Bronchoconstriction: Methylxanthines (Nursing)

by Prof. Lawes

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    00:00 Okay, now Methylxanthines.

    00:02 I told you that we used to use this a lot more but we don't really use this as much but they're still out there, so you need to know it.

    00:09 It causes bronchodilation by relaxing the smooth muscle but it also causes some pretty significant CNS excitation, it can also make you urinate a lot, diuresis, pulls off a lot of fluid and you have vasodilation.

    00:24 So, here's a lot of different options that go along with this.

    00:27 That's different than a LABA or a SABA because it's not hitting the beta-2 adrenergic agonist, that's not how the theophylline works.

    00:36 So usually there is an oral dose but it also can be give IV but we have to do a lot of monitoring for these types of medications and they're not as effective as beta-2 agonists.

    00:47 Now they will last longer, Methylxanthines will last longer than beta 2 agonist but they've got those drawbacks.

    00:54 You end up with the patient having this diuresis which may or may not be something we want.

    00:58 They have more significant CNS excitation and they're just not as effective.

    01:04 That narrow therapeutic window, that means that in the patient, if we drew lab from them, that we want them above 5 but below 15, otherwise we're gonna have toxicity issues.

    01:16 So you can see that these aren't as effective, they have some side effects that patients don't enjoy and we need to do lab monitoring for them.

    01:24 That's why they're not our best choice.

    01:26 However, everybody's body is different.

    01:30 So there's gonna be some patients that may not respond as well to other types of medications and will go back to this old school one.

    01:37 Every plan needs to be individualized for the patient.

    01:40 Now Theophylline is an example of a Methylxanthine but it has some serious toxic effects and I want you to be aware of what those are.

    01:48 But most likely, the patient's level, their blood level will be greater than 30.

    01:53 Remember that therapeutic index was 5 to 15, but once you get over 30, you're gonna see those serious toxicities.

    02:02 Remember it used to be standardized therapy but it's not our first choice anymore 'cause you wanna try something else.

    02:07 And methylxanthines are in the caffeine family.

    02:11 Now if you are watching this, in the United States, we usually overdose on caffeine particulary for those of us that are in school.

    02:19 So, because you already have that stimulation from being on a methylxanthine, you don't wanna add a lot of caffeine on top of it.

    02:27 These meds kinda make your patient kind of edgy when they're on them and caffeine will also exacerbate that and the diuretic effect.

    02:34 So you wanna educate your patients and this usually doesn't go over well.

    02:38 They like to try to limit their caffeine if possible.

    02:42 But we've got some serious coffee drinkers or even some soda drinkers that may really become an issue for you patient.

    02:49 Unless you explain to them that they will honestly feel better if they limit their caffeine while on this medications.

    About the Lecture

    The lecture Bronchoconstriction: Methylxanthines (Nursing) by Prof. Lawes is from the course Respiratory Medications (Nursing).

    Included Quiz Questions

    1. They require frequent monitoring for therapeutic levels
    2. They are very expensive for clients to receive
    3. They are highly addictive
    4. They are unreliable in treating the condition
    1. Caffeine
    2. Taurine
    3. Ginseng
    4. B vitamins

    Author of lecture Bronchoconstriction: Methylxanthines (Nursing)

     Prof. Lawes

    Prof. Lawes

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