Pulmonary Flashcards
Amiodarone
-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
Nitrofurantoin
imbalance of oxidant/anti -oxidant
methotrexate
hypersensitivity
bleomycin
-antineoplastic
-cytokine inflammatory cells and free o2 radical induction
busulfan
-antineoplastic
-direct alveolar injury
lung mechanisms of injury
-oxidant injury
-immune complex
-interference with matrix formation
-interference with lipid metablism
cyclophosphamide
direct alveolar injury
gemcitabine
endothelial dysfunction after cytokine release
mTORis
DAD or hypersensitivity
Taxanes
Hypersensitivity, direct toxicity or organ pneumonia
Grade 1 pneumonitis
-consider holding medication
-reassess in 1-2 weeks
Grade 2 pneumonitis
-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)
Grade 3,4 pneumonitis
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
mTORIs Grade 1
blank
mTORIs Grade 2
-dose reduce or hold medication
-prednisolone 0.75 - 1 mg/kg/day
-continue until grade 1
mTORIs Grade 3
-hold med
-prednisone 0.75 - 1 mg/kg/day
-continue until grade 1
mTORIs Grade 4
-permanently d/c med
-prednisolone 0.75 - 1 mg/kg/day
-continue until grade 1
Bleomycin treatment
Prednisone 0.75 mg/kg/day for 4-6 weeks then taper
Carmustine treatment
Prednisone 60 mg PO BID then 30 mg PO daily then tapered by 10 mg PO weekly then 5 mg PO weekly
Amiodarone treatment
Prednisone 0.5 - 1 mg/kg/day continue for several months to one year
Prevention of DIILD
-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
BOOP pneumonia
-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
Eosiophilic pneumonia
-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
Hypersensitivity pneumonitis
-sx:urticaria, angioedema, rhinitis, dyspnea
-chest x-ray: localized or bilateral alveolar infiltrates
-meds: NSAIDs, methotrexate
-treatment: d/c drug. antihistamines and possibly steroids
Drug Induced Lupus
-meds: procainamide, hydralazine, isoniazid, or anti TNF alpha
