Chlorpropamide

INTRODUCTION

Indications

Control of blood sugar in type 2 diabetes mellitus when diet therapy fails. Requires some pancreatic function. Unlabeled Use: Management of neurogenic diabetes insipidus.

Action

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.

Adverse Reactions/Side Effects

CNS: anorexia, dizziness, headache. GI: constipation, diarrhea, drug-induced hepatitis, increased appetite, nausea, vomiting. Derm: photosensitivity, rash, pruritus, urticaria. Endo: hypoglycemia, syndrome of inappropriate antidiuretic hormone (SIADH) secretion. F and E: hyponatremia. Hemat: APLASTIC ANEMIA, agranulocytosis, eosinophilia, hemolytic anemia, leukopenia, pancytopenia, thrombocytopenia. Misc: disulfiram-like reaction.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• 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.

• Monitor signs of fluid-electrolyte imbalance due to syndrome of inappropriate antidiuretic hormone (SIADH). SIADH causes increased water retention that leads to relatively low sodium concentration (hyponatremia). Symptoms include confusion, lethargy, weakness, myoclonus, and depressed reflexes. Severe or sudden onset may also cause seizures, ataxia, nystagmus, tremor, dysarthria, dysphagia, and coma. Notify physician if these signs occur.

• Monitor and report signs of disulfiram-like reaction (i.e., toxicity occurring when this drug is taken with alcohol). Signs include throbbing headache, difficulty breathing, nausea, vomiting, sweating, thirst, chest pain, palpitations, tachycardia, hypotension, syncope, agitation, confusion, weakness, vertigo, and blurred vision.

• Assess any dizziness (See Appendix C) 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.

• 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.

Interventions

• 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).

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