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Chapter 11: Problem 206

Patients receiving theophylline for reactive airway disease (asthma) should be counseled that the following item can decrease the clearance of theophylline resulting in an increased serum theophylline level: 1\. viral infection 2\. e-mycin (erythromycin) 3\. fever 4\. penicillin

Short Answer

Expert verified
E-mycin (erythromycin) decreases the clearance of theophylline.

Step by step solution

01

Analyze the Context

The question is about theophylline, a drug used for asthma, and how its clearance from the body can be affected. The goal is to determine which of the provided options can decrease clearance, thereby increasing serum levels.
02

Understand Theophylline Metabolism

Theophylline is metabolized in the liver by the cytochrome P450 enzymes. Factors that inhibit these enzymes can slow the metabolism and clearance of theophylline.
03

Evaluate Each Option

1. Viral infection: Many viral infections can impair liver function and enzyme activity, decreasing drug clearance. 2. E-mycin (erythromycin): This is a known inhibitor of cytochrome P450 enzymes and can reduce theophylline clearance. 3. Fever: While it can affect metabolism indirectly by increasing metabolic rate, it is less direct than other inhibitors. 4. Penicillin: This antibiotic doesn't typically interact with theophylline clearance.
04

Select the Most Likely Option

Among the options, erythromycin (e-mycin) is a well-documented inhibitor of cytochrome P450 enzymes, which significantly decreases the clearance of theophylline.

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Key Concepts

These are the key concepts you need to understand to accurately answer the question.

Reactive Airway Disease Management
Reactive airway diseases, such as asthma, involve the narrowing of air passages due to inflammation or hyper-responsiveness. This can result in symptoms like wheezing, coughing, and shortness of breath. Effective management is crucial to improving a patient's quality of life.

Patients with reactive airway disease often utilize medications like theophylline to maintain open airways. Theophylline relaxes the muscles of the airways, decreases bronchospasm, and improves breathing.
  • Medications help reduce inflammation and prevent symptoms.
  • Lifestyle adjustments, such as avoiding allergens or irritants, complement medical treatment.
  • Regular consultations with healthcare providers ensure tailored and effective asthma management.
Theophylline is particularly effective but requires careful monitoring because its effective dose is close to its toxic dose. Hence, maintaining appropriate drug levels in the blood is crucial.
Cytochrome P450 Inhibition
Cytochrome P450 enzymes are vital in drug metabolism, particularly in the liver, catalyzing the oxidation of organic substances. When these enzymes are inhibited, the metabolism of drugs like theophylline can be slowed down, affecting drug clearance and serum levels.

Erythromycin is a common cytochrome P450 inhibitor. Its interaction with theophylline is well-documented and can lead to elevated theophylline levels in the blood, increasing the risk of toxicity.

Inhibition of cytochrome P450 can occur due to:
  • Specific medications, such as antihypertensives, antifungals, and some antibiotics.
  • Certain foods and substances, like grapefruit juice, which also inhibits these enzymes.
  • Medical conditions like liver disease that impair enzyme function.
Understanding these interactions helps in predicting drug behavior and avoiding adverse effects.
Drug Interaction Education
Educating patients on drug interactions is crucial for avoiding potentially dangerous consequences. Many patients might not be aware of how their lifestyle, other medications, or even food can affect drug metabolism.

Key points for drug interaction education include:
  • The importance of disclosing all medications being taken, including over-the-counter drugs and supplements.
  • Avoiding self-medication, especially when on drugs with narrow therapeutic indexes like theophylline.
  • Recognizing symptoms of drug toxicity or interactions and knowing when to seek medical advice.
  • Healthcare providers should inform patients about potential interactions specific to their treatment.
Patient education empowers individuals to take an active role in their treatment plan, ensuring better management of their condition and minimizing risks.

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