BRONCHODILATO

RS

Overview of
bronchodilators
Description:
Drugs that reverse airway constriction
bronchodilation accurs with use of anticholinergic
agents,adrenergic agents,and methylxanthines.A course of
steroidsoften accompanies use of bronchodilators.
Action:
Methylxanthines relax bronchial smooth muscle by increasing
cyclic adenosine monophosphate(cAMP)production through
inhibitionof phosphodiesterase, an enzyme that breaksdown
Camp.
Indications:
Relief of reversible bronchospasm associated with acute and
chronic bronchial asthma,exercise induce
bronchospasm,bronchitis,emphysema,bronchiectasis or other
obstructive pulmonary diseases.

Overview of nursing management

Because of the CV side effects, monitor

cardiopulmonary status before the start of drug

therapy and periodically during therapy,paying
particular attention to the presence of persistent
respiratory wheezing,respiratory stridor,or
continued dyspnea and tachyarrhythmias.
In accordance with protocol,obtain blood samples
for analysis of drug toxicity(eg,theophylline
levels) to asses clients response to medication
and to detect stabilization or change despite
compliance with drug regimen.

 Assist the client to recognize and report signs of

deterioratingrespiratory status(eg, use of handheldpeak flow meters)

Teach the family and clients to recognize signs
signifying possible drug
toxicity(eg,nausea,vomiting,severe GI pain,irregular
heart rate,restlessness,tremorsconvulsion)
Evaluate the effectiveness of intervention using the
following criterias:(a) the clients does not experience
any deleterious effects from drug administration. (b)
tissueperfusion is maintained,as evidence by
improveoxygenation.

Methylxanthine bronchodilators
Are chemically related to the natural

metabolite xanthine , a precursor of uric

acid.they are also reffered to as the xanthines
or xanthines derivatives.
Because of their methyl attachments,these
agents are also reffered to as
methylxanthines.
These agents are found as alkaloids in plant
species.

Pharmacodynamics
/action
The mechanism by which xanthines exert their effects and

improve ventilation in cases of airway obstruction in

uncertain.
Although theophylline is usually classified as bronchodilator ,it
actually relative weak bronchodilating effect compared with
the beta against .its therapeutic action in asthma and chronic
obstructive pulmonary disease (COPD) may occur by other
means,such as stimulation of the ventilatory drive or direct
strengthening of the diaphragm.
Methylxanthine bronchodilators produce the following effects:
cerebral stimulation,skeletal muscle
stimulation,bronchodilation with increased vital
capacity,coronary vasodilation,cardiac stimulation and
diuresis.

Pharmacotherapeutics/indication
Symptomatic relief or prevention of bronchial

asthma and bronchospasm associated with

chronic bronchitis,emphysema, and other
COPD.
Unlabeled use: treatment of apnea and
bradycardia or prematurity(investigational
only)

Pharmacokenetics
Methylxanthines are well absorb from oral

liquids and from uncoated plain tablets.

Onset varies with the type of preparation
used.
Maximal plasma concentrates are reached 2
hours after absorption
Metabolism is in the liver.
Half-life is 3-15 hours(nonsmokers)or 4-5
hours(smokers).
Excretion is in the urine.

Contraindications/caution
s
Contra indicated in severe peptic ulcer,active

gastritis,and in clients whom myocardial

stimulation may prove dangerous.
Used with caution in clients with acute cardiac
disease,tachyarrhythmias, renal or hepatic
disease,seizure
disorder,hypertension,myocardial
damage,glaucoma and alcoholics.

interactions
Drug-drug interactions
Amphetamines,sympathomimetics:increased

CNS stimulation effects of these agents.

Cigarette and marijuana
smoking,aminoglutethimide(adrenal steroid
inhibitor),ketoconazole,phenytoin,phenobarbit
al.
Cimetidine,erythromycin,influenza virus
vaccine,oral
contraceptives,troleandomycin,clindamycin,lin
comycin:increase effect of methylxanthine.

 Drug-food interactions
Low-carbohydrates,high protein diet and

charcoal-broiledbeef: increased effects of

methylxanthines.
High-carbohydrate,low-protein diet:decreased
drug elimination.
Food may alter: bioavailability,absorption of
time-release theopylline preparations.

Side/adverse effects
CNS: restlessness,diziness,insomia,muscle

twitching,headache, reflex
hyperexcitability,depression,speech difficulties,tonic
and clonic convulsions.
CV:palpitations,tachycardia,flushing,hypotension,circul
atory failure.
GI:nausea,vomiting,hematemesis,gastric
reflux,diarrhea,intestinal bleeding,activation of ulcer
pain.
RENAL:diuresis,dehydration,protenuria.
OTHER:tachypnea,respiratory arrest,fever,and rectal
irritation.