Drug-Induced Pulmonary Disease (9)

What is Drug-Induced Lung Disease? (DILD)

A heterogeneous group of adverse drug reactions that occur after exposure to a medication. Broad definition of all reactions that could affect the lungs directly or indirectly

What is Drug-Induced Interstitial Lung Disease (DIILD)

group of adverse reactions affecting the lung interstitium that occur after exposure to a medication

What are examples of DIILD?

Pulmonary Fibrosis

Organizing Pneumonia

Noncardiac Pulmonary Edema

What are the two types of DIILD?

Direct toxicity

Immune-mediated toxicity

What is drug toxicity DIILD?

Drugs or metabolites cause cellular damage to lungs

What is Immune-mediated toxicity DIILD?

Abnormal immune response triggered by drug exposure leads to damage to the lungs

General risk factors of Drug-induced pulmonary disease

Age

Genetic susceptibility

concurrent drug use

drug exposure

preexisting lung disease

tobacco smoking

impaired renal/hepatic function

There are medication specific risk factors for drug-induced pulmonary disease such as

antineoplastics

The goal of management of Drug-Induced Pulmonary disease is

to resolve symptoms and prevent damage

What drugs are usually initiated for Drug-Induced Pulmonary disease

Corticosteroids

What is key in managing drug-induced pulmonary disease?

Prevention

What are the two key strategies of preventing drug-induced pulmonary disease?

avoid causative agents in high-risk patients

limit exposure in patients who must receive treatment with causative agents

what is drug-induced apnea?

when drugs suppress brainstem breathing centers or relaxes muscles to pause breathing

What are the two ranges of drug-induced apnea?

medication induced central apnea (similar to OSA)

acute respiratory depression (medical emergency that could result in death)

What are the key CNS depressants?

Opiods

Barbiturates

Benzodiazepines

Z drugs

Muscle Relaxers

Gabapentinoids

What is Drug-Induced Bronchospasm?

when muscles that line airways in lungs become reactive and tighten

What drugs can induce a bronchospasm?

ACE-i

Beta Blockers

NSAIDs

What are the antibiotics associated with DILD?

Nitrofurantoin (Macrobid)

Daptomycin (Cubicin)

What is Nitrofurantoin responsible for in DILD?

the most common reaction of eosinophilic pneumonia (associated with pulmonary fibrosis, pulmonary edema)

What is Daptomycin responsible for in DILD?

the leading cause of drug-induced eosinophilic pneumonia

it is the antibiotic used for MRSA and Vancomycin resistant enterococcus

What is Amiodarone?

Class 3 antiarrhthmic used to treat atrial and ventricular arrhythmias

What is Amiodarone associated with?

pulmonary fibrosis, organizing pneumonia, pulmonary edema

What is Methotrexate?

an antirheumatic associated with pulmonary fibrosis, pulmonary edema, and more

onset can vary from days to years

What is Sulfasalazine?

An antirheumatic associated with pulmonary fibrosis, organizing pneumonia, eosinophilic pneumonia and more

What are Antineoplastic agents?

the most frequently implicated in DILD, accounting for up to 50% of all DILD cases

What are Antineoplastics?

Bleomycin

Busulfan

What is Bleomycin?

Associated with pulmonary fibrosis, organizing pneumonia

Used to treat several types of tumors

What is Busulfan?

Antineoplastic associated with pulmonary fibrosis mainly