Glucagon

Question 1

The trade name for glucagon

Answer 1

GlucaGen

Question 2

Drug classification - glucagon

Answer 2

antihypoglycemic

Question 3

Actions (Pharmacodynamics) - glucagon

Answer 3

❑ Stimulates hepatic production of glucose from glycogen stores (glycogenolysis); Note: Must have hepatic glycogen stores for the anti-hypoglycemic effects.
❑ Has an inotropic myocardial effect that stimulates cyclic AMP in cardiac tissue via non alpha, non beta receptors.

Question 4

Indications - Glucagon

Answer 4

❑ Hypoglycemia (when IV access cannot be established).
❑ Administration of glucagon may be helpful for severe cardiovascular instability associated with beta-blocker toxicity that is refractory to standard measures, including vasopressors

Question 5

Dosage of glucagon for hypoglycemia

Answer 5

Adult: 1 mg SC/IM/IVP, 20 minutes prn

Pediatric: ≤20 kg, 0.5 mg IM; ≥ 20 kg, 1 mg IM

Question 6

Dosage of glucagon for beta blocker toxicity

Answer 6

Adult: 3 – 10 mg SIVP; followed by an infusion of 8 – 10 mg/hr. *Mix: 10 mg in 100ml D5W [0.1mg/ml]

Pediatric: 2mg SIVP/IO/IM q 10 minutes prn to a maximum of 6mg.

Question 7

Contraindications - Glucagon

Answer 7

❑ Hypersensitivity (beef or pork proteins as glucagon is derived from beef or pork pancreas)
❑ Pheochromocytoma

Question 8

Precautions - Glucagon

Answer 8

❑ Cardiovascular or renal disease
❑ Lowers serum potassium levels
❑ Do not mix with saline (forms a precipitate) – use sterile water or D5W
❑ After patient regains LOC – supplemental carbohydrates should be provided as soon as possible

Question 9

Why might glucagon not be effective in malnourished patients (i.e. alcoholism)?

Answer 9

Hepatic stores of glycogen are necessary for glucagon to exert an antihypoglycemic effect. Therefore glucagon may be ineffective on patients who are malnourished.

Question 10

Can glucagon cause vomiting?

Answer 10

May cause vomiting at higher dosages

Question 11

How long does glucagon usually take for noticeable effect?

Answer 11

Administration to comatose patient (with normal liver glycogen stores) usually produces a return to consciousness within 20 minutes.

Question 12

Glucagon may contain phenol. What is a consideration for this?

Answer 12

If the manufacturer diluent contains phenol, you should not use in large bolus doses and subsequent continuous infusions because phenol may cause hypotension, seizures or arrhythmias. If a dose of >2 mg is needed, then reconstitute the glucagon in sterile water to a final concentration of <1 mg/ml.