Week 8 Nurse 676B Drug-Induced Hypoglycemia in Older Adult

Week 8 Nurse 676B Drug-Induced Hypoglycemia in Older Adult

 

Drug-Induced Hypoglycemia in Older Adult

Drug-induced hypoglycemia simply refers to low blood sugar secondary to certain medications. Worldwide, drug-induced hypoglycemia is most prevalent among diabetic individuals on insulin or insulin secretagogues (Shariff et al., 2019). Consequently, this complication poses a threat to effective glycemic control. Additionally, other classes of oral hypoglycemic agents, as well as other medications, have been linked to the causation of hypoglycemia. For instance, beta-blockers (such as atenolol and propranolol), sulfamethoxazole-trimethoprim, pentamidine, levofloxacin, and quine among others (Shariff et al., 2019). Unfortunately, the aforementioned pharmacological agents are prescribed for several reasons and therefore it is crucial to understand the potential drug-drug interactions. In this assignment, drug-induced hypoglycemia in older adults shall be explored based on a case scenario of Samuel, an 82-year-old male, type 2 diabetic on glyburide, lisinopril, Flomax, Lipitor, Paxil, Coenzyme Q10, and multivitamin. He had been treated with sulfamethoxazole/trimethoprim a week prior and has had alprazolam, atenolol, and terazosin prescribed before.

Cause of Hypoglycemia

Hypoglycemia as a complication of diabetic treatment spans from mild to severe or rather a life-threatening that require hospitalization. Clinically manifests as generalized weakness, hunger, tremor, blurred vision, sweating, confusion, tachycardia, loss of consciousness, headache, irritability, and mood changes (Ostroumova et al., 2019). As for Samuel, hypoglycemia could have resulted from several factors. Firstly, the drugs he is taking in this case glyburide. Glyburide is a sulfonylurea that causes hypoglycemia by increasing the release of endogenous insulin. According to Minamoto-Higashioka et al. (2019), glyburide has the highest tendency to cause hypoglycemia among all the sulfonylureas. Besides, Samuel has undergone treatment with sulfamethoxazole-trimethoprim. Minamoto-Higashioka et al. (2019) established that sulfamethoxazole-trimethoprim potentiates the hypoglycemic effects of sulfonylureas.

Additionally, older age predisposes to hypoglycemia especially due to comorbidities such as chronic renal impairment or liver impairment which interferes with metabolism and elimination of the antidiabetic drugs leading to prolonged duration of action of these agents. On the other hand, only high-intensity statins have been shown to increase the risk of hypoglycemic events (Khanimov et al., 2019). Therefore, Lipitor can also be a potential cause of hypoglycemia in Samuel particularly if it is high intensity. Meanwhile, ACEIs such as lisinopril cause hypoglycemia by increasing peripheral insulin sensitivity but paroxetine and tamsulosin have only been shown to cause hypoglycemia in rats and mice. Furthermore, atenolol causes hypoglycemia although it was an older prescription. To sum up, hypoglycemia in Samuel can be attributable to an interaction between older age and glyburide, lisinopril, sulfamethoxazole-trimethoprim, and Lipitor.

Safe Medication Management

Geriatric patients such as Samuel (82 years) ordinarily suffer from several comorbidities thus are usually on more than one medication. For instance, Samuel is on Lipitor, Flomax, glyburide, tamsulosin, multivitamin, coenzyme Q10, and lisinopril. These various agents predispose to diverse drug-drug interactions some of which are life-threatening. In order to safely administer medications in the geriatric population, it is important to seek certain information as follows; Firstly, it is important to inquire about the total number of medications being taken, the route, and how often they are taken (Zagaria et al., 2019). This is critical to establish medication compliance. Secondly, a history of comorbidities and other factors such as alcohol use should also be sought. Additionally, any patient concerns should also be sought including any side effects experienced when taking certain medications to evaluate the possibility of stopping the offending agent. The issue of polypharmacy necessitates an inquiry into the number of prescribers that Samuel has, which facilitates tailoring of treatment based on the functional status of the patient and the drug-drug interactions (Zagaria et al., 2019). Moreover, it is imperative to inquire about his nutritional status as malnutrition and missing meals are frequent in geriatrics and predispose them to hypoglycemia in the context of hypoglycemia-inducing agents. Finally, it is critical to inquire about the reasons underlying intake of the medications since geriatric patients are prone to self-management practices through over-the-counter medications.

Patient Education

Samuel and his family should be educated on the signs and symptoms of hypoglycemia such as sweating, fatigue, hunger, confusion, headaches, and anxiety. Similarly, Samuel should be advised to avoid missing meals which predisposes him to hypoglycemia. Samuel should also be advised to avoid taking alcohol as it can worsen hypoglycemia (Zagaria et al., 2019). Furthermore, Samuel should be provided with education regarding the appropriate dosage to avoid intentional and unintentional overdoses. Together, they should be enlightened on the importance of follow-up testing, regular home-based random blood sugar measurements, and the need for close medical supervision (Zagaria et al., 2019). Besides, Samuel should be advised to consult his primary care physician before attempting self-management practices through over-the-counter medications. Finally, they should be educated on the adverse effects of the various medications Samuel is taking and the need to stop and visit a healthcare provider if the side effects become intolerable.

Conclusion

Drug-induced hypoglycemia is a preventable complication that impairs effective glycemic control in diabetic patients. Care has to be taken when prescribing medication in older adults as they are at an increased risk of drug-induced hypoglycemia. Finally, it is imperative to obtain a detailed subjective assessment of patients and offer extensive and elaborate patient education.

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References

Khanimov, I., Segal, G., Wainstein, J., Boaz, M., Shimonov, M., & Leibovitz, E. (2019). High-intensity statins are associated with an increased incidence of hypoglycemia during hospitalization of individuals not critically ill. The American Journal of Medicine, 132(11), 1305–1310. https://doi.org/10.1016/j.amjmed.2019.04.050

Minamoto-Higashioka, M., Kawamura, R., Umakoshi, H., Yokomoto-Umakoshi, M., Utsunomiya, D., Osawa, H., & Kondo, S. (2019). Seasonal variation in severe glucose-lowering drug-induced hypoglycemia in patients with type 2 diabetes. Internal Medicine (Tokyo, Japan), 58(8), 1067–1072. https://doi.org/10.2169/internalmedicine.1360-18

Ostroumova, O. D., Russian Clinical and Research Center of Gerontology – Pirogov Russian National Research Medical University, Moscow, Russia, Akimova, E. S., Kochetkov, A. I., Pereverzev, A. P., A.I.Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia, A.I.Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia, Russian Clinical and Research Center of Gerontology – Pirogov Russian National Research Medical University, Moscow, Russia, & Russian Clinical and Research Center of Gerontology – Pirogov Russian National Research Medical University, Moscow, Russia. (2019). Medically induced hypoglycemia: focus on medications not included in the group of antihyperglycemic medications. Consilium Medicum, 21(4), 59–65. https://doi.org/10.26442/20751753.2019.4.190196

Shariff, A., Sridhar, S. B., Bittar, H. R., Hamad, A., Ahmed, R., & Kadour, G. (2019). Frequency and predisposing factors for drug-induced hypoglycemia in patients with type-2 diabetes mellitus. Journal of Research in Pharmacy Practice, 8(2), 64–68. https://doi.org/10.4103/jrpp.JRPP_18_58

Zagaria, M. A. E., Phar, MS, BCGP Clinical Consultant Pharmacist, of MZ Associates, Inc. www. mzassociatesinc.com Past Chair, Board of Commissioners, & Commission for Certification in Geriatric Pharmacy Recipient of the Excellence in Geriatric Pharmacy Practice Award from the Commission for Certification in Geriatric Pharmacy. (2019, October 16). Avoiding drug-induced hypoglycemia in older adults. Uspharmacist.Com. https://www.uspharmacist.com/article/avoiding-druginduced-hypoglycemia-in-the-older-adult

Week 8 Nurs 676B
US pharmacist .com article
www. Avoiding Drug-Induced Hypoglycemia in the Older Adult (uspharmacist.com)ding Drug-Induced Hypoglycemia in the Older Adult (uspharmacist.com)

Samuel is an 82-year-old male brought in by his daughter for complaints of low blood sugar. Samuel has a history of type II diabetes well-controlled with glyburide and diet. He was treated last week at an urgent care for a suspected staph infection to his arm with sulfamethoxazole and trimethoprim. He also takes lisinopril, Lipitor, Flomax, Paxil, Coenzyme Q10, and a multivitamin. His daughter also found old prescriptions for alprazolam, atenolol, and terazosin in his medicine cabinet. With what you know about drug-drug interaction in older adults, what could be the cause of his hypoglycemia? What questions do you need to ask the patient and his daughter about safe medication management? What education should be offered to this patient and his family?

US Pharm. 2019;44(10)4-8.
There is much to be learned from those who have examined the unintended effects of medication therapy. As this knowledge base increases, it is important to seek systematic reviews and meta-analyses of these effects and to rely on the evidence these studies provide in order to better serve patients through appropriate medication monitoring and other medication-therapy management (MTM) services. In light of the fact that advancing age is a risk factor for drug-induced (DI) hypoglycemia (TABLE 1) in the article US pharmacist, this brief discussion will provide nuanced guidance and additional resources to help pharmacists better individualize pharmaceutical care to this vulnerable patient population.