زائر
aminphyine (thephyine ethyenediamine)
(am in ff' i in)
Tphyine
Pegnany ategy
Dg asses
Bnhdiat
Xanthine
Theapeti atins
eaxes bnhia smth mse, asing bnhdiatin and ineasing vita apaity, whih has been impaied by bnhspasm and ai tapping; in highe nentatins, it as inhibits the eease f sw-eating sbstane f anaphyaxis (SS-A) and histamine.
Indiatins
· Symptmati eief peventin f bnhia asthma and evesibe bnhspasm assiated with hni bnhitis and emphysema
· nabeed ses: espiaty stimant in heyne-Stkes espiatin; teatment f apnea and badyadia in pemate babies
ntaindiatins and atins
· ntaindiated with hypesensitivity t any xanthine t ethyenediamine, pepti e, ative gastitis; eta ni iitatin infetin (se eta pepaatins).
· se atisy with adia ahythmias, ate myadia injy, HF, pmnae, sevee hypetensin, sevee hypxemia, ena hepati disease, hypethyidism, ahism, ab, atatin.
Avaiabe fms
Tabets--100, 200 mg; tabets--225 mg; iqid--105 mg5 m; injetin--250 mg10 m; sppsities--250, 500 mg
Dsages
Individaize dsage, base adjstments n inia espnses; mnit sem thephyine eves; maintain theapeti ange f 10–20 mgm; base dsage n ean bdy mass; 127 mg aminphyine dihydate = 100 mg thephyine anhyds.
ADTS
· Ate symptms eqiing apid thephyinizatin in patients nt eeiving thephyine: An initia ading dse is eqied, as indiated bew:
Patient Gp
a ading
Fwed by
Maintenane
Nn-smking adts wh ae thewise heathy
7.6 mgkg
3.8 mgkg q 4 h × 3 dses
3.8 mgkg q 6 h
Yng adt smkes
7.6 mgkg
3.8 mgkg q 6 h × 2 dses
3.8 mgkg q 8 h
· ng-tem theapy: sa ange is 600–1,600 mgday P in thee t f divided dses.
· eta: 500 mg q 6–8 h by eta sppsity etentin enema.
PEDIATI PATIENTS
se in hiden < 6 m nt emmended; se f timed-eease pdts in hiden < 6 y nt emmended. hiden ae vey sensitive t NS stimant atin f thephyine; se atin in ynge hiden wh annt mpain f min side effets.
· Ate theapy: F ate symptms eqiing apid thephyinizatin in patients nt eeiving thephyine, a ading dse is eqied. Dsage emmendatins ae as fws:
Patient Gp
a ading
Fwed by
Maintenane
hiden 6 m–9 y
7.6 mgkg
5.1 mgkg q 4 h × 3 dses
5.1 mgkg q 6 h
hiden 9–16 y
7.6 mgkg
3.8 mgkg q 4 h × 3 dses
3.8 mgkg q 6 h
· ng-tem theapy: 12 mgkg pe 24 h P; sw inia adjstment f the a pepaatins is pefeed; mnit inia espnse and sem thephyine eves. In the absene f sem eves, adjst p t the maximm dsage shwn bew, pviding the dsage is teated.
Age
Maximm Daiy Dse
< 9 y
30.4 mgkgday
9–12 y
25.3 mgkgday
12–16 y
22.8 mgkgday
> 16 y
16.5 mgkgday 1,100 mg, whiheve is ess
GEIATI PATIENTS IMPAIED ADTS
se atin, espeiay in edey men and in patients with pmnae, HF, ive disease (haf-ife f aminphyine may be makedy pnged in HF, ive disease). F ate symptms eqiing apid thephyinizatin in patients nt eeiving thephyine, a ading dse is neessay as fws:
Patient Gp
a ading
Fwed by
Maintenane
de patients and pmnae
7.6 mgkg
2.5 mgkg q 6 h × 2 dses
2.5 mgkg q 8 h
HF
7.6 mgkg
2.5 mgkg q 8 h × 2 dses
1.3–2.5 mgkg q 12 h
Phamakinetis
te
nset
Peak
Datin
a
1–6 h
4–6 h
6–8 h
IV
Immediate
30 min
4–8 h
Metabism: Hepati; T12: 3–15 h
Distibtin: sses paenta; passes int beast mik
Exetin: ine
IV fats
Pepaatin: May be infsed in 100–200 m f 5% dextse injetin 0.9% sdim hide injetin.
Infsin: D nt exeed 25 mgmin infsin ate. Sbstitte a theapy IV theapy as sn as pssibe; administe maintenane infsins in a age vme t deive the desied amnt f dg eah h.
Adt: 6 mgkg. F ate symptms eqiing apid thephyinizatin in patients eeiving thephyine: a ading dse is eqied. Eah 0.6 mgkg IV administeed as a ading dse wi est in abt a 1 mgm inease in sem thephyine. Ideay, defe ading dse nti sem thephyine deteminatin is made; thewise, base ading dse n inia jdgment and the knwedge that 3.2 mgkg aminphyine wi inease sem thephyine eves by abt 5 mgm and is nikey t ase danges advese effets if the patient is nt expeiening thephyine txiity befe this dse. Aminphyine IV maintenane infsin ates (mgkgh) ae given bew:
Patient Gp
Fist 12 h
Beynd 12 h
Yng adt smkes
1
0.8
Nnsmking adts thewise heathy
0.7
0.5
Pediati: Afte an IV ading dse, these maintenane ates (mgkgh) ae emmended:
Patient Gp
Fist 12 h
Beynd 12 h
hiden 6 m–9 y
1.2
1
hiden 9–16 y
1
0.8
Geiati: Afte a ading dse, these maintenane infsin ates (mgkgh) ae emmended:
Patient Gp
Fist 12 h
Beynd 12 h
the patients, pmnae
0.6
0.3
HF, ive disease
0.5
0.1–0.2
mpatibiity: Aminphyine is mpatibe with mst IV stins, bt d nt mix in stin with the dgs, inding vitamins.
Y-site inmpatibiity: dbtamine, hydaazine, ndansetn.
Advese effets
· Sem thephyine eves < 20 mgm: advese effets nmmn
· Sem thephyine eves > 20–25 mgm: nasea, vmiting, diahea, headahe, insmnia, iitabiity (75% f patients)
· Sem thephyine eves > 30–35 mgm: hypegyemia, hyptensin, adia ahythmias, tahyadia (> 10 mgm in pemate newbns); seizes, bain damage
· NS: Iitabiity (espeiay hiden); estessness, dizziness, mse twithing, nvsins, sevee depessin, stammeing speeh; abnma behavi haateized by withdawa, mtism, and nespnsiveness atenating with hypeative peids
· V: Papitatins, sins tahyadia, ventia tahyadia, ife-theatening ventia ahythmias, iaty faie
· GI: ss f appetite, hematemesis, epigasti pain, gastesphagea efx ding seep, ineased AST
· G: Pteinia, ineased exetin f ena tba es and Bs; diesis (dehydatin), inay etentin in men with pstate enagement
· espiaty: Tahypnea, espiaty aest
· the: Feve, fshing, hypegyemia, SIADH, ash
Inteatins
Dg-dg
· Ineased effets with imetidine, eythmyin, teandmyin, indamyin, inmyin, infenza vis vaine, a ntaeptives
· Pssiby ineased effets with thiabendaze, ifampin, apin
· Ineased adia txiity with hathane; ineased ikeihd f seizes when given with ketamine; ineased ikeihd f advese GI effets when given with tetayines
· Ineased deeased effets with fsemide, evthyxine, ithynine, itix, thygbin, thyid hmnes
· Deeased effets in patients wh ae igaette smkes (1–2 paks pe day); thephyine dsage may need t be ineased 50%–100%
· Deeased effets with phenbabita, amingtethimide
· Ineased effets, txiity f sympathmimetis (espeiay ephedine) with thephyine pepaatins
· Deeased effets f phenytin and thephyine pepaatins when given nmitanty
· Deeased effets f ithim abnate, nndepaizing nemsa bkes given with thephyine pepaatins
· Mtay antagnisti effets f beta-bkes and thephyine pepaatins
Dg-fd
· Eiminatin is ineased by a w-abhydate, high-ptein diet and by haa bied beef
· Eiminatin is deeased by a high-abhydate, w-ptein diet
· Fd may ate biavaiabiity and absptin f timed-eease thephyine pepaatins, asing txiity. These fms shd be taken n an empty stmah
Dg-ab test
· Intefeene with spetphtmeti deteminatins f sem thephyine eves by fsemide, phenybtazne, pbeneid, thebmine; ffee, tea, a beveages, hate, aetaminphen ase fasey high vaes
· Ateatin in assays f i aid, inay atehamines, pasma fee fatty aids by thephyine pepaatins
Nsing nsideatins
Assessment
· Histy: Hypesensitivity t any xanthine t ethyenediamine, pepti e, ative gastitis, adia ahythmias, ate myadia injy, HF, pmnae, sevee hypetensin, sevee hypxemia, ena hepati disease, hypethyidism, ahism, ab, atatin, eta ni iitatin infetin (aminphyine eta pepaatins)
· Physia: Bwe snds, nma tpt; P, astatin, BP, pefsin, EG; , adventitis snds; feqeny f inatin, viding, nma tpt patten, inaysis, ena fntin tests; ive papatin, ive fntin tests; thyid fntin tests; skin , texte, esins; efexes, biatea gip stength, affet, EEG
Inteventins
· Administe t pegnant patients ny when eay needed--nenata tahyadia, jitteiness, and withdawa apnea bseved when mthes eeived xanthines p nti deivey.
· atin patient nt t hew sh entei-ated timed-eease fms.
· Give immediate-eease, iqid dsage fms with fd if GI effets .
· D nt give timed-eease fms with fd; these shd be given n an empty stmah 1 h befe 2 h afte meas.
· Maintain adeqate hydatin.
· Mnit ests f sem thephyine eves aefy, and aange f eded dsage if sem eves exeed theapeti ange f 10–20 mgm.
· Take sem sampes t detemine peak thephyine nentatin dawn 15–30 min afte an IV ading dse.
· Mnit f inia signs f advese effets, patiay if sem thephyine eves ae nt avaiabe.
· Maintain diazepam n standby t teat seizes.
Teahing pints
· Take this dg exaty as pesibed; if a timed-eease pdt is pesibed, take this dg n an empty stmah, 1 h befe 2 h afte meas.
· D nt t hew sh timed-eease pepaatins.
· Administe eta stin sppsities afte emptying the etm.
· It may be neessay t take this dg and the k f adeqate nt f asthma attaks.
· Avid exessive intake f ffee, tea, a, a beveages, hate.
· Smking igaettes the tba pdts impats the dg's effetiveness. Ty nt t smke. Ntify the ae pvide if smking habits hange whie taking this dg.
· Be awae that feqent bd tests may be neessay t mnit the effet f this dg and t ense safe and effetive dsage; keep a appintments f bd tests and the mniting.
· These side effets may : nasea, ss f appetite (taking this dg with fd may hep if taking the immediate-eease iqid dsage fms); diffity seeping, depessin, emtina abiity (evesibe).
· ept nasea, vmiting, sevee GI pain, estessness, nvsins, iega heatbeat.
Advese effets in Itai ae mst mmn; thse in Bd ae ife-theatening.
(am in ff' i in)
Tphyine
Pegnany ategy
Dg asses
Bnhdiat
Xanthine
Theapeti atins
eaxes bnhia smth mse, asing bnhdiatin and ineasing vita apaity, whih has been impaied by bnhspasm and ai tapping; in highe nentatins, it as inhibits the eease f sw-eating sbstane f anaphyaxis (SS-A) and histamine.
Indiatins
· Symptmati eief peventin f bnhia asthma and evesibe bnhspasm assiated with hni bnhitis and emphysema
· nabeed ses: espiaty stimant in heyne-Stkes espiatin; teatment f apnea and badyadia in pemate babies
ntaindiatins and atins
· ntaindiated with hypesensitivity t any xanthine t ethyenediamine, pepti e, ative gastitis; eta ni iitatin infetin (se eta pepaatins).
· se atisy with adia ahythmias, ate myadia injy, HF, pmnae, sevee hypetensin, sevee hypxemia, ena hepati disease, hypethyidism, ahism, ab, atatin.
Avaiabe fms
Tabets--100, 200 mg; tabets--225 mg; iqid--105 mg5 m; injetin--250 mg10 m; sppsities--250, 500 mg
Dsages
Individaize dsage, base adjstments n inia espnses; mnit sem thephyine eves; maintain theapeti ange f 10–20 mgm; base dsage n ean bdy mass; 127 mg aminphyine dihydate = 100 mg thephyine anhyds.
ADTS
· Ate symptms eqiing apid thephyinizatin in patients nt eeiving thephyine: An initia ading dse is eqied, as indiated bew:
Patient Gp
a ading
Fwed by
Maintenane
Nn-smking adts wh ae thewise heathy
7.6 mgkg
3.8 mgkg q 4 h × 3 dses
3.8 mgkg q 6 h
Yng adt smkes
7.6 mgkg
3.8 mgkg q 6 h × 2 dses
3.8 mgkg q 8 h
· ng-tem theapy: sa ange is 600–1,600 mgday P in thee t f divided dses.
· eta: 500 mg q 6–8 h by eta sppsity etentin enema.
PEDIATI PATIENTS
se in hiden < 6 m nt emmended; se f timed-eease pdts in hiden < 6 y nt emmended. hiden ae vey sensitive t NS stimant atin f thephyine; se atin in ynge hiden wh annt mpain f min side effets.
· Ate theapy: F ate symptms eqiing apid thephyinizatin in patients nt eeiving thephyine, a ading dse is eqied. Dsage emmendatins ae as fws:
Patient Gp
a ading
Fwed by
Maintenane
hiden 6 m–9 y
7.6 mgkg
5.1 mgkg q 4 h × 3 dses
5.1 mgkg q 6 h
hiden 9–16 y
7.6 mgkg
3.8 mgkg q 4 h × 3 dses
3.8 mgkg q 6 h
· ng-tem theapy: 12 mgkg pe 24 h P; sw inia adjstment f the a pepaatins is pefeed; mnit inia espnse and sem thephyine eves. In the absene f sem eves, adjst p t the maximm dsage shwn bew, pviding the dsage is teated.
Age
Maximm Daiy Dse
< 9 y
30.4 mgkgday
9–12 y
25.3 mgkgday
12–16 y
22.8 mgkgday
> 16 y
16.5 mgkgday 1,100 mg, whiheve is ess
GEIATI PATIENTS IMPAIED ADTS
se atin, espeiay in edey men and in patients with pmnae, HF, ive disease (haf-ife f aminphyine may be makedy pnged in HF, ive disease). F ate symptms eqiing apid thephyinizatin in patients nt eeiving thephyine, a ading dse is neessay as fws:
Patient Gp
a ading
Fwed by
Maintenane
de patients and pmnae
7.6 mgkg
2.5 mgkg q 6 h × 2 dses
2.5 mgkg q 8 h
HF
7.6 mgkg
2.5 mgkg q 8 h × 2 dses
1.3–2.5 mgkg q 12 h
Phamakinetis
te
nset
Peak
Datin
a
1–6 h
4–6 h
6–8 h
IV
Immediate
30 min
4–8 h
Metabism: Hepati; T12: 3–15 h
Distibtin: sses paenta; passes int beast mik
Exetin: ine
IV fats
Pepaatin: May be infsed in 100–200 m f 5% dextse injetin 0.9% sdim hide injetin.
Infsin: D nt exeed 25 mgmin infsin ate. Sbstitte a theapy IV theapy as sn as pssibe; administe maintenane infsins in a age vme t deive the desied amnt f dg eah h.
Adt: 6 mgkg. F ate symptms eqiing apid thephyinizatin in patients eeiving thephyine: a ading dse is eqied. Eah 0.6 mgkg IV administeed as a ading dse wi est in abt a 1 mgm inease in sem thephyine. Ideay, defe ading dse nti sem thephyine deteminatin is made; thewise, base ading dse n inia jdgment and the knwedge that 3.2 mgkg aminphyine wi inease sem thephyine eves by abt 5 mgm and is nikey t ase danges advese effets if the patient is nt expeiening thephyine txiity befe this dse. Aminphyine IV maintenane infsin ates (mgkgh) ae given bew:
Patient Gp
Fist 12 h
Beynd 12 h
Yng adt smkes
1
0.8
Nnsmking adts thewise heathy
0.7
0.5
Pediati: Afte an IV ading dse, these maintenane ates (mgkgh) ae emmended:
Patient Gp
Fist 12 h
Beynd 12 h
hiden 6 m–9 y
1.2
1
hiden 9–16 y
1
0.8
Geiati: Afte a ading dse, these maintenane infsin ates (mgkgh) ae emmended:
Patient Gp
Fist 12 h
Beynd 12 h
the patients, pmnae
0.6
0.3
HF, ive disease
0.5
0.1–0.2
mpatibiity: Aminphyine is mpatibe with mst IV stins, bt d nt mix in stin with the dgs, inding vitamins.
Y-site inmpatibiity: dbtamine, hydaazine, ndansetn.
Advese effets
· Sem thephyine eves < 20 mgm: advese effets nmmn
· Sem thephyine eves > 20–25 mgm: nasea, vmiting, diahea, headahe, insmnia, iitabiity (75% f patients)
· Sem thephyine eves > 30–35 mgm: hypegyemia, hyptensin, adia ahythmias, tahyadia (> 10 mgm in pemate newbns); seizes, bain damage
· NS: Iitabiity (espeiay hiden); estessness, dizziness, mse twithing, nvsins, sevee depessin, stammeing speeh; abnma behavi haateized by withdawa, mtism, and nespnsiveness atenating with hypeative peids
· V: Papitatins, sins tahyadia, ventia tahyadia, ife-theatening ventia ahythmias, iaty faie
· GI: ss f appetite, hematemesis, epigasti pain, gastesphagea efx ding seep, ineased AST
· G: Pteinia, ineased exetin f ena tba es and Bs; diesis (dehydatin), inay etentin in men with pstate enagement
· espiaty: Tahypnea, espiaty aest
· the: Feve, fshing, hypegyemia, SIADH, ash
Inteatins
Dg-dg
· Ineased effets with imetidine, eythmyin, teandmyin, indamyin, inmyin, infenza vis vaine, a ntaeptives
· Pssiby ineased effets with thiabendaze, ifampin, apin
· Ineased adia txiity with hathane; ineased ikeihd f seizes when given with ketamine; ineased ikeihd f advese GI effets when given with tetayines
· Ineased deeased effets with fsemide, evthyxine, ithynine, itix, thygbin, thyid hmnes
· Deeased effets in patients wh ae igaette smkes (1–2 paks pe day); thephyine dsage may need t be ineased 50%–100%
· Deeased effets with phenbabita, amingtethimide
· Ineased effets, txiity f sympathmimetis (espeiay ephedine) with thephyine pepaatins
· Deeased effets f phenytin and thephyine pepaatins when given nmitanty
· Deeased effets f ithim abnate, nndepaizing nemsa bkes given with thephyine pepaatins
· Mtay antagnisti effets f beta-bkes and thephyine pepaatins
Dg-fd
· Eiminatin is ineased by a w-abhydate, high-ptein diet and by haa bied beef
· Eiminatin is deeased by a high-abhydate, w-ptein diet
· Fd may ate biavaiabiity and absptin f timed-eease thephyine pepaatins, asing txiity. These fms shd be taken n an empty stmah
Dg-ab test
· Intefeene with spetphtmeti deteminatins f sem thephyine eves by fsemide, phenybtazne, pbeneid, thebmine; ffee, tea, a beveages, hate, aetaminphen ase fasey high vaes
· Ateatin in assays f i aid, inay atehamines, pasma fee fatty aids by thephyine pepaatins
Nsing nsideatins
Assessment
· Histy: Hypesensitivity t any xanthine t ethyenediamine, pepti e, ative gastitis, adia ahythmias, ate myadia injy, HF, pmnae, sevee hypetensin, sevee hypxemia, ena hepati disease, hypethyidism, ahism, ab, atatin, eta ni iitatin infetin (aminphyine eta pepaatins)
· Physia: Bwe snds, nma tpt; P, astatin, BP, pefsin, EG; , adventitis snds; feqeny f inatin, viding, nma tpt patten, inaysis, ena fntin tests; ive papatin, ive fntin tests; thyid fntin tests; skin , texte, esins; efexes, biatea gip stength, affet, EEG
Inteventins
· Administe t pegnant patients ny when eay needed--nenata tahyadia, jitteiness, and withdawa apnea bseved when mthes eeived xanthines p nti deivey.
· atin patient nt t hew sh entei-ated timed-eease fms.
· Give immediate-eease, iqid dsage fms with fd if GI effets .
· D nt give timed-eease fms with fd; these shd be given n an empty stmah 1 h befe 2 h afte meas.
· Maintain adeqate hydatin.
· Mnit ests f sem thephyine eves aefy, and aange f eded dsage if sem eves exeed theapeti ange f 10–20 mgm.
· Take sem sampes t detemine peak thephyine nentatin dawn 15–30 min afte an IV ading dse.
· Mnit f inia signs f advese effets, patiay if sem thephyine eves ae nt avaiabe.
· Maintain diazepam n standby t teat seizes.
Teahing pints
· Take this dg exaty as pesibed; if a timed-eease pdt is pesibed, take this dg n an empty stmah, 1 h befe 2 h afte meas.
· D nt t hew sh timed-eease pepaatins.
· Administe eta stin sppsities afte emptying the etm.
· It may be neessay t take this dg and the k f adeqate nt f asthma attaks.
· Avid exessive intake f ffee, tea, a, a beveages, hate.
· Smking igaettes the tba pdts impats the dg's effetiveness. Ty nt t smke. Ntify the ae pvide if smking habits hange whie taking this dg.
· Be awae that feqent bd tests may be neessay t mnit the effet f this dg and t ense safe and effetive dsage; keep a appintments f bd tests and the mniting.
· These side effets may : nasea, ss f appetite (taking this dg with fd may hep if taking the immediate-eease iqid dsage fms); diffity seeping, depessin, emtina abiity (evesibe).
· ept nasea, vmiting, sevee GI pain, estessness, nvsins, iega heatbeat.
Advese effets in Itai ae mst mmn; thse in Bd ae ife-theatening.