Rosiglitazone

INTRODUCTION

Indications

Type 2 diabetes mellitus (with diet and exercise); may be used with metformin, sulfonylureas, or insulin.

Action

Improves sensitivity to insulin by acting as an agonist at receptor sites involved in insulin responsiveness and subsequent glucose production and utilization.

Requires insulin for activity. Therapeutic Effects: Decreased insulin resistance, resulting in glycemic control without hypoglycemia.

Adverse Reactions/Side Effects

CV: CHF, edema. EENT: new onset and worsening diabetic macular edema. Derm: urticaria. GI: hepatitis, ↑ liver enzymes. Hemat: anemia. Metab: LACTIC ACIDOSIS, ↑ total cholesterol, LDL and HDL, weight gain. Misc: angioedema (rare), fractures (arm, hand, foot) in female patients.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess signs of congestive heart failure, including dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Report these signs to the physician immediately.

• Monitor signs of lactic acidosis, especially during exercise. Signs include confusion, lethargy, stupor, shallow rapid breathing, tachycardia, hypotension, nausea, and vomiting. Notify physician immediately if these signs occur.

• Assess any pain that might indicate fractures, especially in the arms, hand, and feet in women. Protect and support any suspected fracture sites, and report the problem to the physician for further evaluation.

• Monitor signs of drug-induced hepatitis, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, skin rashes, flu-like symptoms, and muscle/joint pain. Report these signs to the physician.

• 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 anemia, including unusual fatigue, shortness of breath with exertion, and bruising. Notify physician immediately if these signs occur.

• Monitor signs of angioedema, including rashes, raised patches of red or white skin (welts), burning/itching skin, swelling in the face, and difficulty breathing. Notify physician immediately of these signs.

• Periodically assess body weight and report a rapid or sustained weight gain. Advise patient that this drug may cause problems in fat metabolism, and that periodic blood tests may be needed to monitor plasma lipids.

• 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).

• Because ...