Methylxanthines

Who is at risk for toxicity and why?

Older patients are at much higher risk for toxicity when taking methylxanthines.

Systemic anticholinergics are included in Beers Criteria for Potentially Inappropriate Use in 

Older Adults; they should not be substituted for inhaled anticholinergics

These drugs are contraindicated for patients with untreated seizure disorders or peptic ulcer 

disease.

Use with caution in patients with heart disease (can exacerbate dysrhythmias), liver dysfunction 

(increased risk for toxicity), peptic ulcer disease (can exacerbate condition), or seizure disorders 

(can exacerbate seizures).

Asthma & COPD

Step 1 therapy

Complete this sentence: Manage with a ______ as needed.

SABA

symptoms associated with mild persistent asthma

Symptoms: More than 2 d/wk but less than daily

nighttime awakenings:

3–4 times/month

SABA use= more than 2 days/week but less than daily AND no more than 1 time on any day.

Effect on activity= minimal activity limitation.

Risk for exacerbations requiring systemic glucocorticoids= 2 or more times/6 months OR 

wheezing lasting more than 1 day 4 or more times/year (2 or more times/year for 5 y.o. & up).

symptoms associated with moderate persistent asthma

Symptoms: Daily

nighttime awakenings: 

3-4 times/month More than once/week but less than nightly

SABA use= daily.

Effect on activity= some activity limitation.

Risk for exacerbations requiring systemic glucocorticoids= increased frequency & intensity of

exacerbations or wheezing.

symptoms associated with severe persistent asthma

symptoms: several times daily

nighttime awakenings: often nightly

SABA use= several times a day

Effect on activity= severe activity limitation.

Risk for exacerbations requiring systemic glucocorticoids= even greater increased frequency & 

intensity

of exacerbations or wheezing.

symptoms associated with intermittent asthma

symptoms: 2d/wk or less 

nighttime awakenings: 2 times/month or less

effect on activity: none

SABA use= 2 days/week or less.

Risk for exacerbations requiring systemic glucocorticoids= 0-1 time/year.

What are some examples of a SABA?

albuterol, levalbuterol

benefits of SABA

Rescue inhaler, all asthma patients should have a SABA, they are for prophylaxis of exerciseinduced bronchospasms and to relieve ongoing asthma attacks and COPD exacerbations