M KISSOON
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Blog #3.1

30 Nov 2021, 01:00 Publicly Viewable
  • What are the therapeutic effects of theophylline in the treatment of bronchial asthma?
Theophylline provides anti inflammatory effects by inhibiting the adenosine receptors
  • What are the primary mechanisms according to which the therapeutic effects are evoked? What is the mechanistic connection with b2-agonists and antimuscarinic drugs? How would you describe the interaction with the b2-agonists molecular-pharmacologically?
The primary mechanism is the inhibition of phosphodiesterase that prevents the conversion of camp to Amp that promotes smooth muscle contraction. B2 agonists are used together with Theophylline to provide relief from chronic asthma as they both promote bronchodilation
  • On which other systems in the body do the methylxanthines have an effect?  Where do you see the potential for undesirable side-effects and possibly also for other therapeutic applications of these side-effects?  Place special emphasis on the central and skeletal muscle effects.
Cns, CVS, GIT, Renal and skeletal muscles. Undesirable effects may occur in GIT in form of gastric acid and digestive enzyme secretions. The therapeutic applications are with COPD and the skeletal muscles that promote diaphragm ventilation. 
  • What can you say about serious toxicities and the therapeutic index of theophylline?  How can the plasma levels of theophylline be influenced by pharmacokinetic drug interactions?  With which drugs can it be clinically important and why?
It has a small therepeutic index. Above 20 ug/ml undesirable effects may occur. Plasma levels are affected by age and have reduce clearance in neonates. It can be clinically important with B2 agonists LABA to relieve asthmatic conditions. 
  • How is theophylline administered?  What are the advantages of the slow-release forms? 
Theophylline can be administered orally and the slow release forms can help relieve chronic asthma
  • You have a patient who uses theophylline for the treatment of chronic asthma.  Your patient, however, develops a cold leading to a worsening of asthma.  After a week your patient develops a secondary bacterial infection and the doctor prescribes a penicillin antibiotic.  You are an alert pharmacist and quickly detect that your patient is allergic to penicillin.  You phone the doctor who suggests that you must rather give erythromycin antibiotic.  Do you think it is a good idea?  Assume your patient has developed a genitor-urinary tract infection, do you think it is a good idea to use ciprofloxacin?  And if she has a problem with heartburn, are there drugs that you should be careful to recommend?  Make use of your SAMF in considering the case.
  • No, because theophylline can help prevent anti inflammatory effects, but can affect renal. It can cause diuresis which could contraindication the patients health urinary tract infections. We should becareful to prescribe drugs such as propranolol, erythromycin, antifungal, antibiotics etc since these can can contraindicated his conditions.