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“Nursing Notes and Community”
Drug Name Dosages Therapeutic Indications Adverse effects Contraindicatio Nursing
Actions ns considerations
aminophylline  Individualize dosage: Base  Relaxes  Symptomatic  Serum  Contraindicate Assessment
(theophylline adjustments on clinical responses; bronchial relief or theophyllin d with  History:
ethylenediamin monitor serum theophylline levels; smooth prevention of e levels < hypersensitivit Hypersensitivity
e) maintain therapeutic range of 10–20 muscle, bronchial 20 mcg/mL: y to any to any xanthine
(am in off' i lin) mcg/mL; base dosage on lean body causing asthma and Adverse xanthine or to or to
Truphylline mass; 127 mg aminophylline dihydrate bronchodilatio reversible effects ethylenediami ethylenediamine
= 100 mg theophylline anhydrous. n and bronchospas uncommon ne, peptic , peptic ulcer,
Pregnancy increasing vital m associated ulcer, active active gastritis,
Category C ADULTS capacity, with chronic  Serum gastritis; rectal cardiac
which has bronchitis theophyllin or colonic arrhythmias,
    Drug classes Oral been impaired and e levels > irritation or acute
 Bronchodilator  Acute symptoms requiring rapid by emphysema 20–25 infection (use myocardial
 Xanthine bronchospasm mcg/mL: rectal injury, CHF, cor
theophyllinization in patients not  Unlabeled Nausea,
and air preparations). pulmonale,
receiving theophylline: An initial trapping; in uses: vomiting, severe
loading dose is required, as indicated higher Respiratory diarrhea,  Use cautiously hypertension,
below: concentrations stimulant in headache, with cardiac severe
, it also inhibits Cheyne- insomnia, arrhythmias, hypoxemia,
the release of Stokes irritability acute renal or hepatic
 Patient  Loa  Followed  Mainten
Group ding by ance slow-reacting respiration; (75% of myocardial disease,
substance of treatment of patients) injury, CHF, hyperthyroidism
 7.6  3.8 mg/kg  3.8
 Young adult
mg/k q 4 hr × 3 mg/kg q 6 anaphylaxis apnea and cor pulmonale, , alcoholism,
smokers
g doses hr (SRS-A) and bradycardia  Serum severe labor, lactation,
 Adult histamine. in premature theophyllin hypertension, rectal or colonic
nonsmokers  7.6  3.8 mg/kg  3.8 babies e levels > severe irritation or
who are mg/k q 6 hr × 2 mg/kg q 8 30–35 hypoxemia, infection
otherwise g doses hr mcg/mL: renal or
healthy
(aminophylline
Hyperglyce hepatic rectal
*Expressed as aminophylline mia, disease, preparations)
 Long-term therapy: Usual range is hypotension, hyperthyroidis  Physical: Bowel
600–1,600 mg/day PO in three to four cardiac m, alcoholism, sounds, normal
divided doses. arrhythmias, labor, output; P,
seizures, lactation, auscultation,
Rectal tachycardia pregnancy. BP, perfusion,
 500 mg q 6–8 hr by rectal suppository (> 10 ECG; R,
or retention enema. mcg/mL in adventitious
premature sounds;
PEDIATRIC PATIENTS newborns); frequency of
brain urination,
Children are very sensitive to CNS damage voiding, normal
stimulant action of theophylline; use output pattern,
 CNS: urinalysis, LFTs,
caution in younger children unable to
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complain of minor side effects. Irritability renal function
 < 6 mo: Not recommended. (especially tests; liver
 < 6 yr: Use of timed-release children); palpation;
products not recommended. restlessness thyroid function
, dizziness, tests; skin color,
Oral muscle texture, lesions;
twitching, reflexes,
 Acute therapy: For acute
seizures, bilateral grip
symptoms requiring rapid severe strength, affect,
theophyllinization in patients not depression, EEG
receiving theophylline, a loading stammering
dose is required. speech; Interventions
Recommendations are as follows: abnormal  Administer to
behavior pregnant
characterize patients only
 Patient  Followed d by
Group
 Loading
by
 Maintenance when clearly
withdrawal, needed—
mutism, and neonatal
 5.1 mg/kg
 Children 6  7.6
q 4 hr × 3
 5.1 mg/kg q 6 unresponsiv tachycardia,
mo–9 yr mg/kg hr eness
doses jitteriness, and
alternating withdrawal
 Children  7.6
 3.8 mg/kg
 3.8 mg/kg q 6
with apnea observed
q 4 hr × 3 hyperactive
9–16 yr mg/kg
doses
hr when mothers
periods received
 Long-term therapy: 20.3 mg/kg or xanthines up
508 mg/day (immediate-release)  CV: until delivery.
or 15.2 mg/kg or 508 mg/day Palpitations,  Caution patient
sinus not to chew or
(extended-release) PO; slow tachycardia,
clinical adjustment of the oral crush enteric-
ventricular coated timed-
preparations is preferred; tachycardia, release forms.
monitor clinical response and life-
serum theophylline levels. In the threatening  Give immediate-
absence of serum levels, adjust ventricular release, liquid
arrhythmias, dosage forms
up to the maximum dosage circulatory
shown below, providing the with food if GI
failure effects occur.
dosage is tolerated.
 GI: Loss of  Do not give
appetite, timed-release
 Age  Maximum Daily Dose hematemesi forms with food;
 < 9 yr  30.4 mg/kg/day s, epigastric these should be
pain, given on an
 9–12 yr  25.3 mg/kg/day gastroesoph empty stomach
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 12–16 yr  22.8 mg/kg/day ageal reflux 1 hr before or 2
during sleep, hr after meals.
 16.5 mg/kg/day or 1,100 increased
 > 16 yr
mg, whichever is less AST  Maintain
adequate
*Expressed as aminophylline  GU: hydration.
Proteinuria,
increased  Monitor results
excretion of of serum
renal tubular theophylline
cells and levels carefully,
RBCs; and arrange for
diuresis reduced dosage
(dehydration if serum levels
), urinary exceed
retention in therapeutic
men with range of 10–20
prostate mcg/mL.
enlargement
 Take serum
 Respiratory samples to
: determine peak
Tachypnea, theophylline
respiratory concentration
arrest drawn 15–30
min after an IV
 Other: loading dose.
Fever,
flushing,  Monitor for
hyperglycem clinical signs of
ia, SIADH, adverse effects,
rash particularly if
serum
theophylline
levels are not
available.

 Ensure that
diazepam is
readily available
to treat
seizures.

Teaching points
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 Take this drug
exactly as
prescribed; if a
timed-release
product is
prescribed, take
this drug on an
empty stomach,
1 hour before or
2 hours after
meals.
 Do not to chew
or crush timed-
release
preparations.

 Administer
rectal solution
or suppositories
after emptying
the rectum.

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

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

 Smoking
cigarettes or
other tobacco
products
impacts the
drug's
effectiveness.
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Try not to
smoke. Notify
your health care
provider if
smoking habits
change while
taking this drug.

 Frequent blood
tests may be
necessary to
monitor the
effect of this
drug and to
ensure safe and
effective
dosage; keep all
appointments
for blood tests
and other
monitoring.

 You may
experience
these side
effects: Nausea,
loss of appetite
(taking this drug
with food may
help if taking the
immediate-
release or liquid
dosage forms);
difficulty
sleeping,
depression,
emotional
lability
(reversible).

 Report nausea,
vomiting, severe
GI pain,
restlessness,
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seizures,
irregular
heartbeat.

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