Drug Induced Pulmonary Disease (DIPD)

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Drug Induced Pulmonary Disease (DIPD)

• John Noviasky, PharmD

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Background

• The number of medications linked to lung toxicity
  has doubled since 1972
• Therapy related pulmonary disease approaches 10
• Multiple mechanisms
• Related to Bradykinin (e.g.ACEI cough)
• Antagonize normal airway tone maintenance (e.g. B
  Blockers)
• Excess Leukotriene production (e.g. ASA)

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Background

• Multiple mechanisms
• Increased capillary permeability (e.g.heroin)
• IgE-mediated bronchospasm/anaphylaxis (e.g.
  cephalosporins)
• Fluid Overload (e.g. Excess IV fluids)
• Phospholipid storage disorder (e.g. Amiodarone)
• Superoxide free radical (e.g. Paraquat)
• Many unknown

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Table 26-1Common

• Bronchospasm
• ACEI, Aspirin, B Blockers, Aerolized medications,
  NSAID, Sulfites
• IgE-Mediated
• Cephalosporin
• Impairment of Respiratory Muscles
• hypoventilation -Alcohol, narcotics, sedative
• Neuromuscular Blockade- Aminoglycosides,
  Ca-Channel
• Neuropathy - Amiodarone, captopril,

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Table 26-1Common

• Pulmonary Edema
• Heroin, Methadone
• IV fluids
• Pulmonary Fibrosis
• Amiodarone
• Methysergide
• Paraquat
• Pulmonary Hypertension
• Magnesium Trisilicate

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Section 1

• What points away from infectious process in CM?

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Section 2

• How many cases of pulmonary reactions from
  nitrofurantoin have been reported?
• What is clinical course of acute pneumonitis?
• How common is eosinophilia and ESR elevation in
  nitrofurantoin induced pneumonitis?
• What is Loefflers Syndrome?

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Section 3

• How long should resolution of symptoms occur
  after withdrawal of offending agent?

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Section 11

• What is the most common presentation of
  amiodarone induced pulmonary toxicity?

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Section 12

• How often does amiodarone pulmonary toxicity
  (APT)occur in patients taking amiodarone?
• How long has a patient usually been receiving
  amiodarone prior to APT? Usual dose?
• Besides duration of therapy and dose, what are
  other risk factors for developing APT?

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Section 13

• What are 2 postulated mechanisms of Amiodarone
  pulmonary toxicity (APT)?

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Section 14

• How long after amiodarone is discontinued does
  APT usually reverse?
• What is the half-life of amiodarone?
• What dose of prednisone is a patient usually
  started on with APT?