Download Prescribing Guideline for Adult Intravenous Aminophylline in Severe Asthma and more Exams Pathology in PDF only on Docsity!
Adult Intravenous Aminophylline in Acute Severe
Asthma Prescribing Guideline
Subject: Adult Intravenous Aminophylline
Prescribing Guideline
Policy Number N/A
Ratified By: Clinical Guidelines Committee (v1)
Date Ratified: Reviewed March 2015
Version: 2.
Policy Executive Owner: ICAM Divisional Director
Designation of Author: Dr Sara Lock (Consultant)
Layla Siebert, Respiratory Pharmacist
Name of Assurance Committee: As above
Date Issued: March 2015
Review Date: 3 years hence
Target Audience: Respiratory clinical staff, Pharmacists
¾ Background/ Introduction
Aminophylline consists of a mixture of theophylline and ethylenediamine. It is a
bronchodilator and must be administered by very slow intravenous injection (it is
too irritant for intramuscular use).
A plasma theophylline concentration of 10-20 mg/litre (55-110 micromol/litre) is
required for satisfactory bronchodilation. Adverse effects can however occur within
the 10-20 mg/litre range, and severity increases at levels above 20 mg/litre.
Monitoring of levels is therefore essential during IV aminophylline therapy.
¾ Inclusion
Adult patients with severe acute asthma not responding to treatment with
bronchodilators, steroids and Magnesium as appropriate, according to BTS/Sign
Asthma guidelines, and who have been assessed by a senior clinician (medical SpR
or consultant) as requiring intravenous aminophylline, ideally only after discussion
with a respiratory SpR or consultant for the treatment of severe airway
obstruction (as measured by Peak Expiratory Flow (PEF)) and/or respiratory
failure due to asthma.
¾ Exclusions
Intravenous aminophylline is NOT indicated as a treatment for wheeze without
evidence of severe airway obstruction (as measured by PEF) or respiratory
failure due to asthma.
Intravenous aminophylline is NOT indicated for patients with breathlessness
and/or respiratory failure due to COPD in the absence of asthma.
Maintenance infusion table
Preparation: Dilute 500mg aminophylline in 500 mL sodium chloride 0.9% or
glucose 5% to give a 1 mg/ml solution
Administration: Rate = 0.5 mg/kg/hour (rate is half patients weight – see table
below)
Dose and rate of aminophylline 1 mg/ml infusion
Patient weight - kg (use
IBW if patient obese)
Dose (mg/hr) Infusion rate (ml/hr)
Theophylline levels
The therapeutic range for theophylline is 10-20 mg/litre.
A plasma-theophylline level should be planned and taken 4-6 hours after the start of the maintenance intravenous infusion, using a red top serum sample bottle.
The infusion dosage should be adjusted accordingly once the level result is known.
Theophylline assays are carried out each afternoon, Monday to Friday. Out-of-hours levels are available only if URGENT, by paging the senior person on-call for Chemical Pathology.
Levels should be checked and the result acted on every 24 hours for all patients on aminophylline infusions.
¾ Further information
The plasma theophylline concentration is increased in heart failure, cirrhosis, viral infections, in the elderly, and by drugs that inhibit its metabolism e.g. clarithromycin/ erythromycin/ ciprofloxacin.
Plasma theophylline concentration is decreased in smokers, in chronic alcoholism and by drugs that induce its metabolism e.g. rifampicin.
A list of drug interactions can be consulted in Appendix A BNF
Out-of-hours contacts
- For clinical discussion: Respiratory consultant/respiratory SpR via switchboard
- For drug specific information: On-call pharmacist via switch board
¾ References (evidence upon which the guideline is based)
- SIGN/ BTS Asthma Guidelines 2014. Accessed November 2014.
- BNF 68
To be completed and attached to any procedural document when submitted to the appropriate
committee for consideration and approval
Yes/No Comments
1. Does the procedural document affect one group less or more favourably than another on the basis of: - Race No - Ethnic origins (including gypsies and travellers)
No
- Nationality No
- Gender No
- Culture No
- Religion or belief No
- Sexual orientation including lesbian, gay and bisexual people
No
- Age No
- Disability - learning disabilities, physical disability, sensory impairment and mental health problems
No
2. Is there any evidence that some groups are affected differently?
No
3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable?
No
4. Is the impact of the procedural document likely to be negative?
No
5. If so can the impact be avoided? (^) N/A 6. What alternatives are there to achieving the procedural document without the impact?
N/A
7. Can we reduce the impact by taking different action?
N/A
If you have identified a potential discriminatory impact of this procedural document, please refer it
to the Director of Human Resources, together with any suggestions as to the action required to
avoid/reduce this impact.
For advice in respect of answering the above questions, please contact the Director of
Human Resources.
Checklist for the Review and Approval of Procedural Document
To be completed and attached to any procedural document when submitted to the relevant
committee for consideration and approval.
Title of document being reviewed:
Yes/No Comments
1. Title
Is the title clear and unambiguous? Yes
Is it clear whether the document is a guideline, policy, protocol or standard?
Yes
2. Rationale
Are reasons for development of the document stated?
Yes
3. Development Process
Is it clear that the relevant people/groups have been involved in the development of the document?
Yes
Are people involved in the development? Yes
Is there evidence of consultation with stakeholders and users?
Yes
4. Content
Is the objective of the document clear? Yes
Is the target population clear and unambiguous? Yes
Are the intended outcomes described? Yes
5. Evidence Base
Name Date
Signature
Responsible Committee Approval – only applies to reviewed procedural documents with minor changes
The Committee Chair’s signature below confirms that this procedural document was ratified by the
responsible Committee
Name Date
Name of
Committee
Name & role of Committee Chair
Signature
Tool to Develop Monitoring Arrangements for Policies and guidelines What key element(s) need(s) monitoring as per local approved policy or guidance?
Who will lead on this aspect of monitoring? Name the lead and what is the role of the multidisciplinary team or others if any.
What tool will be used to monitor/check/observe/ Assess/inspect/ authenticate that everything is working according to this key element from the approved policy?
How often is the need to monitor each element? How often is the need complete a report? How often is the need to share the report?
What committee will the completed report go to?
Element to be monitored
Lead
Tool
All
elements
of
the
guideline
Respiratory
Pharmacist
Monitoring
of
DATIX
reports
relating
to
oxygen
therapy
in
adults
Ongoing
monitoring
of
reported
incidents
Patient
Safety
Committee
and
with
responsible
Departments,
as
appropriate
