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(DIE-aze-OX-ide)
Hyperstat IV
Class: Agent for hypertensive emergencies

 Action Relaxes smooth muscle in peripheral arterioles, thus reducing blood pressure.

 Indications Short-term emergency reduction of blood pressure in severe, nonmalignant and malignant hypertension in hospitalized patients.

 Contraindications Dissecting aortic aneurysm; hypersensitivity to thiazides or other sulfonamide derivatives; treatment of compensatory hypertension, such as that associated with aortic coarctation or arteriovenous shunt. Diazoxide is ineffective against hypertension caused by pheochromocytoma.

 Route/Dosage

ADULTS: IV 1–3 mg/kg (maximum 150 mg in single injection) by rapid injection. May repeat at 5–15 min intervals until satisfactory reduction in blood pressure. May repeat at intervals of 4–24 hr until oral therapy can be initiated. Do not use for more than 10 days.

 Interactions

Antihypertensive agents: Enhanced antihypertensive effect. Highly protein-bound agents: Higher blood levels of these agents may occur as a result of displacement by diazoxide. Hydantoins: Possible loss of seizure control. Sulfonylureas: Hyperglycemia may occur. Thiazide diuretics: May increase hyperuricemic, hyperglycemic and antihypertensive effects of diazoxide.

 Lab Test Interferences Hyperglycemia and hyperuricemia produced by diazoxide may affect assessment of these metabolic states. Increased renin secretion and IgG concentrations and decreased cortisol secretion may occur. May cause false-negative insulin response to glucogon.

 Adverse Reactions

CV: Sodium and water retention; hypotension to shock levels; congestive heart failure; edema; myocardial ischemia (angina, arrhythmias, ECG changes); supraventricular tachycardia; palpitations; bradycardia. CNS: Dizziness; weakness; cerebral ischemia; cerebral infarction (unconsciousness, convulsions, paralysis, confusion, focal neurologic deficit); sweating; flushing and feelings of warmth; transient neurologic findings (eg, headache, lethargy, somnolence, euphoria, ringing in the ears, momentary hearing loss). DERM: Cellulitis or phlebitis at site of extravasation; warmth or pain along course of injected vein. GI: Nausea; vomiting; acute; pancreatitis; diarrhea; abdominal discomfort. META: Hyperglycemia; hyperosmolar coma; hyperuricemia. OTHER: Hypersensitivity reactions; papilledema.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Special risk patients: Diabetic patients may need treatment for hyperglycemia. Use with care in patients with impaired cerebral or cardiac circulation in whom rapid reduction in BP might be deleterious. Observe caution when reducing severely elevated BP. Fluid and electrolyte balance: Because of sodium and water retention, with possible edema and congestive heart failure, concomitant use of diuretic may be needed. However, thiazide diuretics may potentiate diazoxide’s antihypertensive, hyperglycemic and hyperuricemic actions.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer IV, not SC or IM, over £ 30 sec.
  • Have patient remain supine during IV administration.
  • Protect liquid solution from light. Do not freeze.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Obtain baseline BP and pulse before therapy. Monitor BP and pulse frequently.
  • Monitor for hyperglycemia in the diabetic patient.
  • If signs of cerebral ischemia occur such as slowed mental processes or anxiety, help patient into supine position, elevate patient’s legs and notify physician.
  • If signs of CHF (edema, dyspnea, weight gain, jugular vein distention) occur, notify physician.
  • If headache occurs, administer analgesics as prescribed by physician.
  • If nausea or vomiting occurs, offer small frequent feedings and fluids. Give antiemetic if ordered.

OVERDOSAGE: SIGNS & SYMPTOMS
  Hypotension, hyperglycemia

 Patient/Family Education

  • Emphasize importance of follow-up exams and blood testing to assure effectiveness and to minimize adverse reactions.
  • Tell patient to report adverse reactions to physician.
  • Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
  • Instruct patient not to take otc medications without consulting physician.

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