1.Does theophylline have any CARDIAC or ANTI inflammatory effects on the human body?: YES
– INcreases CO
– DEcreases resistance
– INcreases myocardial perfusion in ischemic areas
INFLAMMATORY and BRONCHOPROTECTIVE – through inhibition of cAMP specific PDE3 and PDE4
2.For rapid theophyllization the Pt is given the drug by which ROUTE of administration?: ORAL – at 5 mg/kg if there the Pt has NOT taken any theophylline prior
– Anhydrous ONLY
– does NOT distribute into FATTY tissues
3.Increasing cAMP (cyclic Adneosine Methyl 3′, 5′ -Monophosphate) has WHAT effect on bronchial SM – RELAX or CONSTRICT?: RELAX
4.Is it POSSIBLE for theophylline OR other xanthinesto have an effect on endogenous CATECHOLAMINE production or release?: YES, theoretically, thereby causing:
– muscle tremors
– tachycardia
** – Bronchodilation
5.Is theophylline considered a STRONG or a WEAK PDE (Phosopho DiEsterase) inhibitor?: WEAK – at human clinical levels inhibiting PDE INCREASES cAMP activity, thereby RELAXING bronchial SM.
6.Name 3 factors that:
– INCREASE theophylline blood levels
– DECREASE theophylline blood levels: INCREASE – alchohol, Beta blocking agents, Ca channels blockers
DECREASES – Beta aginits, barbituates, cigarettes
7.What are the CLINICAL indications for using XANTHINES?: – OBSOLETE – Diuretic
– 2nd & 3rd line agents for Pt’s over 5 years of age for STABLE or ACUTE cases of asthma or COPD
– 1st line agents for PREMATURITY of APNEA
8.What are three general physiology effects in HUMANS of XANTHINES have?: – CNS stimulation
– Myocardial stimulation
– Diuresis
– Bronchial, uterine and vascular SM relaxation
– Peripheral & coronary vasodilation
– Cerebral vaso CONSTRICTION

 

9.What effect does ADENOSINE have when inhaled by asthmatic Pt’s?: – BRONCHOCONSTRICTION
– Theophylline is a POTENT inhibitor of A1 and A2 receptors and COULD (theoretically) BLOCK SM contraction mediated by A1 receptors.
10.What is the OPTIMAL SERUM level of theophylline? Is the theraputic range BROAD or NARROW and what are the side effects outside of this range?: – 10 – 20 ug/mL
– < 5 ug/mL – INEFFECTIVE
– > 20 ug/mL – NAUSEA
– > 30 ug/mL – Cardiac arrythmia
– > 40 ug/mL – Seizures
11.What is the peak absorption time for SERUM theophylline? WHY is this important?: – 1 to 2 hours
– MUST be monitored during the PEAK period in order to know the Pt’ s rate of metabolic absorption &, ergo, the dosage schedule and rate, etc.
12.What is theophylline?: A XANTHINE drug that is TRADITIONALLY used to treat Pt’s with asthma and COPD in STABLE and ACUTE phases.
– MECHANISM is UNCLEAR
– Used as a 2nd or 3rd line agents for adults
– 1st line agent for prematurity of apnea
13.WHERE in the human body is theophylline metabolized? How does liver function affect theoiphylline levels?: – LIVER
– Increases or decreases in liver function effects theophylline metabolism
– cigarette smoking STIULATEs liver enzymes and INCREASES methylxanthine metabolism
14.WHY is CAFFIENE citrate considered by Bhatia the agent of choice for APNEA of PREMATURITY?: – HIGHER theraputic index than THEOPHYLLINE
– Penetrates CF better
– Admin PO or IV
15.WHY must serum theophylline be TITRATED to be effective?: Because Pt’s metabolize theophyline at such varying rates and to avoid negative SE’s
– Doage range NOW – 5 – 10ug/mL
– titrated on a DOSAGE schedule
16.WHYS is theophylline NOT used as a 1st line agent?: – NARROW theraputic index – 10 – 20 ug/mL
– Minor bronchodilator & NOT as effective as beta agonists or anticholinergic as a bronchodilator