Aminophylline

Aminophylline is used in the treatment of asthma (as a bronchodilator) and in chronic obstructive pulmonary disease. In acute bronchospasm, aminophylline should not be given by the intravenous route the oral route is preferred. Parenteral administration can cause pain and is not recommended. Aminophylline is used as a cosmetic to remove fat from the thigh.45 

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For many years oral xanthines, shown in Table 2, were the preferred first-line treatment for asthma in the United States, and if the aerosol and oral formulations of P2" go sts are considered separately, as they are in Table 1, this was still the case in 1989. Within this class of compounds theophylline (8), or one of its various salt forms, such as aminophylline [317-34-0] (theophylline ethylenediamine 2 l), have been the predominant agents. Theophylline, 1,3-dimethylxanthine [58-55-9], is but one member of a class of naturally occurring alkaloids. Two more common alkaloids are theobromine (9), isomeric with theophylline and the principal alkaloid in cacao beans, and caffeine, (10), 1,3,7-Trimethylxanthine [58-08-2], found in coffee and tea. 

Historically, the use of xanthines has been hampered by poor aqueous solubiUty, rapid but highly variable metaboHsm, and the existance of a low therapeutic index. SolubiUty problems were partially solved by the preparation of various salt forms, eg, aminophylline. However, it was since recognized that the added base in aminophylline only increases solubiUty by increasing pH and thus does not affect the rate of absorption from the gut (65). Thus, in more recent medical practice, theophylline is commonly dispensed in anhydrous form and aminophylline is only recommended for iv adrninistration. 

Xanthines such as caffeine (1)> theophylline (aminophylline) (2), and theobromine (3) are a class of alkaloids that occur in numerous plants. The CNS stimulant activity of aqueous infusions containing these compounds has been recognized since antiquity. This has, of course, led to widespread consumption of such well-known beverages as coffee (Coffea arabica), tea (Thea sinesis), mate, and cola beverages (in part Cola acuminata). The annual consumption of caffeine in the United States alone has been estimated to be in excess of a billion kilos. The pure compounds have found some use in the clinic as CNS stimulants. In addition, caffeine is widely used in conjunction with aspirin in various headache remedies. 

Examples of the xanthine derivatives (drag that stimulate the central nervous system [CNS] resulting in bronchodilation, also called methylxanthines) are theophylline and aminophylline. Additional information concerning the xanthine derivatives is found in the Summary Drag Table Bronchodilators. 

The nurse can give some of these drug (for example, aminophylline or theophylline) IV, either direct IV or as an IV infusion. When giving theophylline or aminophylline IV, the nurse monitors die patient for hypotension, cardiac arrhythmias, and tachycardia. If a bronchodilator is given IV, the nurse administers it through an infusion pump. The nurse checks die IV infusion site at frequent intervals because these patients may be extremely restless, and extravasation can occur. 

Which of the following laboratory exams would the nurse expect to be ordered for a patient taking aminophylline ... 

Mr. Potter, age 57 years, is admitted to the pulmonary unit in acute respiratory distress. The primary health care provider orders IV aminophylline. In developing a care plan for Mr. Potter, you select the nursing diagnosis Ineffective Airway Clearance. Suggest Jiursing interventions that would be most important in managing this problem. 

Opodex) wfm Campho-pneumine aminophylline (Merrell)-comb. wfm... 

Albumin, aminophylline, aspirin, heparin, insulin, metoclopramide, NSAIDs, muromonab-CD3 (OKT3), opiates, penicillins, propafenone, quinidine, senna, sulfonamide antimicrobials, and vancomycin... 

Abciximab, aminophylline, amiodarone, amrinone, aspirin, carbamazepine, chlorpromazine, danazol, diltiazem, eptifi-batide, heparin, histamine2-receptor antagonists, low molecular weight heparins, methyldopa, milrinone, procainamide, quinidine, quinine, NSAIDs, thiazide diuretics, ticlopidine, tirofiban, and valproic acid... 

Theophylline and aminophylline may produce bronchodilation by inhibition of phosphodiesterase (thereby increasing cyclic adenosine monophosphate levels), inhibition of calcium ion influx into smooth muscle, prostaglandin antagonism, stimulation of endogenous catecholamines, adenosine receptor antagonism, and inhibition of release of mediators from mast cells and leukocytes. 

Sustained-release theophylline preparations improve patient compliance and achieve more consistent serum concentrations than rapid-release theophylline and aminophylline preparations. Caution should be used in switching from one sustained-release preparation to another because there are considerable variations in sustained-release characteristics. 

Treat bronchospasm with a -agonist given intermittently or continuously, consider the use of aminophylline 5.6 mg/kg as an IV loading dose, given over 20 minutes, or to maintain a blood level of 8— 15 mcg/mL... 

This traditional diuretic is a double compound of theophylline (240) and ethylenediamine. When a solution of aminophylline was exposed to oxygen and daylight, it gave dimethylalloxan (241), N A -dimethyloxamide and ammonia [147]. 

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