Parmacon Ass Edt

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ASSIGNMENT: BRONCHODILATORS

OVER VIEW

Bronchodilators are class of medications that facilitate breathing by relaxing lung muscles
and widening the airways. They are often used to treat long term airway conditions like
asthma and chronic obstructive pulmonary diseases. They may be either long acting or
short acting. An example of a bronchodilator is:

Generic name: Theophylline

Trade name: Aminophylline

MECHANISM OF ACTION/PHARMACOKINETICS

This bronchodilator relaxes the smooth muscles located in the bronchial airways and
pulmonary blood vessels. It also reduces the airway responsiveness to histamine, adenosine,
methacholine, and allergens. It exerts these effects mainly through two distinct mechanisms:

 It acts as a competitive nonselective phosphodiesterase inhibitor (inhibiting type III


and type IV phosphodiesterase), which increases the concentration of intracellular
cAMP, activates protein kinase A, inhibits TNF-alpha, and leukotriene synthesis, and
also decreases inflammation and innate immunity.

 It is also a nonselective adenosine receptor antagonist. It acts on A1, A2, and A3


receptors with almost the same affinity, which possibly explains theophylline's
cardiac effects. Adenosine-mediated channels also increase the contraction force of
diaphragmatic muscles by enhancing their calcium uptake.

Aminophylline is rapidly and completely absorbed by the body and converted to


theophylline, up to 40% bound by albumin. The remaining unbound theophylline distributes
freely throughout the body except for body fat. The volume of distribution ranges from 0.3
to 0.7 L/kg.

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INDICATIONS: It’s indicated for the treatment of acute exacerbations of the symptoms and
reversible airflow obstruction associated with,

Asthma

Prevention of apnoea in infants

Chronic obstructive pulmonary diseases, e.g., emphysema and chronic bronchitis.

CONTRAINDICATIONS:
 Theophylline is contraindicated if the patient previously developed a hypersensitivity
reaction to the drug or any component of its formulation (such as an allergy to corn-
related products (in injection use only).
 Other contraindications include hypersensitivity to xanthine derivatives and patients
with coronary artery disease (where the cardiac stimulation effect
of theophylline might prove harmful).
SPECIAL CNCERN:

 Elderly patients: Theophylline use requires extreme caution in elderly patients as


these patients are at an increased risk of serious theophylline toxicity.  
 Paediatric patients: Dose selection requires caution, and regular monitoring of
concentrations is necessary (especially if the child is younger than 1 year of age) as
the rate of clearance varies significantly in these patients.

SIDE EFFECTS:

CNS: Headache, Insomnia, Tremors

Gastrointestinal: Nausea, Vomiting, Constipation

Cardiovascular: Irregular heartbeat, Rapid heart rate

Miscellaneous: High blood sugar, Seizure, Hypokalemia, Hyperglycemia, Polyuria,


Numbness, Muscle weakness, dry mouth, fruity breath.

DRUG INTERACTION:

 Ciprofloxacin slows theophylline clearance and elevates its serum concentration.


 If the patient previously developed a hypersensitivity reaction to the drug or any
component of its formulation.
 Zileuton can significantly increase theophylline levels

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 Anticonvulsants, such as phenytoin, carbamazepine
 Cimetidine
 Verapamil
 Propanolol

How it’s supplied: Capsule, extended release: 100mg, 200mg, 300mg, 400mg.

Tablet, extended release: 400mg, 600mg

Intravenous solution: 400mg in 250/500mls of D5%

800mg in 500mls of D5%

Dosage: Pediatric, 0.5 to 0.9mg/kg/hr IV

10-18mg/kg/day PO in divided doses. (6-12 months old)

5.6-8mg/kg PO (extended release) 8 hourly.

Adult, 0.4-0.6 mg/kg/hr IV OR 4.8-7.2 mg/kg PO (extended release).

Nursing considerations/Storage:

1. Avoid over the counter therapy unless instructed by the Doctor.


2. Caution patient not to chew or crush enteric-coated timed-release
preparations
3. Protect drug from light and moisture. Store at a temperature of about 15-30
degrees Celsius.

Assessment:

1. Assess client’s ability to tolerate medication


2. Document symptoms and indications of treatment
3. Monitor patient vital signs

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4. Monitor plasma drug level closely in patients with heart failure, kidney or liver
dysfunction, alcoholism, high fever. Plasma clearance of xanthines may be reduced.

Client/Family teaching:

 Take medication at the same time every day.


 Avoid charcoal-broiled foods (high in polycyclic carbon content); may increase
theophylline elimination and reduce the half-life as much as 50%.
 Limit caffeine intake because it may increase incidence of adverse effects.
 Cigarette smoking may significantly lower theophylline plasma concentration.
 Be aware that a low-carbohydrate, high-protein diet increases theophylline
elimination, and a high-carbohydrate, low-protein diet decreases it.
 Drink fluids liberally (2000–3000 mL/d) if not contraindicated to decrease viscosity
of airway secretions.
 Avoid self-dosing with OTC medications, especially cough suppressants, which may
cause retention of secretions and CNS depression.
 Breastfeeding mothers should nurse their infants before taking the medication, as it’s
distributed into breast milk.

Nursing Responsibilities

Before drug administration:

1. Assess patient’s ability to tolerate medication


2. Check patient’s respiratory pattern
3. Pass an intravenous line for IV administration
4. Teach patient about the therapeutic and adverse effect of the medication
5. Encourage patient to ask questions
6. Administer intranasal nasal oxygen through nasal prongs

During administration:

1. Administer iv medications very slowly within 15 to 20 minutes


2. Monitor patient’s respiratory pattern
3. Monitor patient’s pulse rate
4. Observe patient for signs of restlessness

After administration:

1. Monitor for the therapeutic and side effect of the drug

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2. Monitor patients vital signs especially blood pressure and respiration
3. Monitor for signs of relief of dyspnoea
4. Monitor cannula site to prevent infiltration

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