The Dreaded Glucagon for Hypoglycemia Order

A 59 year old female is on the following medications:

  1. Alprazolam 1 mg four times daily as needed
  2. Norvasc 10 mg daily
  3. Simvastatin 40 mg at bedtime
  4. Cyclobenzaprine 10 mg hs prn
  5. Tylenol PM as needed
  6. Lasix 20 mg daily
  7. Glucagon kit as needed
  8. Glipizide 5 mg daily
  9. Lantus 18 units daily
  10. Humalog 8 units TID
  11. Vicodin 5/325 1 tablet TID
  12. Levothyroxine 88 mcg daily
  13. Temazepam 15 mg hs
  14. Losartan 50 mg daily
  15. Effexor XR 187.5 mg once daily
  16. Zofran 4 mg as needed
  17. Lyrica 50 mg TID

Past medical history includes

  • Anxiety
  • HTN
  • MI
  • Spasms
  • Inosmnia
  • CHF
  • DM
  • OA
  • Hypothyroid
  • Neuropathy
  • Falls

So where do we begin….anywhere of course!

Glucagon for hypoglycemia is always an order that I’m going to ask about.  It likely indicates that they have had trouble with low blood sugars in the past.  You want to know how frequently someone has had to use this.  A1C assessment will be important as well.  It would be nice to simplify this patient’s regimen if possible (reduce number of injections and/or DC glipizide if possible).

Anxiety and sleep is obviously an issue.  She is on several sedating medications, including duplicate benzodiazepines.  Eliminating some sedating medications that may not be working would be an important thing to look at.  With a history of falls, this makes it that much more important.

Lots of prn’s to investigate.  Very important to assess use and ask questions from there.

A beta-blocker would be indicated given the compelling indications, but I suspect this may have been tried in the past?  Something that I would dig into further.  BP, Pulse, hypoglycemia would all be important factors.

TSH, Kidney function, and electrolytes would all be important.

Norvasc/Zocor interaction is an imporant one to remember.

Pregabalin, edema risk is another consideration.

What else?

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  1. Nahed

    Thank you so much. It’s a very interesting case. It would be necessary to monitor glucose level in diabetics and the risk of osteoporosis should be considered in patients on levothyroxine. Unnecessary medications such as Vicodin or Tylenol should be DC. Rhabdomyolysis should be considered with pregabalin and simvastatin

    • Felipe Lopez

      No DDI between Lyrica and Zocor. You meant Norvasc and Zocor.

      • Nahed

        Rhabdomyolysis risk is increased with the combination of zocor and pregabalin. Lexicomp 2016



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Written By Eric Christianson

November 16, 2016

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