Pulmonary

Question 1

Amiodarone

Answer 1

-direct toxic effect
-4 weeks - 6 years
-smaller doses over years > 2 years or larger doses shorter time frames; about 400 mg/day (> 2 months)
-age > 60 years old 3X increase

Question 2

Nitrofurantoin

Answer 2

imbalance of oxidant/anti -oxidant

Question 3

methotrexate

Answer 3

hypersensitivity

Question 4

bleomycin

Answer 4

-antineoplastic
-cytokine inflammatory cells and free o2 radical induction

Question 5

busulfan

Answer 5

-antineoplastic
-direct alveolar injury

Question 6

lung mechanisms of injury

Answer 6

-oxidant injury
-immune complex
-interference with matrix formation
-interference with lipid metablism

Question 7

cyclophosphamide

Answer 7

direct alveolar injury

Question 8

gemcitabine

Answer 8

endothelial dysfunction after cytokine release

Question 9

mTORis

Answer 9

DAD or hypersensitivity

Question 10

Taxanes

Answer 10

Hypersensitivity, direct toxicity or organ pneumonia

Question 11

Grade 1 pneumonitis

Answer 11

-consider holding medication
-reassess in 1-2 weeks

Question 12

Grade 2 pneumonitis

Answer 12

-hold meds
-prednisone/methylpred 1-2 mg/kg/day (treat until improved to grade 1 the taper; no improvement in 48-72 hours then treat as grade 3)

Question 13

Grade 3,4 pneumonitis

Answer 13

Permanent d/c or methylpred 1-2 mg/kg/day then taper; or if no improvement in 48 hours treat with infliximab, IVIG or MMF

Question 14

mTORIs Grade 1

Answer 14

blank

Question 15

mTORIs Grade 2

Answer 15

-dose reduce or hold medication
-prednisolone 0.75 - 1 mg/kg/day
-continue until grade 1

Question 16

mTORIs Grade 3

Answer 16

-hold med
-prednisone 0.75 - 1 mg/kg/day
-continue until grade 1

Question 17

mTORIs Grade 4

Answer 17

-permanently d/c med
-prednisolone 0.75 - 1 mg/kg/day
-continue until grade 1

Question 18

Bleomycin treatment

Answer 18

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

Question 19

Carmustine treatment

Answer 19

Prednisone 60 mg PO BID then 30 mg PO daily then tapered by 10 mg PO weekly then 5 mg PO weekly

Question 20

Amiodarone treatment

Answer 20

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

Question 21

Prevention of DIILD

Answer 21

-baseline spirometry, DLCO, and chest x-ray in high risk patients
-should occur every 2 weeks to every 4 months
-amiodarone: baseline the every 3-6 months if indicated
-bleomycin: chest x-ray every 1-2 weeks and DLCO monthly

Question 22

BOOP pneumonia

Answer 22

-inflammatory response in lung
-nonproductive cough, dyspnea, BL crackles, occ fever/rash; x-ray: BL patchy infiltrates
-meds: minocycline/nitrofurantoin, bleomycin, amiodarone, sulfasalazine, CBZ, cocaine

Question 23

Eosiophilic pneumonia

Answer 23

-infiltration of pulmonary interstitium with eosinophils; drug or toxin mediated
-dry cough, dyspnea, chest pain, fever, BL ground glass opacities
-meds: daptomycin, nitrofurantoin, minocycline, mesalamine, sulfasalazine
-acute: treat with steroids

Question 24

Hypersensitivity pneumonitis

Answer 24

-sx:urticaria, angioedema, rhinitis, dyspnea
-chest x-ray: localized or bilateral alveolar infiltrates
-meds: NSAIDs, methotrexate
-treatment: d/c drug. antihistamines and possibly steroids

Question 25

Drug Induced Lupus

Answer 25

-meds: procainamide, hydralazine, isoniazid, or anti TNF alpha