Drugs for Interstitial lung disease Flashcards
What is the MOA (broadly) in a drug used for both asthma & interstitial lung disease?
anti-inflammatory & Immune suppression
Prednisone
What are patients on prednisone at risk of developing?
Cushings syndrome & hyperglycemia
from HPA axis suppression
What are the indications for using mycophenalte in treating interstitial lung disease?
prophylaxis of organ rejection (heart & liver) and patients with RA resistant to methotrexate
what is the black box warnings for mycophenolate?
embryofetal toxicity, 1st tri loss, & lymphoma or skin malignancy
what are expected adverse reactions if giving a patient mycophenolate?
Vomit, diarrhea, infection, leukopenia
think things associated with immune suppression!
what may reduce the efficacy of mycophenolate in treating interstitial disease?
Mg, AlOH anatacids, PPIs
what drug does mycophenolate inhibit?
OCPs
increase other contraception options!
what drug should be used in patients with neoplasia, psoriasis, or RA?
Methotrexate
what drug should be used in patients with neoplasia, psoriasis, or RA?
Methotrexate
what are the potential risks of taking methotrexate?
- 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)
If a patient is having a radiotherapy and on methotrexate, what is a potential adverse event?
soft tissue or bone necrosis
If a patient has renal impariment, ascites, or pleural effusion what may result if administering methotrexate?
reduced elimination -> prolonged effect
A patient is taking an NSAID along with methotrexate, what are they at risk of developing?
marrow suppression, aplastic anemia, & GI toxicity
Using methotrexate is contraindicated in what situations?
Pregnancy, alcoholism, liver disease, renal disease
If a patient is on oral antibiotics, what may result when giving methotrexate cocomitantly?
Tetracycline, Chloramphenical, broad specturms
reduced intestinal absorption & metabolism -> prolonged effect
What may reduce renal clearance of methotrexate?
penicillins
A patient is being treated for emphysema with a methylxanthine prescription. What would result if methotrexate was added to this patients care plan?
decreased clearance of theophylline
What are two major factors in the severity of adverse methotrexate events?
dose & frequency
what are the indications for using azathioprine?
prevent renal homotransplant rejection & active RA
What group of patients should not be given azathioprine?
- RA with previous treatment with alkylating agents
- malignancy
Azathioprine is a purine antimetabolite -> increase cancer risk
A patient is diagnosed with idiopathic pulmonary fibrosis, what is the MOA of a pharmacologic therapy?
kinase inhibitor
If prescribing nintedanib, what adverse events should be looked for?
- fetal toxicity
- arterial thromboembolism
- bleeding risk or GI perf (post-op)
- elevated AST/ALT/bili
What s/e should be watched for in patients on nintedanib?
N/V/D, jaundice, decreased appetitie, weight loss, HTN, HA
co-administration of nintedanib with what class of drugs increases its exposure?
P-gp & CYP3A4 inhibitors
