Pharm: ILD Flashcards
What is initial tx for moderate to severe ILD?
Glucocorticoids (prednisone)
Mycophenolate
Methotrexate
Axathioprine
Nintedanib
What is predinisone used for?
Anti-inflammatory or immunosupressive agent
Lots of clinical applications
What is a warning for prednisone?
HPA axis supression
Monitor for Cushings and hyperglycemia
Taper doses gradually in chronic users to prevent withdrawl
What are some AEs for prednisone?
fluid retention
hyperglycemia
HTN
behavioral and mood changes
Increased appetite/weight gain
What is the MOA of mycophenolate?
immunosupressive drug
What is the black box warning for mycophenolate?
May cause fetal harm/death and miscarriage in 1st trimester of pregnancy
Also associated with congenital malformaitons & serious infections (incl. opportunistic infections)
What are the contraindications for mycophenolate?
hypersensitivity to mycophenolate mofetil, MPA acid, or polysorbate 80
What are some drug interactions important to consider?
Efficacy may be reduced with antacids, Mg, or aluminum hydroxide
May reduce effectiveness of oral contraceptives
What is the black box warning for methotrexate?
Bone marrow (supression, anemia)
Liver (hepatotoxicity, cirrhosis, fibrosis)
Lung (methotrexate-induced lung disesase, very dangerous, can occur any time)
Kidney (reduced elimination in those with impaired renal function, ascites, or pleural effusuions)
Congenital malformations/fetal death
What are some drug interactions with methotrexate
Many interactions with antibiotics, esp penicillin (decrease absorption of methotrexate)
NSAID use prolongs serum methotrexate levels –> deaths reported
High risk of hepatotoxicity when given with other hepatotoxic drugs
What is the MOA of axathioprine?
Immunosupressive antimetabolite
What are some contraindications of azathioprine?
Don’t give to pregnant women
May increase risk of malignancy
Carries risk of serious toxic hematologic and GI effects
What is the black box warning for azathioprine?
Malignancy
What is the MOA of nintedanib?
A kinase inhibitor used to tx idiopathic pulmonary fibrosis
What are warnings/precautions associated with nintedanib?
elevated liver enzymes
GI disorders
Embryofetal toxicity (avoid pregnancy)
Arterial thromboembolic events
Bleeding risks
GI perforation
