Drugs for Interstitial lung disease

Question 1

What is the MOA (broadly) in a drug used for both asthma & interstitial lung disease?

Answer 1

anti-inflammatory & Immune suppression

Prednisone

Question 2

What are patients on prednisone at risk of developing?

Answer 2

Cushings syndrome & hyperglycemia

from HPA axis suppression

Question 3

What are the indications for using mycophenalte in treating interstitial lung disease?

Answer 3

prophylaxis of organ rejection (heart & liver) and patients with RA resistant to methotrexate

Question 4

what is the black box warnings for mycophenolate?

Answer 4

embryofetal toxicity, 1st tri loss, & lymphoma or skin malignancy

Question 5

what are expected adverse reactions if giving a patient mycophenolate?

Answer 5

Vomit, diarrhea, infection, leukopenia

think things associated with immune suppression!

Question 6

what may reduce the efficacy of mycophenolate in treating interstitial disease?

Answer 6

Mg, AlOH anatacids, PPIs

Question 7

what drug does mycophenolate inhibit?

Answer 7

OCPs

increase other contraception options!

Question 8

what drug should be used in patients with neoplasia, psoriasis, or RA?

Answer 8

Methotrexate

Question 8

what drug should be used in patients with neoplasia, psoriasis, or RA?

Answer 8

Methotrexate

Question 9

what are the potential risks of taking methotrexate?

Answer 9

• fetal death or congenital defect
• drug-induced lung disease
• ulcerative stomatitis & diarrhea
• hepatotoxicity
• marrow suppression
• aplastic anemia
• GI toxicity
• lymphoma
• tumor lysis syndrome
• severe skin reaction
• Pneumocystis carinii pneumonia (opportunistic infection)
• ST or bone necrosis (w/ radiation)

Question 10

If a patient is having a radiotherapy and on methotrexate, what is a potential adverse event?

Answer 10

soft tissue or bone necrosis

Question 11

If a patient has renal impariment, ascites, or pleural effusion what may result if administering methotrexate?

Answer 11

reduced elimination -> prolonged effect

Question 12

A patient is taking an NSAID along with methotrexate, what are they at risk of developing?

Answer 12

marrow suppression, aplastic anemia, & GI toxicity

Question 13

Using methotrexate is contraindicated in what situations?

Answer 13

Pregnancy, alcoholism, liver disease, renal disease

Question 14

If a patient is on oral antibiotics, what may result when giving methotrexate cocomitantly?

Tetracycline, Chloramphenical, broad specturms

Answer 14

reduced intestinal absorption & metabolism -> prolonged effect

Question 15

What may reduce renal clearance of methotrexate?

Answer 15

penicillins

Question 16

A patient is being treated for emphysema with a methylxanthine prescription. What would result if methotrexate was added to this patients care plan?

Answer 16

decreased clearance of theophylline

Question 17

What are two major factors in the severity of adverse methotrexate events?

Answer 17

dose & frequency

Question 18

what are the indications for using azathioprine?

Answer 18

prevent renal homotransplant rejection & active RA

Question 19

What group of patients should not be given azathioprine?

Answer 19

• RA with previous treatment with alkylating agents
• malignancy

Azathioprine is a purine antimetabolite -> increase cancer risk

Question 20

A patient is diagnosed with idiopathic pulmonary fibrosis, what is the MOA of a pharmacologic therapy?

Answer 20

kinase inhibitor

Question 21

If prescribing nintedanib, what adverse events should be looked for?

Answer 21

• fetal toxicity
• arterial thromboembolism
• bleeding risk or GI perf (post-op)
• elevated AST/ALT/bili

Question 22

What s/e should be watched for in patients on nintedanib?

Answer 22

N/V/D, jaundice, decreased appetitie, weight loss, HTN, HA

Question 23

co-administration of nintedanib with what class of drugs increases its exposure?

Answer 23

P-gp & CYP3A4 inhibitors