A client who takes Theo-24 (theophylline) for asthma, is experiencing theophylline toxicity. Which of these may be a contributing factor? (Select all that apply.) a) First pass effect b) Forgetfulness (double dosing) c) Chewing the capsule d) Cirrhosis wi

Answer: B and D may be contributing factors to the client's theophylline toxicity. Explanation: Theophylline is a medication used to treat asthma and other respiratory disorders. However, it can be toxic if the dosage is not closely monitored. The following factors could contribute to the individual experiencing theophylline toxicity: a) First-pass effect: This refers to the liver's ability to metabolize a medication before it enters the systemic circulation. Theophylline has a high first-pass effect, which means that a significant portion of the medication is broken down by the liver before it reaches the bloodstream. Therefore, the first-pass effect is unlikely to contribute to the client's toxicity. b) Forgetfulness (double dosing): Forgetting to take a dose on time, or taking an extra dose, can result in theophylline toxicity. If the client has been forgetful or has doubled up on doses, it could contribute to their current situation. c) Chewing the capsule: The medication is usually given as a capsule. Chewing the capsule can accelerate the release of theophylline, leading to toxicity. d) Cirrhosis with Gallstones: Cirrhosis is a medical condition in which the liver is damaged and unable to function properly. Gallstones can also impair liver function. As a result, the liver may not be able to metabolize theophylline effectively, leading to higher concentrations of the medication in the bloodstream, which may cause toxicity. e) Taking the medication with food: Taking the medication with food may delay the absorption of theophylline, but it is unlikely to contribute to toxicity. However, grapefruit juice and other citrus juices can interfere with the metabolism of theophylline and increase its concentration in the bloodstream, leading to toxicity.