DRUG STUDY

Drug Name aminophyllin e (theophylline ethylenedia mine) (am in off' i lin) Truphylline Pregnancy Category C Drug classes Bronchodilat or Xanthine Dosages Individualize dosage: Base adjustments on clinical responses; monitor serum theophylline levels; maintain therapeutic range of 10 20 mcg/mL; base dosage on lean body mass; 127 mg aminophylline dihydrate = 100 mg theophylline anhydrous. ADULTS Oral Acute symptoms requiring rapid theophyllinization in patients not receiving theophylline: An initial loading dose is required, as indicated below:
Patient Group Young adult smokers Loa Followe Mainte ding d by nance 3.8 7.6 3.8 mg/kg q mg/k mg/kg q 4 hr 3 g 6 hr doses

Therapeutic Actions Relaxes bronchial smooth muscle, causing bronchodilation and increasing vital capacity, which has been impaired by bronchospasm and air trapping; in higher concentrations, it also inhibits the release of slowreacting substance of anaphylaxis (SRS-A) and histamine.

Indications Symptomatic relief or prevention of bronchial asthma and reversible bronchospasm associated with chronic bronchitis and emphysema Unlabeled uses: Respiratory stimulant in Cheyne-Stokes respiration; treatment of apnea and bradycardia in premature babies

Adverse effects Serum theophylline levels < 20 mcg/mL: Adverse effects uncommon Serum theophylline levels > 2025 mcg/mL: Nausea, vomiting, diarrhea, headache, insomnia, irritability (75% of patients) Serum theophylline levels > 3035 mcg/mL: Hyperglycemia, hypotension, cardiac arrhythmias, seizures, tachycardia (> 10 mcg/mL in premature newborns); brain damage CNS: Irritability (especially children); restlessness, dizziness, muscle twitching, seizures, severe depression, stammering speech; abnormal behavior characterized by withdrawal, mutism, and unresponsiveness alternating with hyperactive periods CV: Palpitations, sinus tachycardia, ventricular tachycardia, lifethreatening ventricular arrhythmias, circulatory failure GI: Loss of appetite, hematemesis, epigastric pain, gastroesophageal reflux during sleep, increased AST GU: Proteinuria, increased excretion of renal tubular cells and RBCs; diuresis (dehydration), urinary retention in men with prostate enlargement Respiratory: Tachypnea, respiratory arrest Other: Fever, flushing, hyperglycemia, SIADH, rash

Contraindications Contraindicated with hypersensitivity to any xanthine or to ethylenediamine, peptic ulcer, active gastritis; rectal or colonic irritation or infection (use rectal preparations). Use cautiously with cardiac arrhythmias, acute myocardial injury, CHF, cor pulmonale, severe hypertension, severe hypoxemia, renal or hepatic disease, hyperthyroidism, alcoholism, labor, lactation, pregnancy. Assessment

Nursing considerations

History: Hypersensitivity to any xanthine or to ethylenediamine, peptic ulcer, active gastritis, cardiac arrhythmias, acute myocardial injury, CHF, cor pulmonale, severe hypertension, severe hypoxemia, renal or hepatic disease, hyperthyroidism, alcoholism, labor, lactation, rectal or colonic irritation or infection (aminophylline rectal preparations) Physical: Bowel sounds, normal output; P, auscultation, BP, perfusion, ECG; R, adventitious sounds; frequency of urination, voiding, normal output pattern, urinalysis, LFTs, renal function tests; liver palpation; thyroid function tests; skin color, texture, lesions; reflexes, bilateral grip strength, affect, EEG Interventions Administer to pregnant patients only when clearly neededneonatal tachycardia, jitteriness, and withdrawal apnea observed when mothers received xanthines up until delivery. Caution patient not to chew or crush enteric-coated timed-release forms. Give immediate-release, liquid dosage forms with food if GI effects occur. Do not give timed-release forms with food; these should be given on an empty stomach 1 hr before or 2 hr after meals. Maintain adequate hydration. Monitor results of serum theophylline levels carefully, and arrange for reduced dosage if serum levels exceed therapeutic range of 1020 mcg/mL. Take serum samples to determine peak theophylline concentration drawn 1530 min after an IV loading dose. Monitor for clinical signs of adverse effects, particularly if serum theophylline levels are not available. Ensure that diazepam is readily available to treat seizures. Teaching points Take this drug exactly as prescribed; if a timedrelease product is prescribed, take this drug on an empty stomach, 1 hour before or 2 hours after meals. Do not to chew or crush timed-release preparations. Administer rectal solution or suppositories after emptying the rectum. It may be necessary to take this drug around-theclock for adequate control of asthma attacks. Avoid excessive intake of coffee, tea, cocoa, cola

Adult 3.8 nonsmoker 7.6 3.8 mg/kg q s who are mg/k mg/kg q 6 hr 2 otherwise g 8 hr doses healthy

*Expressed as aminophylline Long-term therapy: Usual range is 6001,600 mg/day PO in three to four divided doses. Rectal 500 mg q 68 hr by rectal suppository or retention enema. PEDIATRIC PATIENTS Children are very sensitive to CNS stimulant action of theophylline; use caution in younger children unable to complain of minor side effects. < 6 mo: Not recommended. < 6 yr: Use of timed-release products not recommended.

Oral Acute therapy: For acute symptoms requiring rapid

DRUG STUDY
theophyllinization in patients not receiving theophylline, a loading dose is required. Recommendations are as follows:
Patient Group Loadin Followed Maintenanc g by e 5.1 mg/kg 5.1 mg/kg q q 4 hr 3 6 hr doses 3.8 mg/kg 3.8 mg/kg q q 4 hr 3 6 hr doses

Children 7.6 6 mo9 yr mg/kg

Children 7.6 916 yr mg/kg

beverages, and chocolate. Smoking cigarettes or other tobacco products impacts the drug's effectiveness. Try not to smoke. Notify your health care provider if smoking habits change while taking this drug. Frequent blood tests may be necessary to monitor the effect of this drug and to ensure safe and effective dosage; keep all appointments for blood tests and other monitoring. You may experience these side effects: Nausea, loss of appetite (taking this drug with food may help if taking the immediate-release or liquid dosage forms); difficulty sleeping, depression, emotional lability (reversible). Report nausea, vomiting, severe GI pain, restlessness, seizures, irregular heartbeat.

Long-term therapy: 20.3 mg/kg or 508 mg/day (immediate-release) or 15.2 mg/kg or 508 mg/day (extended-release) PO; slow clinical adjustment of the oral preparations is preferred; monitor clinical response and serum theophylline levels. In the absence of serum levels, adjust up to the maximum dosage shown below, providing the dosage is tolerated.
Maximum Daily Dose 30.4 mg/kg/day 25.3 mg/kg/day

Age < 9 yr 912 yr

1216 yr 22.8 mg/kg/day 16.5 mg/kg/day or > 16 yr 1,100 mg, whichever is less

*Expressed as aminophylline