Dymelor

acetoHEXAMIDE

Dymelor

Indications

Action

Pharmacokinetics

Time/action profile (hypoglycemic activity)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• dizziness (most frequent)
• drowsiness
• headache (most frequent)
• weakness

Gastrointestinal

• anorexia (most frequent)
• cholestatic jaundice (life-threatening)
• constipation (most frequent)
• cramps
• diarrhea (most frequent)
• drug-induced hepatitis
• epigastric fullness (most frequent)
• heartburn (most frequent)
• ↑ appetite
• nausea
• vomiting

Dermatologic

• photosensitivity (most frequent)
• rash

Endocrinologic

• hypoglycemia (most frequent)
• syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

Hematologic

• aplastic anemia (life-threatening)
• agranulocytosis
• hemolytic anemia
• leukopenia
• pancytopenia
• thrombocytopenia

Interactions

Drug-Drug interaction

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• Observe patient for signs and symptoms of hypoglycemic reactions (sweating, hunger, weakness, dizziness, tremor, tachycardia, anxiety).
• Assess patient for allergy to sulfonamides.
• Lab Test Considerations: Monitor serum glucose and Hb A_1c periodically during therapy to evaluate effectiveness of treatment.
  • Monitor CBC periodically throughout therapy. Notify health care professional promptly if ↓ in blood counts occurs.
  • May cause an increase in AST, LDH, BUN, and serum creatinine.
Overdose is manifested by symptoms of hypoglycemia. Mild hypoglycemia may be treated with administration of oral glucose. Severe hypoglycemia should be treated with IV D50W followed by continuous IV infusion of more dilute dextrose solution at a rate sufficient to keep serum glucose at approximately 100 mg/dL.

Potential Nursing Diagnoses

Implementation

• high alert: Accidental administration of oral hypoglycemic agents to non-diabetic adults and children has resulted in serious harm or death. Before administering, confirm that patient has diabetes.
• high alert: Do not confuse acetohexamide with acetazolamide.
• Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma, infection, or surgery may require administration of insulin.
  • To convert from other oral hypoglycemic agents, the initial dose of acetohexamide should be about half the dose of tolbutamide and double the dose of chlorpropamide. A transition period is necessary with chlorpropamide because of the long half-life. Subsequent dose adjustments should be made based on the patient’s response. For patients on an insulin dose of <20 units/day, insulin can be discontinued immediately after starting acetohexamide. Patients taking >20 units/day should convert gradually by receiving an initial dose of acetohexamide of 250 mg and a 25–30% reduction in insulin dose the first day, with gradual insulin dose reduction as tolerated. Hospitalization should be considered during the transition from insulin to acetohexamide.
• Oral: May be administered once in the morning or divided into 2 doses. Administer with meals to ensure best diabetic control and to minimize gastric irritation. Do not administer after last meal of the day.
  • Tablets may be crushed and taken with fluids if patient has difficulty swallowing.

Patient/Family Teaching

• Instruct patient to take medication at same time each day. Take missed doses as soon as remembered unless almost time for next dose. Do not take if unable to eat.
• Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long-term.
• Review signs of hypoglycemia and hyperglycemia with patient. If hypoglycemia occurs, advise patient to take a glass of orange juice or 2–3 tsp of sugar, honey, or corn syrup dissolved in water and to notify health care professional.
• Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hypoglycemic or hyperglycemic episodes.
• Instruct patient in proper testing of serum glucose and ketones. These tests should be closely monitored during periods of stress or illness and health care professional notified if significant changes occur.
• May occasionally cause dizziness or drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
• Advise patient to notify health care professional promptly if unusual weight gain, swelling of ankles, drowsiness, shortness of breath, muscle cramps, weakness, sore throat, rash, or unusual bleeding or bruising occurs.
• Caution patient to avoid alcohol while on acetohexamide as it may cause a disulfiram-like reaction (facial flushing, breathlessness).
• Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
• Advise patient to inform health care professional of medication regimen before treatment or surgery.
• Insulin is the preferred method of controlling blood sugar during pregnancy. Counsel female patients to use a form of contraception other than hormonal contraceptives and to notify health care professional promptly if pregnancy is planned or suspected.
• Advise patient to carry a form of sugar (sugar packets, candy) and identification describing disease process and medication regimen at all times.
• Emphasize the importance of routine follow-up exams.

Evaluation/Desired Outcomes

• Control of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes.