7/29/2019 Amino Phyl Line in Table Format

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DRUG STUDY

Drug Name Dosages Therapeutic

Actions

Indications Adverse effects Contraindications Nursing considerations

aminophylline

(theophylline

ethylenediami

ne)

(am in off' i lin)

Truphylline

Pregnancy

Category C

Drug classes

Bronchodilator

Xanthine

Individualize dosage: Baseadjustments 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 theophyllineanhydrous.

ADULTS

Oral

Acute symptoms requiring rapidtheophyllinization in patients not

receiving theophylline: An initial

loading dose is required, as

indicated below:

PatientGroup

Loading

Followedby

Maintenance

Youngadultsmokers

7.6mg/kg

3.8mg/kg q4 hr 3doses

3.8mg/kg q6 hr

Adultnonsmokers

who areotherwisehealthy

7.6

mg/kg

3.8mg/kg q6 hr 2

doses

3.8

mg/kg q8 hr

*Expressed as aminophylline

Long-term therapy: Usual range is6001,600 mg/day PO in three to

four divided doses.

Rectal

500 mg q 68 hr by rectalsuppository 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

Relaxes bronchial

smooth muscle,

causing

bronchodilation

and increasing

vital capacity,

which has been

impaired by

bronchospasm

and air trapping;

in higherconcentrations, it

also inhibits the

release of slow-

reacting

substance of

anaphylaxis (SRS-

A) and histamine.

Symptomatic reliefor prevention of

bronchial asthma

and reversible

bronchospasm

associated with

chronic bronchitis

and emphysema

Unlabeled uses:Respiratory

stimulant inCheyne-Stokes

respiration;

treatment of

apnea and

bradycardia in

premature babies

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 (especiallychildren); restlessness,

dizziness, muscle twitching,

seizures, severe depression,

stammering speech;

abnormal behavior

characterized by

withdrawal, mutism, and

unresponsiveness

alternating with

hyperactive periods

CV: Palpitations, sinustachycardia, ventricular

tachycardia, life-

threatening ventricular

arrhythmias, circulatory

failure

GI: Loss of appetite,hematemesis, epigastric

pain, gastroesophageal

reflux during sleep,

increased AST

GU: Proteinuria, increasedexcretion 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

Contraindicated withhypersensitivity to any xanthine or

to ethylenediamine, peptic ulcer,

active gastritis; rectal or colonic

irritation or infection (use rectal

preparations).

Use cautiously with cardiacarrhythmias, acute myocardial

injury, CHF, cor pulmonale, severe

hypertension, severe hypoxemia,

renal or hepatic disease,hyperthyroidism, alcoholism, labor,

lactation, pregnancy.

Assessment

History: Hypersensitivity to any xanthine or toethylenediamine, peptic ulcer, active gastritis

arrhythmias, acute myocardial injury, CHF, co

pulmonale, severe hypertension, severe hypo

renal or hepatic disease, hyperthyroidism, alc

labor, lactation, rectal or colonic irritation or in

(aminophylline rectal preparations)

Physical: Bowel sounds, normal output; P, auscBP, perfusion, ECG; R, adventitious sounds; freof urination, voiding, normal output pattern, u

LFTs, renal function tests; l iver palpation; thyro

function tests; skin color, texture, lesions; reflex

bilateral grip strength, affect, EEG

Interventions

Administer to pregnant patients only when cleneededneonatal tachycardia, jitteriness, an

withdrawal apnea observed when mothers re

xanthines up until delivery.

Caution patient not to chew or crush enteric-timed-release forms.

Give immediate-release, liquid dosage forms wif GI effects occur.

Do not give timed-release forms with food; thebe given on an empty stomach 1 hr before ormeals.

Maintain adequate hydration. Monitor results of serum theophylline levels ca

and arrange for reduced dosage if serum leve

exceed therapeutic range of 1020 mcg/mL.

Take serum samples to determine peak theopconcentration drawn 1530 min after an IV loa

dose.

Monitor for clinical signs of adverse effects, paif serum theophylline levels are not available.

Ensure that diazepam is readily available to trseizures.

Teaching points

Take this drug exactly as prescribed; if a timedproduct is prescribed, take this drug on an emstomach, 1 hour before or 2 hours after meals

Do not to chew or crush timed-release prepar Administer rectal solution or suppositories afte

emptying the rectum.

It may be necessary to take this drug around-for adequate control of asthma attacks.

Avoid excessive intake of coffee, tea, cocoa,beverages, and chocolate.

7/29/2019 Amino Phyl Line in Table Format

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DRUG STUDY

Acute therapy: For acutesymptoms requiring rapid

theophyllinization in patients

not receiving theophylline, a

loading dose is required.

Recommendations are as

follows:

PatientGroup

LoadingFollowedby

Maintenance

Children 6mo9 yr

7.6mg/kg

5.1 mg/kgq 4 hr 3

doses

5.1 mg/kg q6 hr

Children916 yr

7.6mg/kg

3.8 mg/kgq 4 hr 3doses

3.8 mg/kg q6 hr

Long-term therapy: 20.3 mg/kgor 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.

Age Maximum Daily Dose

< 9 yr 30.4 mg/kg/day

912 yr 25.3 mg/kg/day

1216 yr 22.8 mg/kg/day

> 16 yr16.5 mg/kg/day or

1,100 mg, whichever isless

*Expressed as aminophylline

Smoking cigarettes or other tobacco productthe drug's effectiveness. Try not to smoke. Not

health care provider if smoking habits change

taking this drug.

Frequent blood tests may be necessary to moeffect of this drug and to ensure safe and effe

dosage; keep all appointments for blood tests

other monitoring.

You may experience these side effects: Nauseappetite (taking this drug with food may help

the immediate-release or li quid dosage forms

difficulty sleeping, depression, emotional labili

(reversible). Report nausea, vomiting, severe GI pain, restle

seizures, irregular heartbeat.