Aminophylline Drug Study

In making a Drug Study, the following elements must be present: Generic Name and the Brand name (not all brands, just the brand used by the patient), Action, Indication, Pregnancy Category, Drug Classification, and Contraindication, Adverse Effect, Drug interaction and Nursing Consideration/Intervention…. Most clinical instructors preferred this to be in a long bond paper in printed or handwritten with paper in landscape.

Aminophylline (theophylline ethylenediamine)

Brand Name: Truphylline

Pregnancy Category C

Drug classes: Bronchodilator, Xanthine

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 slow-reacting 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

Contraindications

· Contraindicated with hypersensitivity to any xanthine or to ethylenediamine, peptic ulcer, active gastritis; rectal or colonic irritation or infection (use rectal preparations).

Adverse effects

Irritability (especially children); restlessness, dizziness, muscle twitching, convulsions, severe depression, stammering speech; abnormal behavior characterized by withdrawal, mutism, and unresponsiveness alternating with hyperactive periods, Palpitations, sinus tachycardia, ventricular tachycardia, life-threatening ventricular arrhythmias, circulatory failure, Loss of appetite, hematemesis, epigastric pain, gastroesophageal reflux during sleep, increased AST, Proteinuria, increased excretion of renal tubular cells and RBCs; diuresis (dehydration), urinary retention in men with prostate enlargement, Tachypnea, respiratory arrest, Fever, flushing, hyperglycemia, SIADH, rash

Drug Interactions:

· Increased effects with cimetidine, erythromycin, troleandomycin, clindamycin, lincomycin, influenza virus vaccine, oral contraceptives

· Possibly increased effects with thiabendazole, rifampin, allopurinol

· Increased cardiac toxicity with halothane; increased likelihood of seizures when given with ketamine; increased likelihood of adverse GI effects when given with tetracyclines

· Increased or decreased effects with furosemide, levothyroxine, liothyronine, liotrix, thyroglobulin, thyroid hormones

· Decreased effects in patients who are cigarette smokers (1–2 packs per day); theophylline dosage may need to be increased 50%–100%

· Decreased effects with phenobarbital, aminoglutethimide

· Increased effects, toxicity of sympathomimetics (especially ephedrine) with theophylline preparations

· Decreased effects of phenytoin and theophylline preparations when given concomitantly

· Decreased effects of lithium carbonate, nondepolarizing neuromuscular blockers given with theophylline preparations

· Mutually antagonistic effects of beta-blockers and theophylline preparations

Interaction with Food:

· Elimination is increased by a low-carbohydrate, high-protein diet and by charcoal broiled beef

· Elimination is decreased by a high-carbohydrate, low-protein diet

· Food may alter bioavailability and absorption of timed-release theophylline preparations, causing toxicity. These forms should be taken on an empty stomach

Interaction with lab test

· Interference with spectrophotometric determinations of serum theophylline levels by furosemide, phenylbutazone, probenecid, theobromine; coffee, tea, cola beverages, chocolate, acetaminophen cause falsely high values

· Alteration in assays of uric acid, urinary catecholamines, plasma free fatty acids by theophylline preparations

Nursing considerations

· Administer to pregnant patients only when clearly needed--neonatal 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 10–20 mcg/mL.

· Take serum samples to determine peak theophylline concentration drawn 15–30 min after an IV loading dose.

· Monitor for clinical signs of adverse effects, particularly if serum theophylline levels are not available.

· Maintain diazepam on standby to treat seizures.