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INTRODUCTION

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HIGH ALERT

tolazamide (tole-a-za-mide)

Tolamide, Tolinase

Classification

Therapeutic: antidiabetics

Pharmacologic: sulfonylureas

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Indications
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Control of blood sugar in type 2 diabetes mellitus when diet therapy fails. Requires some pancreatic function.

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Action
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Lowers blood sugar by stimulating the release of insulin from the pancreas and increasing the sensitivity to insulin at receptor sites. May also decrease hepatic glucose production. Therapeutic Effects: Lowering of blood sugar in diabetic patients.

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Adverse Reactions/Side Effects
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CNS: dizziness, drowsiness, headache, weakness. GI: constipation, cramps, diarrhea, drug-induced hepatitis, dyspepsia, increased appetite, nausea, vomiting. Derm: photosensitivity, rashes. Endo: hypoglycemia. F and E: hyponatremia. Hemat: APLASTIC ANEMIA, agranulocytosis, leukopenia, pancytopenia, thrombocytopenia.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of aplastic anemia (fatigue, weakness, shortness of breath with exertion, tachycardia, dizziness, headache), agranulocytosis (fever, sore throat, mucosal lesions, signs of infection, bruising), thrombocytopenia (bruising, nose bleeds, and bleeding gums), or unusual weakness and fatigue that might be due to other blood dyscrasias. Report these signs to the physician immediately.

  • Be alert for signs of hypoglycemia, especially during and after exercise. Common neuromuscular signs include anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; difficulty in concentration; drowsiness; excessive hunger; headache; irritability; nervousness; tremor; weakness; unsteady gait. Report persistent or repeated episodes of hypoglycemia to the physician.

  • Assess any dizziness (See Appendix C) or drowsiness that might impair gait, balance, and other complex motor tasks (driving a car). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • Monitor signs of low sodium levels (hyponatremia), including headache, confusion, lethargy, irritability, decreased consciousness, and neuromuscular abnormalities (muscle weakness and cramps). Report severe or prolonged signs to the physician.

  • Assess blood pressure periodically (See Appendix F). A sudden or sustained increase in blood pressure (hypertension) may indicate problems in diabetes management, and should be reported to the physician.

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Interventions
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  • Implement aerobic exercise and endurance training programs to maintain optimal body weight, improve insulin sensitivity, and reduce the risk of macrovascular disease (heart attack, stroke) and microvascular problems (reduced blood flow to tissues and organs that causes poor wound healing, neuropathy, retinopathy, and nephropathy).

  • Provide a source of oral glucose (fruit juice, glucose gels/tablets, etc.) to treat mild hypoglycemia. Call for emergency assistance if symptoms persist or in cases of severe hypoglycemia. Emergency treatment typically consists of IV glucose, glucagon, or epinephrine.

  • Causes photosensitivity; use care if administering UV treatments.

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Patient/Client-Related Instruction
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  • Encourage patient to monitor blood glucose before and after exercise and to adjust food intake to maintain normal glycemic levels.

  • Emphasize the importance of adhering to nutritional guidelines and the need for periodic assessment of ...

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