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Theophylline (Theo-24)

Tee-off-feline
Picmonic
Theophylline (Theo-24) is a methylxanthine that causes CNS stimulation and bronchial smooth muscle relaxation. This medication is used in the treatment of asthma. Side effects include insomnia, restlessness, arrhythmias, and seizures. Since this drug has a narrow therapeutic range, it is important to monitor the patient's plasma levels. Instruct the patient to notify the health care provider about current medication use, since many drugs increase or decrease the effects of theophylline.
8 KEY FACTS
MECHANISM
Bronchial Smooth Muscle Relaxation
Broccoli Smooth Muscle Smoothie Relaxing

As an effective bronchodilator, theophylline causes relaxation of bronchial smooth muscle by blocking adenosine receptors. This action decreases airway resistance and increases airflow to the lungs.

INDICATIONS
Asthma
Asthma-inhaler

Oral theophylline decreases the frequency and severity of asthma attacks and is indicated as maintenance therapy for chronic asthma. This drug's long duration of action in the sustained release form makes it an appropriate medication for patients with nocturnal attacks. Although intravenous theophylline is available, this route is used only in emergencies due to the risk of fatal cardiovascular reactions.

SIDE EFFECTS
Insomnia
Taped-awake-insomniac

Since this medication causes CNS stimulation, an elevated theophylline blood level between 20-25 mcg/mL may cause insomnia.

Restlessness
Restlessness-wrestler

A theophylline blood level between 20-25 mcg/mL may cause restlessness. Avoid giving theophylline with caffeine to prevent excess CNS excitation that may exacerbate the restlessness.

Arrhythmias
Broken Arrhythmia-drum

Theophylline toxicity, which typically presents with drug plasma levels about 30 mcg/mL, may cause arrhythmias such as ventricular fibrillation. Administering lidocaine (see Picmonic "Lidocaine") may help control severe cardiac dysrhythmias.

Seizures
Caesar

Theophylline toxicity, which typically presents with drug plasma levels about 30 mcg/mL, may cause seizures. Administering IV diazepam may help decrease seizure activity.

CONSIDERATIONS
Narrow Therapeutic Range
Narrow Therapeutic-massage Range

Since theophylline has a narrow therapeutic range, the dosage of this drug must be carefully managed in relation to the patient's plasma levels. If the patient presents with symptoms indicating a mild reaction (i.e., nausea, vomiting, diarrhea, insomnia, and restlessness), the medication should be stopped immediately before more serious symptoms associated with toxicity occur (i.e., ventricular fibrillation, convulsions). Drugs such as phenobarbital, phenytoin, and rifampin decrease the effects of theophylline by inducing hepatic drug-metabolizing enzyme production. Medications such as cimetidine and ciprofloxacin inhibit hepatic function and cause increased theophylline plasma levels.

Monitor Plasma Levels
Monitor and Plasma-TV

Monitoring theophylline plasma levels is necessary to ensure therapeutic effects and avoid toxicity. Most patients tolerate theophylline blood levels between 5-15 mcg/mL. Theophylline plasma levels of  20-25 mcg/mL may cause mild reactions, while a blood level above 30 mcg/mL may lead to severe adverse effects.

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