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Respirology RC > Lung toxicity > Flashcards

Lung toxicity Flashcards

1
Q

Toxicity from Ethambutol

A

*Color blindness, decreased visual acuity, optic neuritis.
*Pneumonitis, eosinophilic pneumonia
*Dress-like reaction
Peripheral neuritis, headache
Erythema multiforme, dermatitis
Can flare gout
Abdominal pain, anorexia, gastric distress, nausea or vomiting
Hepatitis
Hypersensitivity reaction, anaphylaxis
Nephritis

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2
Q

Hydralazine

A 
Drug induced lupus
Including pleural and pericardial effusions
Pneumonitis
Organizing pneumonia
Alveolar hemorrhage
Bronchospasm
Angioedema
ANCA vasculitis
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3
Q

Phenytoin

A 
Pneumonitis
Eosinophilic or organizing pneumonia
LIP
ARDS
DAH
Bronchospasm, cough
Lymphadenopathy
Lupus syndrome
EGPA
Lymphoproliferative
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4
Q

4 effects of pre-natal exposure

A

Pre-natal exposure: SIDS, bronchitis, pneumonia, asthma, atopy, otitis media, infantile colic, bronchiolitis, short stature lower reading and spelling scores, shorter attention spans, hyperactivity, childhood obesity, decreased school performance
Increased risk T2DM

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5
Q

4 early complications of BMT

A 
Acute GVHD
Pulmonary edema
upper airways swelling
infiltrates (idiopathic pneumonia)
diffuse alveolar hemorrhage
- cytolytic thrombi
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6
Q

4 late complications of BMT

A 
Chronic GVHD
radiation fibrosis
Bronchiolitis obliterans
secondary AP
VTE
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7
Q

4 risk factors for lung disease with bleomycin

A
  • total cumlitative dose
  • renal failure
  • age >40
  • cigarette smoking
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8
Q

List 4 causes of pulmonary symptoms in patient with HIV

A 
Infectious: 
- PJP
- Bacterial PNA.
- TB
- Endemic fungi and parasites.
- Toxoplasmosis.
- Viral—CMV.
Non-infectious: 
- Kaposi’s sarcoma, NHL, constrictive bronchiolitis, bronchiectasis, LG, OP, sarcoidosis, drug reaction, LIP.
IRIS.
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9
Q

List 5 pulmonary complications of crack cocaine use

A
  • Acute Pulmonary Toxicity and Crack Lung
  • Acute Eosinophilic Pneumonia
  • eGPA (related to additives)
  • Pneumothorax and Pneumomediastinum
  • Foreign body granulomatosis (also seen in talc, cotton)
  • pulmonary vascular disease
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10
Q

describe radiologic findings in foreign body granulomatosis (talc)

A
  • Nodular opacities, a diffuse ground glass pattern
  • adenopathy (rare)
  • severe, lower lobe predominant, pan-acinar emphysema.
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11
Q

List 3 pharmacologic agents of smoking cessation

A

Varenicline
Bupropion
Nortriptyline
Nicotine replacement therapy (gum, patch, inhaler)

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12
Q

List 2 major contraindications to nicotine replacement therapy

A

Recent MI < 2 weeks

Recent stroke

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13
Q

List 2 contraindications of Bupropion and 2 side effects

A

CI: Seizure disorder, ETOH withdrawal, bulemia/anorexia, linezolid/MOA inhibitors, hepatic impairment

Side effects: lowers seizure threshold, insomnia, dry mouth, tremor

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14
Q

What are the stages of smoking cessation

A

Pre-contemplative – not ready, unaware of need to change, do not intend to change in 6m
Contemplative – ready to quit in 6m
Preparation – ready to quit in 30d, have taken steps
Action – quit in last 6m
Maintenance – quit > 6m

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15
Q

List 2 CXR and 2 PFT changes of radiation pneumonitis?

A

2 CXR Findings:

  • can be normal
  • Perivascular haziness -> patchy alveolar filling densities.
  • straight-line effect, which does not conform to anatomical 🡪 diagnostic of RILI.

2 PFT Findings:
Reduction in lung volumes (TLC, FVC, RV).
Tidal volumes decreased, and the respiratory rate may be elevated.
DLCO reduced.

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16
Q

List 4 factors of radiation pneumonitis?

A

*Volume of lung irradiation.
*Dose of radiation.
Time-dose factor.
Method of irradiation.
Concurrent chemotherapy.
*Younger age.
*Smoking history.
Poor ECOG prior to treatment.
* = similar to risk factors of bleomycin
COPD.
Female.
ILD.

17
Q

2 features of methotrexate induced lung toxicity

What is the incidence?

A

1-10% incidence
1, - HP (Most common) – loose granulomas, lymphocytic infiltration, +/- eosinophilic infiltration
2. Organizing pneumonia
3. AIP (acute interstitial pneumonitis with non-cardiogenic pulmonary edema)
4. Pulmonary fibrosis
Typically at the bases
5. Effusion/pleuritis
6. Pulmonary infections (PJP, CMV, Nocardia, mycobacteria,
7. Pulmonary lymphoproliferative disease — Lymphoproliferative disease (including non-Hodgkin [B cell] and other lymphomas)

18
Q

Risk factors for MTX lung toxicity

A
  • Age > 60
  • pre-existing lung disease
  • renal disease, low albumin diabetes
  • higher dose
19
Q

3 histological patterns of DAH (diffuse alveolar hemorrhage)

A 
With capillaritis
Without capillaritis (Bland)
Think blood thinners!
Any Anticoagulant
GPIIb/IIIA inhibitors (Integrilin)
DAD, diffuse alveolar damage
20
Q

list two mechanisms by which tocolytics can cause pulmonary edema (terbutaline, albuterol given during preterm labor)

A
  • decreased ventricular filling time, increase HR
  • increase capillary permeability
  • dramatic reflex increase in vessel tone when discontinued after birth is successful, with fluid overload due to fluid shifts in immediate post partum period
21
Q

What are the components of a non-pharmacologic approach to smoking cessation (5 A’s of smoking cessation)

A 
Ask about tobacco use 
Advise quitting 
Assess readiness to quit 
Assist smokers ready to quit 
Arrange follow-up
22
Q

list 4 effects of passive smoking cessation in children

A
  • asthma
  • atherogenic, future CV disease
  • renal impairment
  • middle ear disease
23
Q

in the setting of acute smoke inhalation, what is the most common cause of death?

A
  • acute: CO poisoning

- Chronic: COPD, RADS, tracheal stenosis

24
Q

What is the DLCO threshold for eligibility for SCT

A

> 50%

25
Q

List 5 side effects of Varenicline

A 
N/V
Constipation
Dry mouth 
insomnia
Vivid dreams
may increase cardiovascular risk
26
Q

Give 4 negative effects of oxygen therapy and hyperoxia on the lungs (4).

A

Parenchymal injury (DAD/ARDS)
Absorptive atelectasis
Hyperoxic hypercarbia (increased PaCO2)
Tracheobronchitis and airway injury

27
Q

List 4 patterns of IgG4 related lung disease

A
  • Solid nodular
  • Bronchovascular thickening
  • Alveolar interstitial (with honeycombing, bronchiectasis, and diffuse GGO)
  • Round-shaped, ground-glass opacities
  • Visceral or parietal pleural thickening
28
Q

List 4 features of Castleman’s disease

A 
Lymphadenopathy
Infiltrates, Lymphoid interstitial pneumonitis
Restrictive lung disease
Bronchiolitis obliterans
Pleural effusions
29
Q

What are risk factors of CMV mismatch post allogenic SCT

A
  • CMV mismatch
  • unrelated donors
  • use of ATG
  • use of steroids
  • developing GVHD
30
Q

List 3 distinctive features of amioderone lung toxicity

A
  1. Symptoms - nonspecific
  2. Patterns: organizing pneumonia, diffuse alveolar damage, pulmonary fibrosis
  3. Ct: bilateral high attenuation ground glass infiltrates

Respirology RC (11 decks)

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