DRUG INDUCED PULMONARY DISEASES
Dr [Link] Babu
Professor& Head
Department of Pharmacy Practice
Chebrolu Hanumaiah Institute of Pharmaceutical Sciences
DEFINITION
➢ Drug-induced pulmonary disease is lung disease
caused by a bad reaction to a medication.
Many types of lung injury can result from
medications, and it is often impossible to predict who
will develop lung disease resulting from a medication
or drug.
The clinical manifestations of Drug Induced
Pulmonary diseases are difficult to find because of
Non Specific Pathological changes.
The diagnosis is based on exclusion of all other
possible causes.
DRUGS THAT INDUCE BRONCHOSPASM
Anaphylaxis (IgE-Mediated)
Penicillins Fa
Sulfonamides F
Cephalosporins F
Cimetidine R
Tetracyclines I
a=Relative frequency of reactions:
F = frequent;
I = infrequent;
R = rare.
Cyclooxygenase Inhibition
Aspirin F
Phenylbutazone I
Acetaminophen R
Anaphylactoid Mast-Cell Degranulation
Iodinated-radiocontrast media F
Direct effect on Smooth Muscle
Carbachol
Pilocarpine
Methacholine
Inhibit Hydrolysis of Meditor
Neostigmine
Physostigmine
Antagonism at beta receptors
Propranalol
Atenalol
Reflex Bronchoconstriction :
Inhalers used in
Asthma
Vagal reflex due to non
specific stimulation of
Bronchial, Mucosal
irritant receptors
Bronchoconstriction
To overcome this effect a combination of Sodium Chromoglicate and Isoprenaline
should be given.
SULFITES :
Two mechanisms are involved
Sulfites
E.g. Potassium metabisulfite
Stimulation of afferent
parasympathetic irritant IGe mediated Sulfite-sensitive
receptors anaphylactic reactions
Positive skin test due to reduced
Bronchoconstriction
hydrolase enzyme
TREATMENT :
Pretreatment with Cromolyn, Anticholinergics,
Vitamin B12
Vitamin B12 catalyses the oxidation of sulfite to
sulfate.
OTHER PRESERVATIVES
EDTA : Potentiates bronchial responsiveness to
Histamine mediated by calcium chelation of EDTA.
Benzalkonium chloride : Mast cell degranulation
and stimulation of irritant –C fibers in airways.
Treatment : Cromolyn
PULMONARY OEDEMA
Pulmonary oedema results from failure of
Homeoststic mechanisms.
Etiology
in the Hydrostatic pressure due to left
ventricular failure.
Disrupted osmotic and oncotic pressure in
vasculature.
Integrity of alveolar epithelium.
Interstial lymph flow.
Signs and Symptoms :
❖ Persistent cough
❖ Tachypnea
❖ Dyspnea
❖ Tachycardia
❖ Stiff lungs
❖ Hypoxemia
DRUGS
Naloxone,Codeine Direct toxicity on
alveolar capillary membrane.
PULMONARY VASCULITIS
Results from a Immune Mechanism
Antigen (Drug) + Antibody
Intravascular immune complexes
on vascular endothelium
Activation of complement system
Inflammatory reaction
Pulmonary vasculitis
HYPERSENSITIVITY PNEUMONITIS
Drugs Cyclic reduction and
e.g. Nitrofurantoin oxidation
Re-Oxidation
O2- free radical Reactive Nitrofurantoin
molecule
Acute hypersensitivity Hapten
pneumonitis
DRUG INDUCED APNEA
Patients suffering with COPD, Alveolar
hypoventilation, Chronic co2 retention show
exaggerated response to sedatives and narcotic
analgesics.
Class of drugs involved include
o Benzodiazepines : e.g. midazolam
o Aminoglycoside Antibiotics: e.g. Streptomycin,
Gentamycin
Polymyxin and Aminoglycoside Antibiotics
Cause complexation of calcium and
its depletion at myoneuronal junction
Respiratory paralysis and Rapid
respiratory muscle fatigue
IV Calcium chloride is given to reverse paralysis
INTERSTITIAL LUNG DISEASE
Types of ILD :
a) Pulmonary Eosinophilia
b) Bronchiolitis Obliterans Organizing Pneumonia
c) Pulmonary Fibrosis
d) Diffuse alveolar damage
e) Oxidant Injury
Symptoms :
Non productive cough,
Dyspnea,
Low grade fever.
❑ Management :
✓ Withdrawal of Causative drug.
✓ Respiratory failure is treated with high dose of
Methyl prednisolone.
✓ Respiratory distress treated with low dose of
methyl prednisolone.
✓ Immunosupperesents
PULMONARY EOSINOPHILIA
Pulmonary infiltrates with eosinophlia
Symptoms :
✓ Fever
✓ Non productive cough
✓ Bilateral pulmonary infiltrate
✓ Lung biopsy revels perivasculitis with infiltration
of eosinophils, macrophages and proteniaceous
fluid in the alveoli.
BRONCHOLITIS OBLITERANS ORGANIZING
PNEUMONIA
It is the inflammation of the lungs characterized
by alveolar fibrosis.
Symptoms : Dyspnea, low grade fever, acute
pleuretic chest pain.
Amphoterecin-B
Statins
Sulfasalazine
Amiodarone
Acebutalol
DIFFUSE ALVEOLAR HAEMORRHAFE AND
DAMAGE
Characterized by bleeding from capillaries leading
to accumulation of RBCs in alveolar spaces.
Pathogenesis :
✓ Hypersensitivity reactions.
✓ Direct toxicity.
✓ Coagulation defects
❑ Drugs : Anticoagulants Pulmonary
haemorrhage
❑ Treatment : Withdrawal of the drug,
Corticosteroids
❑ Chemotherapeutic agents Direct epithelial
injury and damage to alveolar capillary basement
membrane.
OXYGEN TOXICITY
OXYGEN TOXICITY
Drugs induce Lung toxicity by
Production of oxidants
e.g. of drugs include Bleomycin,
Nitrofurantoin,Cyclophosphamide.
By inhibiting antioxidant system
e.g. of drugs include Nitrofurantoin.
PULMONARY FIBROSIS
Predisposing factors : Cumulative dose, patient’s
age, Renal dysfunction, previous radiotherapy,
Oxygen administration, concurrent cytotoxic
therapy .
Signs and symptoms : Dry cough, Fever,
breathlessness developing and progressing over
a period of several weeks or months.
Alkylating
Bleomycin DRUGS
agents
High ambient Amiodarone Epithelial cell
oxygen tension
damage
in lung
High lipid
solubility, low
Generation of Trigger AA
rates of
super-oxide inflammatory
elimination
radicals cascade
High
Pulmonary Pulmonary
concentration
fibrosis fibrosis
in lungs than in
plasma
Direct toxicity
Amiodarone is an amphiphillic molecule,
responsible for phospholipid, storage disorders in
the lungs by inhidition of lysosomal
phospholipases.
Treatment : Prednisolone, Corticosteroid therapy
in severe conditions.
REFERENCES
Clinical pharmacy and therapeutics by Roger
Walker
Pharmacotherapy by Dipiro
Applied therapeutics by Koda Kimble
Pathologic basics of disease by Robbins and
cotran
THANK YOU
