Theophylline 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.

Theophylline

Brand Name: Bronkodyl, Elixophyllin, Quibron-T Dividose, Slo-Phyllin, Theolair, theophylline sodium glycinate, Elixir: Acet-Amp (CAN)

Pregnancy Category C

Drug classes: Bronchodilator, Xanthine

Therapeutic actions

Relaxes bronchial smooth muscle, causing bronchodilation and increasing vital capacity that has been impaired by bronchospasm and air trapping; actions may be mediated by inhibition of phosphodiesterase, which increases the concentration of cyclic adenosine monophosphate; in concentrations that may be higher than those reached clinically, it also inhibits the release of slow-reacting substance of anaphylaxis and histamine.

Indications

· Symptomatic relief or prevention of bronchial asthma and reversible bronchospasm associated with chronic bronchitis and emphysema

· Unlabeled use of 2 mg/kg/day to maintain serum concentrations between 3 and 5 mcg/mL: treatment of apnea and bradycardia of prematurity

Contraindications

· Contraindicated with hypersensitivity to any xanthines, peptic ulcer, active gastritis, pregnancy (neonatal tachycardia, jitteriness, and withdrawal apnea), underlying seizure disorders (unless receiving appropriate anticonvulsant medication).

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

Proteinuria, increased excretion of renal tubular cells and RBCs; diuresis (dehydration), urinary retention in men with prostate enlargement

Tachypnea, respiratory arrest

Drug Interactions:

· Increased effects and toxicity with cimetidine, erythromycin, troleandomycin, ciprofloxacin, norfloxacin, ofloxacin, hormonal contraceptives, ticlopidine, ranitidine

· Possibly increased effects with rifampin

· Increased serum levels and risk of toxicity in hypothyroid patients, decreased levels in patients who are hyperthyroid; monitor patients on thioamines, thyroid hormones for changes in serum levels as patients become euthyroid

· Increased cardiac toxicity with halothane

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

· Decreased effects with barbiturates, charcoal

· Decreased effects of phenytoins, benzodiazepines, and theophylline preparations

· Decreased effects of nondepolarizing neuromuscular blockers

· Mutually antagonistic effects of beta-blockers and theophylline preparations

Nursing considerations

· Caution patient not to chew or crush enteric-coated timed-release preparations.

· Give immediate release, liquid dosage forms with food if GI effects occur.

· Do not give timed-release preparations with food; these should be given on an empty stomach, 1 hr before or 2 hr after meals.

· Advise patients that this drug should not be used during pregnancy; use of barrier contraceptives is recommended.

· Monitor results of serum theophylline level determinations carefully, and reduce dosage if serum levels exceed therapeutic range of 10–20 mcg/mL.

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

· Maintain diazepam on standby to treat seizures.