Diazoxide

INTRODUCTION

Indications

IV: Treatment of hypertensive emergency. PO: 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 blood pressure (BP), reflex tachycardia, and increased cardiac output. Inhibits insulin release from the pancreas and ↓ peripheral utilization of glucose. Therapeutic Effects: Lowering of blood pressure. ↑ blood glucose.

Adverse Reactions/Side Effects

CNS: dizziness, headache. CV: hypotension, tachycardia, angina, edema, flushing. Derm: hirsutism. Endo: hyperglycemia, hyperuricemia. F and E: sodium and water retention. GI: nausea, vomiting, constipation. Local: phlebitis at IV site. MS: weakness.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess BP, and determine if BP is maintained in the normal range (See Appendix F). Report low BP (hypotension), especially if patient experiences dizziness or syncope.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report a rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitation s, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Monitor and report any episodes of angina pectoris at rest or during exercise.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to sodium and water retention.

• Be alert for signs of hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels frequently.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess IV site during and after IV administration, and report signs of phlebitis (local pain, swelling, inflammation).

Interventions

• Because of an increased risk of cardiac arrhythmias and abnormal BP responses, use caution during aerobic exercise and endurance conditioning. Terminate exercise if patient exhibits untoward symptoms (chest pain, shortness of breath, unusual fatigue), or displays other criteria for exercise termination (See Appendix L).

• Avoid physical therapy interventions that cause systemic vasodilation (large whirlpool, Hubbard tank). Additive effects of this drug and the intervention may cause a dangerous fall in BP.

• To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

Patient/Client-Related Instruction

• Remind patients to take medication as directed to control hypertension even if they are asymptomatic.

• Counsel patients about additional interventions to help with the long-term ...