Bronchoconstriction: Methylxanthines (Nursing)

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.