Podcast
Questions and Answers
Which of the following is NOT a known effect of xanthines on the body?
Which of the following is NOT a known effect of xanthines on the body?
- Cardiac muscle stimulation
- CNS stimulation
- Smooth muscle contraction (correct)
- Cerebral vasoconstriction
While the exact mechanism of action of xanthines is not fully understood, they are known to have what effect?
While the exact mechanism of action of xanthines is not fully understood, they are known to have what effect?
- Depress ventilatory drive
- Stimulate ventilatory drive (correct)
- Weaken the diaphragm
- Cause bronchoconstriction
According to the information provided, for which condition is theophylline recommended as an alternative treatment option?
According to the information provided, for which condition is theophylline recommended as an alternative treatment option?
- Apnea of prematurity in neonates
- Acute asthma exacerbations
- Mild, persistent asthma (correct)
- Acute COPD exacerbations
Why might caffeine citrate be preferred over theophylline in treating apnea of prematurity?
Why might caffeine citrate be preferred over theophylline in treating apnea of prematurity?
Which of the following statements regarding theophylline dosing is MOST accurate?
Which of the following statements regarding theophylline dosing is MOST accurate?
A patient with COPD is prescribed theophylline. Which of the following should the respiratory therapist consider?
A patient with COPD is prescribed theophylline. Which of the following should the respiratory therapist consider?
A physician is considering prescribing theophylline for a 6-year-old patient with mild, persistent asthma. What factor should the physician consider before prescribing this medication??
A physician is considering prescribing theophylline for a 6-year-old patient with mild, persistent asthma. What factor should the physician consider before prescribing this medication??
Of the following, which is a source of the methylxanthine theobromine?
Of the following, which is a source of the methylxanthine theobromine?
A patient with COPD is prescribed theophylline. What is the target therapeutic range for serum theophylline levels in this patient?
A patient with COPD is prescribed theophylline. What is the target therapeutic range for serum theophylline levels in this patient?
When should serum drug levels be measured after administering an immediate-release theophylline formulation to assess peak absorption?
When should serum drug levels be measured after administering an immediate-release theophylline formulation to assess peak absorption?
A patient taking theophylline reports experiencing nausea. According to the provided information, at what approximate serum theophylline level does nausea typically occur?
A patient taking theophylline reports experiencing nausea. According to the provided information, at what approximate serum theophylline level does nausea typically occur?
Which factor would most likely lead to decreased theophylline levels in a patient taking the drug?
Which factor would most likely lead to decreased theophylline levels in a patient taking the drug?
A patient is prescribed theophylline in addition to a β-agonist. What potential interaction should the clinician be aware of?
A patient is prescribed theophylline in addition to a β-agonist. What potential interaction should the clinician be aware of?
A patient with a history of peptic ulcers is being considered for theophylline therapy. What common side effect of theophylline should be of particular concern in this patient?
A patient with a history of peptic ulcers is being considered for theophylline therapy. What common side effect of theophylline should be of particular concern in this patient?
In which of the following clinical scenarios is the use of theophylline for asthma most appropriate, according to the provided information?
In which of the following clinical scenarios is the use of theophylline for asthma most appropriate, according to the provided information?
You are monitoring a patient on sustained-release theophylline. When should you draw blood to check peak drug levels, relative to their morning dose?
You are monitoring a patient on sustained-release theophylline. When should you draw blood to check peak drug levels, relative to their morning dose?
Flashcards
High Theophylline Levels
High Theophylline Levels
Linked to nausea at 20 μg/mL, cardiac arrhythmias above 30 μg/mL, and seizures at 40-45 μg/mL.
Titration Methods
Titration Methods
Titrate by patient's clinical response and measuring serum drug levels.
Theophylline Peak Absorption
Theophylline Peak Absorption
1-2 hours post-dose for immediate release; 5-9 hours post-morning dose for sustained release.
Theophylline Therapeutic Margin
Theophylline Therapeutic Margin
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Common Side Effects
Common Side Effects
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Factors Affecting Activity
Factors Affecting Activity
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Conditions Increasing Levels
Conditions Increasing Levels
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Condition Decreasing Levels
Condition Decreasing Levels
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Effects of Xanthines
Effects of Xanthines
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Xanthines action
Xanthines action
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Theophylline Use
Theophylline Use
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Theophylline in COPD
Theophylline in COPD
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Xanthines for AOP
Xanthines for AOP
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Xanthine Sources
Xanthine Sources
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Theophylline Dosing
Theophylline Dosing
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Theophylline Salts
Theophylline Salts
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Study Notes
- Xanthines are used in respiratory therapy.
Effects and Mechanisms
- Xanthines induce cerebral vasoconstriction.
- They stimulate cardiac muscle, relax smooth muscle, and stimulate the CNS.
- The exact mechanism of action is unclear, despite bronchodilating effects, stimulating ventilatory drive and strengthening the diaphragm.
Clinical Uses
- Xanthines are used to treat COPD, apnea of prematurity, and asthma.
Use in Asthma
- Theophylline is used as maintenance therapy (step 2) or as an alternative in step 3 with ICS for mild, persistent asthma.
- Consider that side effects and a narrow therapeutic index may make it a poor choice versus other agents, especially for patients older than 5 years.
Use in COPD
- Theophylline is recommended by GOLD as an alternative to β2-agonists and anticholinergics.
- Do not use in acute exacerbations.
Use in Apnea of Prematurity (AOP)
- Xanthines are a first-line treatment.
- Theophylline was most extensively used in the past.
- Caffeine citrate may be a better choice due to a safer profile and higher therapeutic index.
Specific Xanthine Agents
- Xanthines are also known as methylxanthines.
- They are found as alkaloids in plants species.
- Theophylline is derived from tea leaves.
- Theobromine comes from cocoa seeds or beans.
- Caffeine is found in coffee beans, kola nuts, cocoa seeds and tea leaves.
Titrating Theophylline Doses
- Individuals metabolize theophylline at different rates, making it difficult to determine therapeutic doses.
- Anhydrous theophylline is 100% theophylline, salts of theophylline are not pure by weight.
Serum Levels and Titration
- <5 µg/mL: No effects seen
- 10 to 20 µg/mL: Therapeutic range
- >20 µg/mL: Nausea
- >30 µg/mL: Cardiac arrhythmias
- 40 to 45 µg/mL: Seizures
- Asthma: 5 to 15 µg/mL
- COPD: 5 to 10 µg/mL
- Titration methods include clinical reaction and serum drug levels.
- Check serum levels after 1–2 hours for immediate-release and 5–9 hours for sustained-release.
- Dosage should be guided by clinical reaction and measuring serum blood levels at peak absorption times.
Theophylline Toxicity and Side Effects
- Has a narrow therapeutic margin.
- Distressing side effects may occur at therapeutic levels.
- Inhaled theophylline is being studied.
- Common side effects include gastric upset (not recommended for patients with peptic ulcer or acute gastritis), headache, anxiety, nervousness, and diuresis.
Factors Affecting Theophylline Activity
- Conditions affecting the liver or kidneys can alter activity.
- Interactions with other drugs can occur.
- Conditions that increase theophylline levels include viral hepatitis and left ventricular failure.
- Smoking decreases theophylline levels.
- β-Agonists have an additive effect.
Clinical Use Considerations
- For Asthma, the use of Theophylline is debated.
- Theophylline use is only considered after other relievers and controllers have failed.
- For COPD, Theophylline is considered if ipratropium bromide and β2-agonists fail to provide control.
Nonbronchodilating Effects of Theophylline
- Increased force of respiratory muscle contractility
- Increased respiratory muscle endurance
- Increased ventilatory drive
- Cardiovascular effects: increasing cardiac output and decreasing pulmonary vascular resistance
- Has Anti-inflammatory effects
Apnea of Prematurity Treatment
- Xanthines are the first-line choice when nonpharmacological methods are unsuccessful.
- Caffeine citrate is preferred.
- The loading dose of caffeine citrate is 20 mg/kg.
- The daily maintenance dose is 5 mg/kg.
Respiratory Care Assessment
- Monitor pulmonary function studies.
- Educate patients regarding peak flow meters for asthma assessment
- Education to emphasize not treating underlying inflammation or prevent progression of asthma or COPD
- Assess serum blood levels for the agent being used.
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Description
Xanthines are a class of drugs used in respiratory therapy. They are used to treat conditions such as COPD, apnea of prematurity, and asthma. Theophylline is a Xanthine that is used as maintenance therapy for asthma and as an alternative to other drugs for COPD.
