what is pulmonary eosinophilia most often due to?

A

Nitrofuratoin

Para-aminosalicylic acid (topical anti-infective)

35
Q

how does someone with pulmonary eosinophilia present?

A

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

36
Q

when does pulmonary eosinophilia present with nitrofuratoin?

A

w/i 1 month of therapy

will recover within 15 days of DC of med

37
Q

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

A

Chronic pulmonary fibrosis

38
Q

Drugs that cause pulmonary fibrosis

A 
Bleomycin 
Busulfan
Carmustine
Methotrexate
Amiodarone
39
Q 
Non-productive cough
Acute dyspnea
Tachypnea
Lung crackles
PFTs initially normal then reduce CO2
hypoxemia on ABGs
A

pulmonary fibrosis

40
Q

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

A

Both

41
Q

what drug can you give to help drug induced pulmonary fibrosis

A

prednisone

42
Q

risks for amiodarone pulmonary toxicity

A

men
increased age
pre-existing lung dz

43
Q

when does amiodarone pulmonary toxicity usually occur?

A

5 weeks- 6 years after initiating therapy

44
Q

what will amiodarone pulmonary toxicity usually quickly progress to?

A

ARDS

45
Q

MOA of amiodarone pulmonary toxicity

A

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

46
Q

what should you do for people on amiodarone?

A

monitor PFTs and CXR at baseline

CXR every year and PFTs if symptomatic

47
Q

what anorexic agents can cause pulmonary HTN?

A

Fenfluramine and dexfenfluramien (fen-phen)

phentermine (still on market) onset is 23 days-27 years

48
Q

symptoms of drug induced pulmonary HTN?

A

non-specific
excertional dyspnea: most common
chest pain
syncope

49
Q

how does oxygen toxicity present?

A

Cough, chest pain, dyspnea

lungs become progressively stiffer

50
Q

who is it difficult to tell oxygen toxicity in?

A

hard to tell in ventilator dependent patients

51
Q

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

A

50-100%

52
Q

what lung damage do you see with oxygen toxicity?

A

Acute phase edema with alveolar hemorrhage

leads to fibrosis, lack of exchange

Pharm II (16 decks)

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