Dipd - DRUGS INDUCED PULMONAY DISEASES
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Drug induced pulmonary disease is lung disease brought on by a bad reaction to a medicine .
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Dipd - DRUGS INDUCED PULMONAY DISEASES
- 1. Drug Induced Pulmonary Disease By Abhijit Gaikwad Second Year Pharm D
- 2. Drug Induced Pulmonary Diseases Definition : Drug induced pulmonary disease is lung disease caused by a bad reaction to a medication . OR Drug induced pulmonary disease is defined as any lung disease caused by a drug or medication .
- 4. Drug Induced Pulmonary Diseases Drug Induced Pulmonary Diseases 1) Bronchospasm , Cough 2) Pulmonary edema 3) Pulmonary hypertension 4) Interstitial lung disease Interstitial pneumonia Pulmonary Fibrosis
- 5. Drug Induced Pulmonary Diseases 5) Pulmonary eosinophilia 6) Pleural inflammation 7) Diffuse alveolar hemorrhage 8) Diffuse alveolar damage (DAD) 9) Drug hypersensitivity syndrome 10) Amiodarone induced pulmonary toxicity
- 6. Drug Induced Pulmonary Diseases 1) BRONCHOSPASM Bronchospasm (Contract airways) is due to irritation , inflammation of the airways . Most common drug induced pulmonary adverse event Clinical presentation is the same as with non drug induced bronchospasm Risk factors include pre-existing hyper reactive lung disease , smoking , advanced age and respiratory infections .
- 7. Drug Induced Pulmonary Diseases 1) BRONCHOSPASM Drugs – Penicillin , cimetidine ,sulphonamide . MOA –Anaphylaxis IgE mediated . Acetate , Bisulfite , Cromolyn . MOA- Direct Airways Irritations Aspirin , Phenylbutazone , Acetaminophen . MOA - Cyclooxygenase Inhibition
- 8. Drug Induced Pulmonary Diseases Management • Avoidance of causative agents . • Treat acute anaphylaxis with low doses of injectable epinephrine . • Oxygen , Corticosteroids . • Inhaled beta 2 agonists are useful for persistent bronchospasm.
- 9. Drug Induced Pulmonary Diseases 2) Pulmonary Edema ● Cardiogenic and non cardiogenic. • Symptoms include dyspnea , chest discomfort , tachypnea , hypoxemia . • Management focuses on adequate life support and limit the accumulation of extravascular water in the lungs.
- 10. Drug Induced Pulmonary Diseases 3) Pulmonary Hypertnsion • It is rare but life threatening . • Symptoms include dyspnea, fatigue , weakness , chest pain ,syncope. ● Drugs Causing Pulmonary Hypertension : Appetite suppressants , Fenfluramine derivatives , Amphetamine derivatives , Serotonin specific reuptake inhibitors ● Management : • Supplemental oxygen , diuretics ,Inotropic agents, Anticoagulants, Prostacyclin analogues, Endothelin receptors antagonist, Calcium channel blockers.
- 11. Drug Induced Pulmonary Diseases 4) Interstitial Lung Diseases I. Interstitial Pneumonia : • Diseases involving the space between the alveolus and capillary. • The infiltrates consists of fluid and or cells that gather in the areas of the lungs. ● Drugs causing interstitial pneumonia : • Epidermal growth factor receptor antagonist • Tyrosine kinase inhibitors • Methotrexate • Nitrofurantoin
- 12. Drug Induced Pulmonary Diseases 4) Interstitial Lung Diseases II. Pulmonary Fibrosis : • It is characterized by accumulation of excessive connective tissues in the lungs . • Activation of coagulation cascade and generation of coagulation proteases play a key role. ● Drugs that causes Pulmonary Fibrosis : • Cytotoxic drugs like bleomycin , busulfan , carmustine, cyclophosphamide, mitomycin. • Non cytotoxic drugs like amiodarone ,bromocriptine ,ergot ,derivatives ,heroin , methysergide.
- 13. Drug Induced Pulmonary Diseases 5) Pulmonary Eosinophilia ● It is characterized by pulmonary infiltration of eosinophils in alveolar spaces, the interstitial or both • Pulmonary infiltrates with eosinophilia (PIE) • Diagnosis is done by lung biopsy • Loeffler syndrome • Churg – Strauss syndrome (CSS) ● Drugs causing pulmonary eosinophilia: • Antimicrobial agents • NSAIDS • Leukotriene antagonists • Minocycline • nitrofurantoin
- 14. Drug Induced Pulmonary Diseases 6) Pleural Inflammation ● Symptoms are pleuritic chest pain, dyspnea, and cough • Mechanism include hypersensitivity or allergic reaction, direct toxicity, increased production of oxygen-free radicals, suppression of antioxidant defenses, and chemically-induced inflammation ● Drugs causing pleural inflammation includes: • Dantrolene • Ergot alkaloids (Bromocriptine, methergine, pergolide) • nitrofurantoin
- 15. Drug Induced Pulmonary Diseases 7) Diffuse Alveolar Hemorrhage (DAH) & Vasculitis : • DAH is characterized by bleeding from pulmonary capillaries, leading to the accumulation of red blood cells in the alveolar spaces• Symptoms include varying degrees of hemoptysis, cough, and progressive dyspnea • Drug-related pathogenic mechanisms include hypersensitivity reaction, direct toxicity diffuse alveolar damage (DAD), and coagulation defects. ● Drugs causing DAH : • Anticoagulants • Dextran 70 • Platelet aggregation inhibitors • Thrombolytic agents • Chemotherapeutic agents • Cocaine • Hydralazine • Nitrofurantoin • Penicillin
- 16. Drug Induced Pulmonary Diseases 8) Diffuse Alveolar Damage (DAD) ● In DAD, the alveolar epithelial cells are sloughed, and the lung interstitial becomes edematous. • Chronic inflammation and fibroproliferation of the alveolar walls can present early in the process • DAD presents with dyspnea, diffuse pulmonary infiltrates ● Drugs causing DAD : • Alkylating agents • Antibiotics • Antimetabolites • Aspirin
- 17. Drug Induced Pulmonary Diseases 9) Drug Hypersensitivity Syndrome (DHS) : ● DHS is a systemic idiosyncratic reaction • It is defined by the presence of fever, rash, and organ involvement, including pneumonitis • Clinical presentations may involve dermatologic, hematologic, lymphatic, or internal organ systems. • Management involves drug withdrawal, supportive care and corticosteroid therapy ● Drugs causing DHS : • Allopurinol • Anticonvulsants Carbamazepine phenytoin • Sulfonamides
- 18. Drug Induced Pulmonary Diseases 10) Amiodarone Induced Pulmonary Toxicity (APT): ● APT has an average onset of 18-24 months • It can present as various patterns of pulmonary toxicity • Symptoms include fatigue, dyspnea, nonproductive cough, pleuritic chest pain, crackles , weight loss • MOA : During chronic therapy amiodarone and its metabolic product DEAm accumulate in lungs which are toxic to the lung cells ● Management: Corticosteroid therapy for 6 month or 1 year Eg: 0.75 – 1 mg/kg of oral predinisolome .