Acetazolamide

INTRODUCTION

Indications

Lowering of intraocular pressure in the treatment of glaucoma. Management of acute altitude sickness. Unlabeled Use: Diuretic. Adjunct to the treatment of refractory seizures. Reduce cerebrospinal fluid production in hydrocephalus. Prevention of renal calculi composed of uric acid or cystine.

Action

Inhibition of carbonic anhydrase in the eye results in decreased secretion of aqueous humor. Inhibition of renal carbonic anhydrase, resulting in self-limiting urinary excretion of sodium, potassium, bicarbonate, and water. CNS inhibition of carbonic anhydrase and resultant diuresis may decrease abnormal neuronal firing. Alkaline diuresis prevents precipitation of uric acid or cystine in the urinary tract. Therapeutic Effects: Lowering of intraocular pressure. Control of some types of seizures. Prevention and treatment of acute altitude sickness. Prevention of uric acid or cystine renal calculi.

Adverse Reactions/Side Effects

CNS: depression, tiredness, weakness, drowsiness. EENT: transient nearsightedness. GI: anorexia, metallic taste, nausea, vomiting, melena. GU: crystalluria, renal calculi. Derm: STEVENS-JOHNSON SYNDROME, rashes. Endo: hyperglycemia. F and E: hyperchloremic acidosis, hypokalemia, growth retardation (in children receiving chronic therapy). Hemat: APLASTIC ANEMIA, HEMOLYTIC ANEMIA, LEUKOPENIA. Metab: weight loss, hyperuricemia. Neuro: paresthesias. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hypersensitivity reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Be especially alert for dermatitis, exfoliation, and other severe skin reactions that might indicate Stevens-Johnson syndrome. Notify physician immediately about any hypersensitivity reactions.

• Be alert for signs of aplastic or hemolytic anemia (unusual fatigue, weakness, dizziness, pallor, jaundice, abdominal pain), leukopenia (fever, sore throat, mucosal lesions, signs of infection), or fatigue and poor health that might be due to other anemias and blood dyscrasias. Report these signs immediately to the physician.

• Monitor any changes in vision to help document drug effectiveness in decreasing glaucoma.

• If used as an anticonvulsant, document the number, duration, and severity of seizures to help determine if this drug is effective in reducing seizure activity.

• Assess signs of parasthesia (numbness, tingling) or muscle twitching. Perform objective tests including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

• Monitor and report signs of renal calculi and kidney stones, including severe pain in the side and back, pain on urination, bloody urine, and a persistent urge to urinate.

• Monitor signs of hyperglycemia, including confusion, drowsiness, flushed, dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite; and unusual thirst. Insulin dosages may need to be adjusted to prevent repeated episodes of hyperglycemia.

• Monitor signs of acid-base and electrolyte imbalances (acidosis, hypokalemia), ...