Exam 2 - D-I Pulmonary

Question 1

What are the mechanisms of toxicity leading to DIILD? (3)

Answer 1

permanent inflammation, damage cause by fibroblasts/apoptosis, excess deposition of ECM (remodeling/honeycombing/fibrosis)

Question 2

What medications or classes can cause DIILD? (6)

Answer 2

antimicrobials, anti-rheumatics, amiodarone, antineoplastics, immune checkpoint inhibitors, mechanistic target of rapamycin inhibitors

Question 3

What is the MOA of nitrofurantoin DIILD?

Answer 3

oxidant injury

Question 4

What is the MOA of anti-rheumatics DIILD?

Answer 4

hypersensitivity

Question 5

What is the MOA of amiodarone DIILD?

Answer 5

direct effect

Question 6

What is the MOA of bleomycin DIILD? (3)

Answer 6

cytokines, inflammatory cells, free oxygen radical production

Question 7

What is the MOA of busulfan DIILD?

Answer 7

direct alveolar injury

Question 8

What is the MOA of cyclophosphamide DIILD?

Answer 8

direct alveolar injury

Question 9

What is the MOA of gemcitabine DIILD?

Answer 9

endothelial dysfunction after cytokine release

Question 10

What is the MOA of mTORis DIILD? (2)

Answer 10

DAD, hypersensitivity

Question 11

What is the initial treatment for Grade 2 immunotherapy checkpoint inhibitor DIILD? (2)

Answer 11

hold offending medication and prednisone or methylprednisolone 1-2 mg/kg/day until improvement to Grade 1 then taper over 4-6 weeks

Question 12

What is the follow-up treatment for Grade 2 immunotherapy checkpoint inhibitor DIILD?

Answer 12

If no improvement in 48-72 hrs, treat as Grade 3

Question 13

What is the initial treatment for Grade 3 immunotherapy checkpoint inhibitor DIILD? (2)

Answer 13

permanently discontinue offending agent and methylprednisolone 1-2 mg/kg/day until improvement then taper over 4-6 weeks

Question 14

What is the follow-up treatment for Grade 3 immunotherapy checkpoint inhibitor DIILD?

Answer 14

If no improvement in 48 hrs, infliximab, IVIG, MMF

Question 15

What is the initial treatment for Grade 2 mTORi DIILD? (2)

Answer 15

dose reduce or hold offending medication and prednisone 0.75-1 mg/kg/day until Grade 1

Question 16

What is the initial treatment for Grade 3 mTORi DIILD? (2)

Answer 16

hold offending medication and prednisone 0.75-1 mg/kg/day until Grade 1

Question 17

What is the initial treatment for Grade 4 mTORi DIILD? (2)

Answer 17

permanently discontinue offending agent and prednisone 0.75-1 mg/kg/day until Grade 1

Question 18

What is the treatment regimen for bleomycin DIILD?

Answer 18

prednisone 0.75 mg/kg/day for 4-6 weeks then taper

Question 19

What is the treatment regimen for carmustine DIILD?

Answer 19

prednisone 60 mg PO bid, then 30 mg qd, then 10 mg qw, then 5 mg qw

Question 20

What is the treatment regimen for amiodarone DIILD?

Answer 20

prednisone 0.5-1 mg/kg/day for several months to one year

Question 21

What are characteristics of, culprits, and treatment for bronchiolitis obliterans organizing pneumonia (BOOP)?

Answer 21

x-ray = bilateral patchy infiltrates, bleomycin/amiodarone/carbamazepine/cocaine, discontinuation and steroids

Question 22

What are characteristics of, culprits, and treatment for eosinophilic pneumonia?

Answer 22

x-ray = bilateral ground glass opacities, daptomycin/mesalamine/sulfasalazine, steroids

Question 23

What are characteristics of, culprits, and treatment for hypersensitivity pneumonia?

Answer 23

x-ray = localized or bilateral alveolar infiltrates, NSAIDs/methotrexate, discontinuation and antihistamines (and maybe steroids)

Question 24

What are characteristics of, culprits, and treatment for drug-induced pulmonary edema?

Answer 24

x-ray = acinar infiltrates with normal heart size, MANY (narcotics), naloxone

Question 25

What are characteristics of, culprits, and treatment for drug-induced lupus?

Answer 25

x-ray = pleural effusion and diffuse interstitial pneumonitis, procainamide/hydralazine/isoniazid/anti-TNF alphas, discontinuation