not all drugs are good drugs: Pulm Flashcards
Mechanisms of injury: drug induced pulmonary disease
- Oxidant injury
- Interference with matrix formation
- Immune compelx mediated
- Interference with lipid metabolism
Drug induced pulmonary disease: pt related risk factors
- Age (old or young)
- Respiratory acidosis
- Pre-existing lung disease
- Impaired renal or hepatic function
Drug induced pulmonary disease: drug related risk factors
- Dose and cumulative dose
- Admin rate
- Treatment duration
- O2 tehrapy
- Radiation therapy
drug induced interstitial pneumonitis/fibrosis: S/S
- Non-productive cough
- Sudden onset dyspnea
- Fever, rash, eosinophilia
- Chronic: progressing breathlessness, decreased physical activity
- Crackles on expiration, clubbing
drug induced interstitial pneumonitis/fibrosis: chest x-ray
- decreased lung volume
- bilateral diffuse ground-glass opacities
drug induced interstitial pneumonitis/fibrosis: mechanim of tox
- Permanent infalmmation
- Damage causes
- Recruitment of fibroblasts
- Abnormal cellular repair
- Apoptosis
- Excess deposition of extracellular matrix
- Remodeling
- Honeycombing
- Fibrosis
drug induced interstitial pneumonitis/fibrosis: causative agents
- amiodarone
- bleomycin
- busulfan
- carmustine
- cyclophosphamaide
- gemcitabine
- leflunomide
- methotrexate
- nitrofurantoin
_ - immune checkpoint inhibitiors
- mechanistic target of rapamycin inhibitors (MTORi)
immune checkpoint inhibitor induced interstitial pneumonitis/fibrosis Grade 1 treatment
monitor
immune checkpoint inhibitor induced interstitial pneumonitis/fibrosis Grade 2 treatment
- Hold medication OR
- Treat with prednisone/methylprednisolone 1-2mg/kg/day
- Treat until improvement to grade 1 then taper off over 4-6 weeks
- If no improvement in 48-72 hrs, treat as grade 3
- Treat until improvement to grade 1 then taper off over 4-6 weeks
immune checkpoint inhibitor induced interstitial pneumonitis/fibrosis Grade 3 treatment
- Permanantely dc OR
- Treat with methylprednisolone 1-2 mg/kg/day
- Treat until improvement to grade 1 then taper off over 4-6 weeks
- If no improvement in 48 hrs, treat with infliximab, IVIG, or MMF(mycophenolate)
immune checkpoint inhibitor induced interstitial pneumonitis/fibrosis Grade 4 treatment
Same as grade 3
- Permamently dc OR
- Treat with methylprednisolone 1-2 mg/kg/day
- Treat until improvement to grade 1 then taper off over 4-6 weeks
- If no improvement in 48 hrs, treat with infliximab, IVIG, or MMF
MTORi induced interstitial pneumonitis/fibrosis Grade 1 treatment
monitor
MTORi interstitial pneumonitis/fibrosis Grade 2 treatment
- Dose reduce OR
- Hold medication OR
- Treat with prednisone 0.75-1 mg/kg/day
- Treat until improvement to grade 1 then taper off
MTORI pneumonitis/fibrosis Grade 3 treatment
- Hold OR
- Treat with prednisone 0.75-1 mg/kg/day
- Treat until improvement to grade 1 then taper off
MTORI induced interstitial pneumonitis/fibrosis Grade 4 treatment
- Permamently discoontinue OR
- Treat with prednisone 0.75-1 mg/kg/day
- Treat until improvement to grade 1 then taper off
bleomycin induced interstitial pneumonitis/fibrosis treatment
Prednisone 0.75
mg/kg/day for 4 – 6
week
carmustine induced interstitial pneumonitis/fibrosis treatment
- Prednisone 60 mg PO BID
- Then 30 mg PO daily
- Then 10 mg PO weekly
- Then 5 mg PO weekly
amiodarone induced interstitial pneumonitis/fibrosis treatment
- Prednisone 0.5 – 1 mg/kg/day
- Continue for several
months to one y
drug induced bronchiolitis obliterans organizing pneumonia: S/S
- inflammatory response in lungs
- cough
- dyspnea
- b/l crackles
drug induced bronchiolitis obliterans organizing pneumonia: chest x-ray
b/l patchy infiltrates
drug induced bronchiolitis obliterans organizing pneumonia: causative agents
- bleomycin
- amiodarone
- CBZ
- cocaine
drug induced bronchiolitis obliterans organizing pneumonia: treatment
- dc med
- steroids
drug induced eosinophilic pneumonia: S/S
infiltration of the pulmonary interstitial with eosinophils
- dry cough
- chest pain
- fever
drug induced eosinophilic pneumonia: chest x-ray
b/l ground glass opacities
drug induced eosinophilic pneumonia: causative agents
- daptomycin
- mesalamine
- sulfasalazine
drug induced eosinophilic pneumonia: treatment
steroids
drug induced lupus: s/s
- fever
- myalgaias
- rash
- arthralgias
- arthritis
- serositis
- pleuric pain
drug induced lupus: chest x-ray
- pleural effusion
- diffuse interstitial pneumonitis
- alveolar infiltrates
drug induced lupus: causative agents
- procainamide
- hydralazine
- isoniazid
- anti-TNF alfa
drug induced lupus: treatment
med withdrawal
drug induced hypersensitivity pneumonia: s/s
- urticaria
- angiodema
- rhinitis
- dyspnea
drug induced hypersensitivity pneumonia: chest x-ray
localized or b/l alveolar infiltrates
drug induced hypersensitivity pneumonia: causative agents
- NSAIDs
- methotrexate
drug induced hypersensitivity pneumonia: treatment
- dc med
- antihistamines
- possible steroids
drug induced pulmonary edema: s/s
- cough
- crepitation on auscultation
- cyanosis
drug induced pulmonary edema: chest x-ray
acinar infiltrates with normal heart size
drug induced pulmonary edema: causative agents
- Beta mimetics (terbutaline)
- Chlordiazepoxide
- Cocaine
- Cytarabine
- Gemcitabine
- HCTZ
- Mitomycin
- Narcs → treat with naloxone
- Phenothiazines
- Tocolytic agents
- Tricyclics
- Vinca alkaloids
