Proglycem


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Proglycem

 [pro-gli´sem]
trademark for a preparation of oral diazoxide, used in treatment of hypoglycemia.

diazoxide

(dye-az-ox-ide) ,

Hyperstat

(trade name),

Proglycem

(trade name)

Classification

Therapeutic: antihypertensives
Pharmacologic: vasodilators
Pregnancy Category: C

Indications

Intravenous: Treatment of hypertensive emergency. Oral: Treatment of hypoglycemia associated with hyperinsulinism due to islet cell carcinoma or other causes.

Action

Directly relaxes vascular smooth muscle in peripheral arterioles. Produces ↓ in BP, reflex tachycardia and increased cardiac output.
Inhibits insulin release from the pancreas and decreases peripheral utilization of glucose.

Therapeutic effects

Lowering of BP.
Increased blood glucose.

Pharmacokinetics

Absorption: Well absorbed following oral administration.
Distribution: Crosses the blood-brain barrier and placenta.
Protein Binding: >90%.
Metabolism and Excretion: 50% metabolized by the liver; 50% excreted unchanged by the kidneys.
Half-life: 20–36 hr (prolonged in renal impairment).

Time/action profile

ROUTEONSETPEAKDURATION
PO†1 hr8–12 hr8 hr
IV‡immediate5 min3–12 hr
†Blood sugar‡BP

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Hypersensitivity to bisulfites (IV only). Cross-sensitivity with sulfonamides may occur; Hypertension associated with pheochromocytoma or aortic dissection.
Use Cautiously in: Diabetics (hyperglycemia accompanies use); Cardiovascular disease; Renal or hepatic impairment; Obstetric / Lactation: Pregnancy and lactation (safety not established; may inhibit labor).

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • headache

Cardiovascular

  • hypotension (most frequent)
  • tachycardia (most frequent)
  • angina
  • edema
  • flushing

Dermatologic

  • hirsutism

Endocrinologic

  • hyperglycemia (most frequent)
  • hyperuricemia

Fluid and Electrolyte

  • sodium and water retention (most frequent)

Gastrointestinal

  • nausea
  • vomiting
  • constipation

Local

  • phlebitis at IV site

Musculoskeletal

  • weakness

Interactions

Drug-Drug interaction

Concurrent diuretic therapy may potentiate hyperglycemic, hyperuricemic, and hypotensive effects.May ↑ metabolism and ↓ effectiveness of phenytoin.Corticosteroids may ↑ hyperglycemia.May ↑ effects of warfarin.May alter the effects of insulins or oral hypoglycemic agents.Glucosamine may worsen hyperglycemia. Fenugreek, chromium, and coenzyme Q-10 may produce additive hypoglycemic effects.

Route/Dosage

Hypertension
Intravenous (Adults and Children) 1–3 mg/kg (not to exceed 150 mg/dose); may repeat dose in 5–15 min until BP is lowered to desired level; repeat administration every 4–24 hr may be used to maintain BP until oral antihypertensives are started.
Hyperinsulinemic Hypoglycemia
Oral (Adults and Children) 1 mg/kg q 8 hr initially, further adjustments made on the basis of response. Usual maintenance dose is 3–8 mg/kg/day given in divided doses every 8–12 hr.
Oral (Infants and Newborns) 2.7 mg/kg q 8 hr initially, further adjustments made on the basis of response. Usual maintenance dose is 8–15 mg/kg/day in divided doses every 8–12 hr.

Availability (generic available)

Capsules: 100 mg
Oral suspension: 50 mg/mL (contains 7.5% alcohol)
Injection: 15 mg/mL

Nursing implications

Nursing assessment

  • Assess for allergy to sulfonamide drugs.
    • Assess patient routinely for signs and symptoms of HF (peripheral edema, dyspnea, rales/crackles, fatigue, weight gain, jugular venous distention). Notify health care professional if these occur.
  • Hypertension: Monitor BP and pulse every 5 min until stable and then hourly. Report significant changes immediately.
  • Hypoglycemia: Assess patient for signs of hyperglycemia (drowsiness, fruity breath, increased urination, unusual thirst). Monitor blood glucose on diabetic patients requiring frequent doses.
  • Lab Test Considerations: May cause increased serum glucose, BUN, alkaline phosphatase, AST, sodium, and uric acid levels.
    • Monitor blood glucose in diabetic patients requiring frequent parenteral doses.
  • If severe hypotension occurs, treatment includes Trendelenburg position, volume infusion, and sympathomimetics (norepinephrine).
    • Patients who develop marked hyperglycemia must be monitored for 7 days while blood glucose concentrations stabilize.

Potential Nursing Diagnoses

Decreased cardiac output (Side Effects)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Loop diuretics are commonly given concurrently with this medication to prevent sodium and water retention.
    • Oral and injectable solution must be protected from light. Do not administer darkened solution.
  • Oral: Shake oral suspension well before use.
  • Intravenous Administration
  • pH: No Data.
  • Do not administer subcut or IM. Injection may cause warmth and pain along injected vein. Monitor IV site closely; extravasation causes cellulitis and pain. Warm packs may be applied if extravasation occursDiluent: Administer undiluted.
  • Rate: Administer over 30 sec or less only into a peripheral vein.
    • Have patient remain recumbent for at least 1 hr following IV administration. Take BP standing prior to ambulation.
  • Syringe Compatibility: heparin
  • Y-Site Incompatibility: alfentanyl, amikacin, aminophylline, amphotericin B colloidal, ampicillin, ampicillin/sulbactam, ascorbic acid, atracurium, atropine, azathioprine, aztreonam, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate, cefzaolin, cefoperazone, cefotaxime, cetotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, chlorpromazine, cimetidine, clindamycin, cyanocobalomin, cyclosporine, dantrolene, demamethasone, diazepam, digoxin, dipehnhydramine, dobutamine, dopamine, doxycycline, enalaprilat, ephedrine, epinephrine, epoetinalfa, erythromycin, esmolol, famotidine, fentanyl, fluconazole, folic acid, furosmide, ganciclovir, gentamicin, glycopyrrolate, haloperidol, heparin, hydralazine, hydrocortisone, hydroxyzine, imipenem/cilastatin, indomethacin, insulin, isorpoterenol, ketorolac, labetalol, lidocaine, magnesium sulfate, mannitol, meperidine, metaraminol, methoxamine, methyldoapte, methylprednisolone, metoclopramide, metoprolol, midazolam, morphine, multivitamins, nafcillin, nalbuphine, naloxone, nitroglycerin, nitroprusside, norepinephrine, ondansetron, oxacillin, papaverine, pencillin G, pentamidine, pentazocine, pentobarbital, phenobarbital, phentolamine, phenylephrine, phenytoin, phytonadione, potassium chloride, proccainamide, prochlorperazine, promethazine, propranolol, protamine, pyridoxime, ranitidine, sodium bicarbonate, streptokinase, succinylcholine, sufentanil, theophylline, thiamine, ticarcillin/clavulanate, tobramycin, toalzoline, trimetaphan, trimethoprim/sulfamethoxazole, vancomycin, vasopressin, verapamil

Patient/Family Teaching

  • Hypoglycemia: Instruct patient to take medication as directed, at the same time each day.
    • Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hypoglycemic or hyperglycemic episodes.
    • Review signs of hypoglycemia and hyperglycemia with patient.
    • Advise patient not to switch from capsule to oral suspension form without consulting health care professional, because oral suspension produces higher blood concentrations.
    • Advise patient to inform health care professional of medication regimen prior to treatment or surgery.
  • Hypertension: Instruct patient to change positions slowly to minimize orthostatic hypotension.
    • Caution patient to avoid taking other Rx, OTC, or herbal products, especially cold products and NSAIDs, without consulting health care professional.
    • Emphasize the importance of routine follow-up exams, especially during the first few weeks of therapy.

Evaluation/Desired Outcomes

  • Decrease in BP without the appearance of side effects. This drug is utilized in short-term treatment of hypertension. Oral antihypertensives should be introduced as soon as the hypertensive crisis is controlled.
  • Management of hypoglycemia and return to normal serum glucose concentrations. If diazoxide is not effective within 2–3 wk, therapy should be re-evaluated.
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