Mosby's 2014 Nursing Drug Reference (395 page)

Black Box Warning:

Abrupt discontinuation

• 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

• 
PO before or immediately after meals, at bedtime; tab may be crushed or swallowed whole

• 
Reduced dosage in renal dysfunction

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

• 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

• 
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

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