theophylline Nursing Considerations & Management

 Drug Name

Generic Name :  theophylline

Brand Name:

  • Immediate-release capsules, tablets: Bronkodyl, Elixophyllin, Quibron-T Dividose, Slo-Phyllin
  • Timed-release capsules: Slo-Bid Gyrocaps, Theo-24
  • Timed-release tablets: Quibron-T/SR Dividose, Theochron, Theolair-SR, T-Phyl, Uniphyl
  • Liquids: Accurbron, Asmalix, Elixomin, Elixophyllin, Lanophyllin, Slo-Phyllin

Classification: Bronchodilator, Xanthine

Pregnancy Category C 

Therapeutic actions
  • Theophylline competitively blocks phosphodiesterase which increases cAMP tissue concentrations causing bronchodilatation, diuresis, CNS and cardiac stimulation, and gastric acid secretion.
Indications
  • Symptomatic relief or prevention of bronchial asthma and reversible bronchospasm associated with chronic bronchitis and emphysema
  • Unlabeled use of 2 mg/kg/day to maintain serum concentrations between 3 and 5 mcg/mL: Treatment of apnea and bradycardia of prematurity
Adverse effects
  • Nausea, vomiting, abdominal pain, diarrhea, headache, insomnia, dizziness, anxiety, restlessness, tremor, palpitations.
  • Potentially Fatal: Convulsions, cardiac arrhythmias, hypotension and sudden death after too rapid IV injection
Contraindications
  • Hypersensitivity to xanthine derivatives, porphyria.
Nursing considerations
Assessment
  • History: Hypersensitivity to any xanthines; peptic ulcer, active gastritis; status asthmaticus; cardiac arrhythmias, acute myocardial injury, CHF, cor pulmonale; severe hypertension; severe hypoxemia; renal or hepatic disease; hyperthyroidism; pregnancy, lactation
  • Physical: Skin color, texture, lesions; reflexes, bilateral grip strength, affect; P, auscultation, BP, perfusion; R, adventitious sounds; bowel sounds, normal output; frequency, voiding pattern, normal urinary output; ECG; EEG; LFTs, renal and thyroid function tests
Interventions
  • Caution patient not to chew or crush enteric-coated timed-release preparations.
  • Give immediate release, liquid dosage forms with food if GI effects occur.
  • Do not give timed-release preparations with food; these should be given on an empty stomach, 1 hr before or 2 hr after meals.
  • Advise patients that this drug should not be used during pregnancy; using barrier contraceptives is recommended.
  • WARNING: Monitor results of serum theophylline level determinations carefully, and reduce dosage if serum levels exceed therapeutic range of 10–15 mcg/mL.
  • Monitor carefully for clinical signs of adverse effects, particularly if serum theophylline levels are not available.
  •  WARNING: Keep diazepam readily available to treat seizures.
Teaching points
  • Take this drug exactly as prescribed. If a timed-release product is prescribed, take it on an empty stomach, 1 hour before or 2 hours after meals. Do not chew or crush timed-release preparations; it may be necessary for you to take this drug around-the-clock for adequate control of asthma attacks.
  • Avoid excessive intake of coffee, tea, cocoa, cola beverages, and chocolate. These contain theophylline-related substances that may increase your side effects.
  • Smoking cigarettes or other tobacco products may markedly influence the effects of theophylline. It is preferable not to smoke while you are taking this drug. Notify your health care provider if you change your smoking habits while you are taking this drug; it may be necessary to change your drug dosage.
  • Have frequent blood tests to monitor drug effects and ensure safe and effective dosage.
  • Do not use this drug during pregnancy; using barrier contraceptives is advised.
  • You may experience these side effects: Nausea, loss of appetite (take drug with food if taking immediate-release or liquid dosage forms); difficulty sleeping, depression, emotional lability.
  • Report nausea, vomiting, severe GI pain, restlessness, seizures, irregular heartbeat.