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(intensity of reactions may be increased); OB, Lactation, Pedi: Safety not established; may cause fetal/neonatal bradycardia, hypotension, hypoglycemia, or respiratory depression.
timolol (tim-oh-lole)
Apo-Timol, Novo-Timol
Classification
Therapeutic: antihypertensives, vascular headache suppressants
Pharmacologic: beta blockers
Pregnancy Category C
GI: constipation, diarrhea, nausea. GU: erectile dysfunction,plibido. Derm: itching, rashes. Endo: hyperglycemia, hypoglycemia. MS: arthralgia, back pain, muscle
cramps. Neuro: paresthesia. Misc: ANAPHYLAXIS (rare).
Indications
Hypertension (alone or with other agents). Prevention of MI. Prevention of migraine
headaches. Unlabeled Use: Ventricular arrhythmias. Essential tremor. Anxiety.
Action
Blocks stimulation of beta1(myocardial)- and beta2(pulmonary, vascular, and uterine)-adrenergic receptor sites. Therapeutic Effects: Decreased heart rate and
BP. Prevention of MI. Decreased frequency of migraine headache.
Pharmacokinetics
Absorption: Well absorbed after oral administration.
Distribution: Enters breast milk.
Metabolism and Excretion: Extensively metabolized by the liver.
Half-life: 3 4 hr.
TIME/ACTION PROFILE (cardiovascular effects)
ROUTE
ONSET
PEAK
DURATION
PO
unknown
12 hr*
1224 hr
*After single dose, full effect is not seen until several weeks of therapy
Contraindications/Precautions
Contraindicated in: Uncompensated HF; Pulmonary edema; Cardiogenic shock;
Bradycardia or heart block.
Use Cautiously in: Renal impairment; Hepatic impairment; Geri: May haveq
sensitivity to beta blockers; initial dosage reduction recommended); Pulmonary disease (including asthma); Diabetes mellitus (may mask signs of hypoglycemia); Thyrotoxicosis (may mask symptoms); Patients with a history of severe allergic reactions
Canadian drug name.
Plate # 0-Composite
Genetic Implication.
Interactions
Drug-Drug: General anesthesia, IV phenytoin, and verapamil mayqmyocardial depression.qbradycardia may occur with digoxin.qhypotension may occur
with other antihypertensives, acute ingestion of alcohol, or nitrates. Concurrent
use with amphetamines, cocaine, ephedrine, epinephrine, norepinephrine,
phenylephrine, or pseudoephedrine may result in unopposed alpha-adrenergic
stimulation (excessive hypertension, bradycardia). Concurrent thyroid administration maypeffectiveness. May alter the effectiveness of insulins or oral antidiabetics (dosage adjustments may be necessary). Maypeffectiveness of bronchodilators and theophylline. Maypbeneficial cardiovascular effects of dopamine or
dobutamine. Use cautiously within 14 days of MAO inhibitor therapy (may result
in hypertension). Cimetidine may q toxicity. Concurrent NSAIDs may p antihypertensive action.
Route/Dosage
PO (Adults): Antihypertensive 10 mg twice daily initially; may beqq 7 days as
needed (usual maintenance dose is 10 20 mg twice daily; up to 60 mg/day). Prevention of MI 10 mg twice daily, starting 1 4 wk after MI. Prevention of vascular headache 10 mg twice daily initially, may be given as a single daily dose; may
bequp to 10 mg in the morning and 20 mg in the evening.
NURSING IMPLICATIONS
Assessment
Monitor BP and pulse frequently during dose adjustment period and periodically
during therapy. Assess for orthostatic hypotension when assisting patient up from
supine position.
Strikethrough Discontinued.
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May cause drowsiness or dizziness. Caution patients to avoid driving or other ac-
Monitor intake and output ratios and daily weight. Assess patient rou-
Implementation
Patient/Family Teaching
Instruct patient to take medication as directed, at the same time each day, even if
feeling well; do not skip or double up on missed doses. Take missed doses as soon
as possible up to 4 hr before next dose. Abrupt withdrawal may precipitate
life-threatening arrhythmias, hypertension, or myocardial ischemia.
Advise patient to make sure that enough medication is available for weekends, holidays, and vacations. A written prescription may be kept in wallet in case of emergency.
Teach patient and family how to check pulse daily and BP biweekly. Advise patient
to hold dose and contact health care professional if pulse is 50 bpm or BP
changes significantly.
Evaluation/Desired Outcomes
Decrease in BP.
Prevention of MI.
Prevention of vascular headaches.
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