Dr.Sameera Fathima

1. PRESENTED BY UNDER THE GUIDANCE OF
SAMEERA FATHIMA MR.MISBA ALI BAIG
170721883006 Associate Professor
Pharm D (pb)-1st year Department Of Pharmacy Practice

2.  A number of medications are known to cause
undesirable reactions and lead to changes in the lungs
or alter respiratory function. These reactions are
known as Drug-induced pulmonary diseases.
 They could include pneumonitis, pulmonary edema,
fibrosis, and even lung failure. At times, effective
medicaments have to be withdrawn due to serious or
lethal adverse effects.

3.  Theoretic mechanisms include:
1) cytotoxic effects on alveolar capillary endothelial
cells
2) direct oxidative injury
3) amphophilic medications causing deposition of
phospholipid within the cells—particularly the
alveolar macrophage; and
4) immune-mediated lung injury, either through drug-
induced systemic lupus erythematosus (SLE) or via
hypersensitivity reactions.

4.  The different types of lung or pulmonary diseases caused by drugs are:
 Bronchospasm, wheezing and cough
 Pulmonary edema
 Pulmonary hypertension
 Interstitial lung disease
* Interstitial pneumonia/infiltrates
* Pulmonary fibrosis
*Bronchiolitis obliterans organizing pneumonia (BOOP)
 Pulmonary eosinophillia
 Pleural inflammation
 Diffuse alveolar hemorrhage / vasculitis
 Diffuse alveolar damage (DAD)
 Drug hypersensitivity syndrome
 Amiodarone induced pulmonary toxicity

5.  Most common drug induced pulmonary adverse event
 Risk factors include
pre-existing hyper reactive
lung disease, smoking,
advanced age and
respiratory infections

6. DRUGS THAT INDUCE
BRONCHOSPASM
MECHANISM OF ACTION
Penicillin, sulphonamides,
cephalosporin, cimetidine,
tetracycline, allergen extracts
Anaphylaxis- IgE mediated
Acetate, Bisulfite, Cromolyn ,
smoke, inhaled steroids,
N- acetyl cysteine
Direct airway irritation
Methydopa, carbamazepine,
spiramycin
Precipitating IgG antibodies
Aspirin, phenylbutazone,
acetaminophen
Cycloxygenase inhibition
Adrenergic receptor blockers Pharmacologic effects
Narcotic analgesics, ethylene
diamine, Local anaesthetics,
benzalkonium chloride
Anaphylactoid reaction

7.  Withdrawal and avoidance of causative agents
 Treat acute anaphylaxis with low doses of injectable
epinephrine
 Oxygen, corticosteroids, antihistamines are used to
treat bronchospasm
 Inhaled β2-agonists are useful for persistent
bronchospasm

8.  About 4% of the bronchial asthmatic patients, experience bronchospasm,
which is produced by aspirin and other NSAID’S.24 Inhalers that are used
by the asthmatic patients also produce bronchospasm, because the
excipients that are used in production of inhalers may trigger
bronchospasm.
 Bronchospasm generally occurs, after administration of aspirin, within
minutes to hour and more often it is associated with rhinorrhea, flushing of
neck, head and conjunctivitis. Aspirin hypersensitivity is chronic and it is
more often life-threatening.
 MECHANISM OF ACTION :Arachidonic acid is metabolized by the 5-
lipoxygenase pathway may lead to an increase in the production of
leukotrienes that causes bronchospasm.
 DIAGNOSIS : It is done by oral provocation test
 TREATMENT : It includes desensitization or avoidance.

9.  Bronchial asthma can be defined as the chronic inflammatory
disease of air passages that cause hyper responsiveness,
mucosal production and mucosal edema.
 RISK FACTORS : cold air, exercise, viral upper respiratory
infection, cigarette smoke, and respiratory allergens.
 Example : ACETAMENOPHEN induced Bronchial
Asthama
 The increased use of acetaminophen increases the prevalence
of COPD and bronchial asthma is showed in an
epidemiological study.Various study shows that there exists an
relation between acetaminophen and bronchial asthma within
the age of 12 months will lead to development of bronchial
asthma.

10. MECHANISM : It is due to reduction in the secretion of
an endogenous antioxidant enzymes in the airways that
lead to oxidant damage in lungs.
 DIAGNOSIS :It include allergy testing, chest X ray, lung
function test, blood test, arterial blood gas, peek respiratory
flow measurement.

11.  Cardiogenic and non cardiogenic
 Symptoms : include dyspnea, chest discomfort, tachypnea,
hypoxemia, foamy tracheal exudates
 Management: adequate life support and limit the
accumulation of extravascular water in the lungs.
 a) CARDIOGENIC
• It have an insidious onset
• Symptoms are vague fatigue, mild pedal edema , exertional
dyspnea
• Latrogenic cause includes IV fluids with resultant
cardiovascular fluid overload
 • Eg: IV fluids, contrast media, magnesium sulfate

12. b) NON- CARDIOGENIC
• It occurs via drug related increase in capillary pulmonary
permeability
• Eg: Antineoplastic agents, IV β2-agonist, cocaine,
hydrocholorothiazide, naloxone, opiates, salicylates

13.  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

14.  Methotrexate belongs to the class of anti metabolites. It is
used in the treatment of rheumatoid arthritis and other
tissue diseases, but its dose as an anti-inflammatory is very
low, when compared to an antineoplastic agent.
 The major complications faced by the patients, who use
Methotrexate are acute interstitial pneumonitis, interstitial
fibrosis and bronchial asthma.
 About 1-5% of the patients with rheumatoid arthritis faces
Methotrexate induced pulmonary disease.31 Symptoms
may include a progressive cough, fever, difficulty in
breathing, which is temporary.
 Diagnosis :pulmonary function test, high-resolution
computed tomography scan shows pulmonary infiltrates.

15.  It is rare, but life threatening
 Symptoms :exertional dyspnea, fatigue, weakness,
chest pain, syncope
 DRUGS CAUSING PULMONARY
HYPERTENSION :
 Appetite supressants
 fenfluramine derivatives
 Amphetamine derivatives
 Serotonin specific reuptake inhibitors

16. MANAGEMENT : Supplemental oxygen, diuretics,
Inotropic agents, Anticoagulants, Prostacyclin analogues,
Endothelin receptor antagonist, Calcium channel blocker

17.  https://www.everydayhealth.com/pulmonary-arterial-
hypertension
 https://www.researchgate.net/publication/338145361_D
rug_Induced_Pulmonary_Disease-A_Mini_Review.
 https://www.uspharmacist.com/article/therapeutic-
update-on-drug-induced-pulmonary-disorders.
 https://www.slideshare.net/VishwanathAnkola/drug-
induced-pulmonary-diseases.