(Theophylline and Caffeine) --------------------------- All are structurally similar to adenosine. They exert their effects by competitively inhibiting adenosine binding in the CNS where adenosine would allow increased GABA channel flow and peripherally where adenosine is a vasodilator. At high doses, they may act as a phosphodiesterase inhibitor Theophylline levels will increase with smoking cessation. Caffeine overdoses are often from OTC alertness meds (NoDoz) and migraine meds Therapeutic levels of caffeine and theophylline are 5 to 15 ug/ml >20 is toxic range in patients without prior exposure Presents with abdominal pain and n/v with any significant dose sinus tachycardia or MAT, can progress to AMI or **v. tach** vasodilation agitation, nervousness, headache, **seizures** hypokalemia and hyperglycemia hyperthermia Widened pulse pressure, vasodilation leads to decreased diastolic, inotropy leads to increased systolic Theophylline levels Q2 Lavage if sustained release AC for immediate absorption and gut dialysis. 1-2 grams/kg Q2 hrs to 7 doses Consider whole bowel irrigation along with charcoal Fluids For SVT diltiazem or esmolol Phenylephrine or Norepi Vent dysrhythmias give lidocaine and consider b-blockade Seizures-benzos Consider Charcoal Hemoperfusion/HD if Theo level >40 with seizures, hypotension, vent dysrhythmias, or protracted vomiting Theo level >90 acute or >60 chronic Of note, adenosine will not work with theo on board, probably won’t work with a few cups of coffee on board either | | |