Chapter 8 Xanthines Flashcards

1
Q

Name two methylxanthines

A

theophylline and aminophylline

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2
Q

What are the clinical indications for using methylxanthines?

A

management of COPD and asthma;

apnea in prematurity

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3
Q

Would methylxanthines be your first choice of bronchodilator?

A

No. It is a 2nd or 3rd line agent. In asthma, it is relegated to 3rd line use (after all else)

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4
Q

What effect do methylxanthines have?

A

they increase ventilatory drive and strengthen the diaphragm which may improve flow

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5
Q

T/F methylxanthines have comparable bronchodilation as beta agents.

A

false

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6
Q

Theophylline sustained release is used as a long term controller to treat what?

A

stage 2 asthma patients and in stage 2 or moderate stage 3 COPD

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7
Q

T/F Theophylline is preferred to low dose inhaled steroids

A

false. low-dose inhaled steroids or cromolyn sodium is preferred

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8
Q

What is the route of administration of theophylline in COPD exacerbations?

A

IV- only when beta agonists and anticholinergics are inadequate

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9
Q

What are the contraindications for using theophylinne

A

do not use in patients with peptic ulcer or acute gastric diagnosis

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10
Q

What are the routes of admission for xanthine agents?

A

sustained release tablets; IV; rectal- CAN’T BE AEROSOLIZED

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11
Q

Where can naturally occurring xanthine be found?

A

coffee and cola
tea leaves- caffeine and theophylline
cocoa- caffeine and theobromide

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12
Q

Synthetic xanthine is packaged how?

A

aminophylline (theophylline salt)- mix of 79% theophylline and 21% suspension agent

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13
Q

what is the mode of action of xanthines?

A

inhibit phosphodiesterase

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14
Q

What are some general pharmacologic properties of xanthines?

A

CNS stimulation; Cardiac stimulation
diuresis; bronchial, uterine and vascular smooth muscle relaxation; peripheral and coronary vasodilation; cerebral vasoconstriction

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15
Q

What is the therapeutic dosing range of theophylline?

A

10-20 ug/ml

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16
Q

What is the dosage for COPD patients?

A

10-12 ug/ml

17
Q

What is the dosage for asthma patients?

A

5-15 ug/ml

18
Q

The therapeutic range of theophylline is best described as what?

A

narrow- it has many toxic side effects

19
Q

What are the CNS side effects

A

headache, anxiety, restlessness, insomnia, tremor, convulsions

20
Q

What are the gastrointestinal effects?

A

nausea, vomiting, loss of appetite, abdominal pain, diarrhea, hematemesis, GERD

21
Q

What are respiratory side effects?

A

tachypnea

22
Q

What are cardiovascular side effects?

A

palpitations, superventricular tachycardia, ventricular arrhythmias, hypotension

23
Q

What are renal system effects?

A

diuresis

24
Q

Theophylline is metabolized in the ___ and eliminated by the ___

A

liver, kidneys

25
Q

Many factors can increase or decrease blood levels of theophylline. List some common factors that can increase blood levels.

A

alcohol; beta blockers, corticosteroids, flu vaccine, calcium channel blockers, interferon

26
Q

List some of the factors that can decrease blood levels

A

beta agonists, barbituates, cigarette smoking, rifampin

27
Q

What is meant by narrow therapeutic margin?

A

the dose required to produce a therapeutic effect is close to the dose that begins to produce toxic side effects