Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

702 > Lung Toxicity > Flashcards

Lung Toxicity Flashcards

1
Q

Mechanisms of pulmonary injury

A
  • Oxidant injury
  • Immune complex mediated
  • Interference with matrix formation
  • Interference with lipid metabolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Lung toxicity treatment

A
  1. Stop offending agent
  2. Steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Drug-related risk factors

A
  • Dose
  • Administration
  • Duration
  • Oxygen therapy
  • Radiation therapy
  • Cumulative dose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Patient-related risk factors

A
  • Age (very high or very low)
  • Respiratory acidosis
  • Pre-existing lung disease
  • Impaired renal or hepatic function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Drug-induced interstitial pneumonitis/fibrosis (DIILD)

A

Can become pulmonary HTN
- Unproductive cough, dyspnea, fever, rash, eosinophilia
- Chronic: progressing SOB, decreased physical activity
- Crackles, clubbing, bilateral diffuse ground-glass opacities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

DI interstitial pneumonitis/fibrosis mechanism of toxicity (DIILD)

A

Permanent inflammation
Damage causes (fibroblasts, apop.)
Excess extracellular matrix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does nitrofurantoin cause and how?

A

DIILD
- Oxidant imbalance
- Onset 8 months -16 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the presentation of nitrofurantoin toxicity?

A
  • Acute eosinophilic pneumonia
  • Pulmonary fibrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What do antirheumatics cause and how?

A

DIILD
- Hypersensitivity
- Onset days to years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which antirheumatics are we worried about?

A

Leflunomide, Methotrexate (more common)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does amiodarone cause and how?

A

DIILD
- Direct toxic effect
- Onset 4 weeks - 6 years
- Dose dependent, common in elderly, high mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which antineoplastics are we worried about?

A

Bleomycin, busulfan, cyclophosphamide, gemcitabine, ICPis, mTORis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does bleomycin* cause and how?

A

DIILD
- Causes fibrosis (cytokines)
- Onset weeks to months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does busulfan cause and how?

A

DIILD
- Direct alveolar injury
- Onset 4 years after monotherapy but months after high dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does cyclophosphamide cause and how?

A

DIILD
- Direct alveolar injury
- Onset months to years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does gemcitabine cause and how?

A

DIILD
- Endothelial dysfunction (cytokines)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Immune checkpoint inhibitors (ICPis)

A

DIILD
- Hypersensitivity
- Onset 3 months
- Faster when used in combo (of course)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Mechanistic Target of Rapamycin Inhibitors (mTORis)

A

DIILD
- Diffuse alveolar damage + hypersensitivity
- Onset 51-104 days, quicker with daily regimens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Grade 1 DIILD treatment (ICPis)

A

Hold the medication, see what happens

20
Q

Grade 2 DIILD treatment (ICPis)

A

Hold medication
Prednisone/methylprednisolone
1-2 mg/kg/day

21
Q

Grade 2 ICPi improves

A

Treat as grade 1, taper steroids 4-6 weeks

22
Q

Grade 2 ICPi worsens

A

No improvement 48-72 hours?
-> Treat as grade 3

23
Q

Grade 3,4 DIILD treatment (ICPis)

A

(If symptomatic, interferes with AOL)
Permanent discontinuation
Methylprednisolone 1-2 mg/kg/day

24
Q

Grade 3,4 ICPi improves

A

Taper steroid 4-6 weeks

25
Q

Grade 3,4 ICPi worsens

A

No improvement in 48 hours?
-> Infliximab, IVIG, MMF

26
Q

mTORi DIILD grade 2 or 3

A

Hold or reduce dose
Prednisone 0.75-1 mg/kg/day until grade 1

27
Q

mTORi DIILD grade 4

A

Permanently discontinue med
Prednisone 0.75-1 mg/kg/day until grade 1

28
Q

Bleomycin DIILD treatment

A

Prednisone 0.75 mg/kg/day for 4-6 weeks (taper)

29
Q

Carmustine DIILD treatment

A

Prednisone 60 mg PO BID
-> 30 mg QD
-> 10 mg QW
-> 5 mg QW

30
Q

Amiodarone

A

Prednisone 0.5-1 mg/kg/day
Several months - 1 year
(Relapse seen with treatment <6 months)

31
Q

Bronchiolitis Obliterans Organizing Pneumonia (BOOP) presentation

A

Cough, BL crackles, fever/rash, SOB
Chest X-ray bilateral patchy infiltrates***

32
Q

BOOP causes

A
  • Bleomycin
  • Amiodarone
  • Carbamazepine
  • Cocaine
33
Q

BOOP treatment

A
  • Discontinuation
  • Steroids
34
Q

Eosinophilic pneumonia presentation

A

Interstitial pulmonary infiltrates (with eos)
Dry cough, chest pain, fever
Chest X-ray bilateral ground glass opacities***

35
Q

Eosinophilic pneumonia causes

A
  • Daptomycin
  • Mesalamine
  • Sulfasalazine
36
Q

Eosinophilic pneumonia treatment

A

Steroids

37
Q

Hypersensitivity pneumonia presentation

A

Urticaria, angioedema, rhinitis, dyspnea
Chest X-ray: localized or bilateral alveolar infiltrates

Can be chronic but commonly immediate

38
Q

Hypersensitivity pneumonia causes

A
  • NSAIDs
  • Methotrexate
39
Q

Hypersensitivity pneumonia treatment

A

Drug discontinuation
Antihistamines
Steroids

40
Q

DI pulmonary edema presentation

A

Cough, crepitation/auscultation, cyanosis**
Chest X-ray acinar infiltrates with normal heart size (as opposed to HF)

41
Q

DI pulmonary edema causes

A

Narcotics (moderate to high dose)

42
Q

DI pulmonary edema timelines

A

24-48 hours: symptoms
2-5 days: X-ray changes
10-12 weeks: PFTs

43
Q

DI pulmonary edema treatment

A

Naloxone

44
Q

Drug-induced lupus presentation

A

Fever, myalgias, rash, arthralgias, serositis, pleuritic pain
Chest X-ray pleural effusion, diffuse interstitial pneumonitis, alveolar infiltrates

45
Q

Drug-induced lupus causes

A

Procainamide***, hydralazine, isoniazid, anti-TNF alpha

NOT dose-dependent
Onset possible up to 3 years

46
Q

Drug-induced lupus treatment

A

Medication withdrawal
Recovery 6 weeks

702 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions