Podcast
Questions and Answers
Which of the following conditions is not a clinical indication for the use of theophylline?
Which of the following conditions is not a clinical indication for the use of theophylline?
Theophylline is considered a less-preferred alternative to which of the following drugs in the treatment of stable asthma?
Theophylline is considered a less-preferred alternative to which of the following drugs in the treatment of stable asthma?
The primary mechanism by which theophylline exerts its therapeutic effect in asthma and COPD is:
The primary mechanism by which theophylline exerts its therapeutic effect in asthma and COPD is:
Which of the following statements about theophylline in the treatment of COPD exacerbations is true?
Which of the following statements about theophylline in the treatment of COPD exacerbations is true?
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Which of the following statements about theophylline use in children is correct?
Which of the following statements about theophylline use in children is correct?
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Which of the following is a preferred treatment option for stable COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines?
Which of the following is a preferred treatment option for stable COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines?
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Which of the following is a historical use of theophylline that is no longer considered clinically relevant?
Which of the following is a historical use of theophylline that is no longer considered clinically relevant?
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In the management of apnea of prematurity, methylxanthines like theophylline are considered:
In the management of apnea of prematurity, methylxanthines like theophylline are considered:
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What is a significant advantage of caffeine citrate over theophylline?
What is a significant advantage of caffeine citrate over theophylline?
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Which of the following is NOT a physiological effect of xanthine agents?
Which of the following is NOT a physiological effect of xanthine agents?
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What was determined to be the optimal serum theophylline level for maximal bronchodilation in adults?
What was determined to be the optimal serum theophylline level for maximal bronchodilation in adults?
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How should theophylline dosages be managed in patients?
How should theophylline dosages be managed in patients?
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What is the mechanism of action proposed for xanthines like theophylline?
What is the mechanism of action proposed for xanthines like theophylline?
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At what serum level does theophylline begin to cause nausea?
At what serum level does theophylline begin to cause nausea?
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Which natural plant sources contain theobromine?
Which natural plant sources contain theobromine?
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What effect does theophylline have at serum levels between 30 to 40 mcg/mL?
What effect does theophylline have at serum levels between 30 to 40 mcg/mL?
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Flashcards
Theophylline
Theophylline
A xanthine used in asthma, COPD, and apnea of prematurity.
Clinical Uses of Theophylline
Clinical Uses of Theophylline
Management of asthma, COPD, and apnea of prematurity.
Use in Asthma
Use in Asthma
Sustained-release theophylline is a maintenance therapy for asthma in older children.
COPD Management
COPD Management
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Theophylline Toxicity
Theophylline Toxicity
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Use in Apnea of Prematurity
Use in Apnea of Prematurity
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Sustained-release Theophylline
Sustained-release Theophylline
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Bronchodilators in COPD
Bronchodilators in COPD
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Caffeine Citrate
Caffeine Citrate
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Xanthines
Xanthines
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Therapeutic Range of Theophylline
Therapeutic Range of Theophylline
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Effects of Theophylline Serum Levels
Effects of Theophylline Serum Levels
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Metabolism Variability
Metabolism Variability
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CNS Effects of Xanthines
CNS Effects of Xanthines
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Titration of Theophylline Doses
Titration of Theophylline Doses
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Study Notes
Xanthines Clinical Indications
- Theophylline is used to treat asthma, COPD, and apnea of prematurity in newborns.
- It has a weaker bronchodilating effect than beta2 agonists, but may improve ventilation by stimulating the ventilatory drive or strengthening the diaphragm.
- Theophylline is an alternative maintenance therapy for mild, persistent asthma in patients over 5 years old, combined with inhaled corticosteroids (a step 3 or higher approach).
- It's not recommended for children under 5 or acute asthma exacerbations.
- For stable COPD, inhaled bronchodilators are preferred but theophylline can be an alternative due to potential toxicity.
- Xanthines should not be used to treat COPD exacerbations.
- Intravenous aminophylline isn't superior to beta2 agonists and anticholinergics in COPD exacerbations.
- For apnea of prematurity, methylxanthines are first-line, with theophylline used largely but caffeine citrate (Cafcit) possibly preferred due to better CSF penetration and a higher therapeutic index.
- Caffeine citrate can be given intravenously or orally.
Xanthine Agents and Structure
- Theophylline is chemically related to xanthine (a uric acid precursor).
- Theophylline (1,3-dimethylxanthine), caffeine (1,3,7-trimethylxanthine), and theobromine are methylxanthines.
- These substances are alkaloids found in plants like coffee beans, kola nuts, tea leaves, and cocoa.
- General physiologic effects include CNS stimulation, cardiac muscle stimulation, diuresis, relaxation of bronchial, uterine, and vascular smooth muscle, and peripheral and coronary vasodilation, with cerebral vasoconstriction.
Mechanism of Action
- The exact mechanism of xanthines remains unclear.
- Antagonism of adenosine receptors is a potential partial mechanism.
Theophylline Dosing & Serum Levels
- Individual metabolism rates vary, requiring individualized dosing based on effectiveness, avoidance of side effects, and serum levels.
- Optimal serum theophylline level for bronchodilation in adults is 10-20 mcg/mL.
- No effects are seen below 5 mcg/mL, nausea occurs above 20 mcg/mL, cardiac arrhythmias above 30 mcg/mL, and seizures at 40-45 mcg/mL.
- Recommended serum levels for COPD management are 5-10 mcg/mL; 5-15 mcg/mL for asthma.
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Description
Test your knowledge on the clinical uses of xanthines, specifically theophylline, in treating conditions like asthma, COPD, and apnea in newborns. Understand the guidelines for use and the alternative therapies available. This quiz covers key indications and contraindications for xanthines in clinical practice.
