Dipd - DRUGS INDUCED PULMONAY DISEASES
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This document discusses drug-induced pulmonary diseases. It defines drug-induced pulmonary disease as any lung disease caused by a medication. Some common types of drug-induced pulmonary diseases include bronchospasm, pulmonary edema, pulmonary hypertension, interstitial lung disease, pulmonary eosinophilia, pleural inflammation, diffuse alveolar hemorrhage, diffuse alveolar damage, and drug hypersensitivity syndrome. Specific drugs that can cause each type of lung disease are provided. The document also discusses definitions, symptoms, mechanisms, and management approaches for each type of drug-induced pulmonary disease.
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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 .