Mosby's 2014 Nursing Drug Reference (395 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(tye′moe-lole)
Apo-Timol
, Novo-Timol
Func. class.:
Antihypertensive
Chem. class.:
Nonselective β-blocker
Competitively blocks stimulation of β-adrenergic receptor within vascular smooth muscle (decreases rate of SA node discharge, increases recovery time); slows conduction of AV node and decreases heart rate, which decreases O
2
consumption in myocardium; also decreases renin-aldosterone-angiotensin system; at high doses, inhibits β
2
-receptors in bronchial system
Mild to moderate hypertension, migraine prophylaxis, to decrease mortality after MI
Unlabeled uses:
Tremors, angina pectoris
Hypersensitivity to β-blockers, cardiogenic shock, heart block (2nd/3rd degree), sinus bradycardia, CHF, cardiac failure, severe COPD, asthma
Precautions:
Pregnancy (C), breastfeeding, major surgery, diabetes mellitus, COPD, well-compensated heart failure, CAD, nonallergic bronchospasm, peripheral vascular disease, thyroid/renal/hepatic disease, diabetes mellitus
Black Box Warning:
Abrupt discontinuation
Calculator
• Adult:
PO
10 mg bid or 20 mg/day, may increase by 10 mg q7days, max 60 mg/day
• Geriatric patients:
PO
initiate dose cautiously
• Adult:
PO
10 mg bid beginning 1-4 wk after MI
• Adult:
PO
10 mg bid or 20 mg/day; may increase to 30 mg/day, 20 mg in
AM
, 10 mg in
PM
; discontinue if not effective after 8 wk
Available forms:
Tabs 5, 10, 20 mg
•
PO before or immediately after meals, at bedtime; tab may be crushed or swallowed whole
•
Reduced dosage in renal dysfunction
CNS:
Insomnia, dizziness
, hallucinations, anxiety, fatigue, depression, headache
CV:
Hypotension, bradycardia,
CHF,
edema, chest pain, claudication, angina, AV block, ventricular dysrhythmias
EENT:
Visual changes;
sore throat;
double vision;
dry, burning eyes
GI:
Nausea
, vomiting,
ischemic colitis,
diarrhea,
abdominal pain
,
mesenteric arterial thrombosis,
flatulence, constipation
GU:
Impotence, urinary frequency
HEMA:
Agranulocytosis, thrombocytopenia, purpura
INTEG:
Rash, alopecia, pruritus, fever
META:
Hypoglycemia
MUSC:
Joint pain, muscle pain
RESP:
Bronchospasm,
dyspnea
, cough, crackles, nasal stuffiness
Peak 1-2 hr; half-life 4 hr; metabolized by liver; excreted in urine, breast milk; protein binding <10%
Increase:
hypotension, bradycardia—hydrALAZINE, methyldopa, prazosin, anticholinergics, alcohol, reserpine, nitrates
Increase:
effects of β-blockers, calcium channel blockers
Decrease:
antihypertensive effects—NSAIDs, sympathomimetics, thyroid, salicylates
Decrease:
hypoglycemic effects—insulin, sulfonylureas
Decrease:
bronchodilation—theophyllines
Increase:
renal, hepatic studies, uric acid
Interference:
glucose, insulin tolerance test
Black Box Warning:
Abrupt discontinuation:
may result in myocardial ischemia, MI, severe hypotension, ventricular dysrhythmias in those with preexisting cardiovascular disease
•
Headaches:
location, severity, duration, frequency at baseline and throughout treatment
•
I&O, weight daily
•
B/P during initial treatment, periodically thereafter, pulse q4hr; note rate, rhythm, quality
•
Apical/radial pulse before administration; notify prescriber of any significant changes
•
Baselines of renal, hepatic studies before therapy begins
•
Edema in feet, legs daily
•
Dry storage at room temp; do not freeze
•
Therapeutic response: decreased B/P after 1-2 wk
•
To take before or immediately after meals
Black Box Warning:
Not to discontinue product abruptly; to taper over 2 wk; may cause precipitate angina
•
Not to use OTC products containing α-adrenergic stimulants (nasal decongestants, cold preparations) unless directed by prescriber
•
To report bradycardia, dizziness, confusion, depression, fever, sore throat, SOB to prescriber
•
To take pulse at home; advise when to notify prescriber
•
To avoid alcohol, smoking, sodium intake
•
To comply with weight control, dietary adjustments, modified exercise program
•
To carry emergency ID to identify product, allergies
•
To avoid hazardous activities if dizziness is present
•
To report symptoms of
CHF:
difficulty breathing, especially on exertion or when lying down; night cough; swelling of extremities
•
To take medication at bedtime; to wear support hose to minimize effect of orthostatic hypotension
Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O
2
, diuretic for cardiac failure, hemodialysis; administer vasopressor (norepinephrine)
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(tie-moe′lol)
Istalol, Timoptic, Timoptic-XE
Func. class.:
Antiglaucoma
Chem. class.:
β-Blocker
Can decrease aqueous humor and increase outflows
Treatment of chronic open-angle glaucoma and ocular hypertension
Hypersensitivity, AV block, heart failure, bradycardia, sick sinus syndrome, asthma
Precautions:
Abrupt discontinuation, pregnancy, breastfeeding, children, COPD, depression, diabetes mellitus, myasthenia gravis, hyperthyroidism, pulmonary disease, angle-closure glaucoma
Calculator
• Adult:
Instill 1 drop in each affected eye bid (0.25% solution) initially; if no response, 1 drop in each affected eye bid (0.5% solution) or 1 drop of gel in each affected eye daily
Available forms:
Ophthalmic solution 0.25, 0.5%; ophthalmic gel 0.25%, 0.5%
•
For ophthalmic use only
•
Do not touch the tip of the dropper to the eye, fingertips, or other surface to prevent contamination
•
Wash hands before and after use
•
Tilt head back slightly and pull the lower eyelid down with the index finger to form a pouch; squeeze the prescribed number of drops into the pouch; close eyes to spread drops; to avoid excessive systemic absorption, apply finger pressure on the lacrimal sac for 1–2 min after use
•
If >1 topical ophthalmic drug product is being used, the drugs should be administered at least 5 min apart
•
Administer other topically applied ophthalmic medications at least 10 min before timolol gel-forming solution
•
To avoid contamination or the spread of infection, do not use dropper for more than one person
•
Some products contain the preservative benzalkonium chloride, which can be absorbed by soft contact lenses; remove contact lenses before administration of the solution; lenses may be reinserted 15 min after administration
•
Decreased intraocular pressure can take several weeks, monitor IOP after a month
CNS:
Insomnia, headache, dizziness, anxiety, depression, headache, nightmares
CV:
Palpitations, heart failure
EENT:
Eye stinging/burning, tearing, photophobia, visual disturbances
GI:
Nausea, dry mouth
PULM:
Bronchospasm
Onset 30 min, peak 1-2 hr, duration 12-24 hr
Increase:
β-Blocking effect—oral β-blockers
Increase:
Intraocular pressure reduction—topical miotics, dipivefrin, EPINEPHrine, carbonic anhydrase inhibitors; this may be beneficial
Increase:
B/P, severe—when abruptly stopping cloNIDine
Increase:
Depression of AV nodal conduction, bradycardia, or hypotension—adenosine, cardiac glycosides, disopyramide, other antiarrhythmics, class 1C antiarrhythmic drugs (flecainide, propafenone, moricizine, encainide quiNIDine, calcium-channel blockers, or drugs that significantly depress AV nodal conduction)
Increase:
AV block nodal conduction, induce AV block—high doses of procainamide
Increase:
Antihypertensive effect—other antihypertensives
Systemic absorption
: When used in the eye, systemic absorption is common with the same adverse reactions and interactions
•
Glaucoma: Monitor intraocular pressure
•
Decreasing intraocular pressure
•
That product is for ophthalmic use only
•
Not to touch the tip of the dropper to the eye, fingertips, or other surface to prevent contamination
•
To wash hands before and after use
•
To tilt the head back slightly and pull the lower eyelid down with the index finger to form a pouch, squeeze the prescribed number of drops into the pouch, close eyes to spread drops
•
To apply finger pressure on the lacrimal sac for 1–2 min following use to prevent excessive systemic absorption
•
To administer drugs at least 5 min apart if more than one topical ophthalmic drug product is being used
•
To administer other topically applied ophthalmic medications at least 10 min before timolol gel-forming solution
•
To not use dropper for more than one person to avoid contamination or the spread of infection
•
That some products contain the preservative benzalkonium chloride, which may be absorbed by soft contact lenses; to remove contact lenses before administration of the solution; that lenses may be reinserted 15 min after administration