Week 5 Nur 676A
Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, choice #2 using Schedule II substances.
1. Jana, a 36-year-old single mother of three children, has a 15-year history of asthma. For the past month, she has been using albuterol every day. Previously, she had been using the inhaler every 3 to 4 months. She is in the office for a refill. What further information is needed to treat this patient and why? What clinical guidelines should you refer to for her medication management and why?
2. Susan is a 47-year-old female patient in for a follow-up visit to monitor her treatment for type 2 diabetes. Regular insulin was added to her treatment regimen last month. She denies symptoms of hypoglycemia and her glucose levels have been between 60 and 80. She tells you that her visit to her cardiologist went well and she has prescribed a new medication, atenolol. Discuss the possible complications when patients with diabetes are treated with a beta-blocker. Are certain beta-blockers more likely to create problems more than others are?
3. Lester is a 67-year-old male who is prescribed Warfarin for his new onset atrial fibrillation. He is concerned about starting this medication and admits he is forgetful about taking meds and doesn’t understand why he has to have follow-up blood tests. Discuss the patient education you would offer about Warfarin (include side effects). How would you address his concerns and questions? How can you ensure your patient education information is accurate and up to date?

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Solution

Week 5 Nur 676A Case Study

DQ 2: Complications of treating diabetic patients with beta blockers.

Beta-blockers have been established to decrease cardiovascular and total morbidity and mortality rates in hypertensive diabetic patients. Severe hypoglycemia is a major risk in diabetic patients on insulin therapy or sulfonylureas (Tsujimoto et al., 2017). Hypoglycemia is a severe iatrogenic complication that mostly occurs in Type 1 diabetes (TIDM) and in advanced diabetic nephropathy. Studies suggest that beta blockers can avert or mitigate the undesirable effects following an incidence of severe hypoglycemia, including hypokalemia and severe hypertension (Tsujimoto et al., 2017). Beta blockers are also associated with reducing cardiac arrhythmias and mortalities caused by severe hypoglycaemia.

Beta-adrenergic stimulation increases secretion of insulin and glucagon and enhances gluconeogenesis, glycogenolysis, and lipolysis. Even though beta blockers can help in attaining the maximum desired effects of glycemic therapy owing to reduced effects after a severe low blood sugar incident, they are associated with a risk of another incident of severe hypoglycemia. According to Dungan et al. (2019), beta-blockers have been attributed to a high cardiovascular risk in diabetics and cardiac conditions. However, it is uncertain if low blood sugar or hypoglycemic agents contribute to the risk.

In T1DM, beta-blockers can prolong, improve, or alter hypoglycemic symptoms. However, beta-blockers are attributed to a major risk of hyperglycemia in Type 2 diabetes (T2DM) (Tsujimoto et al., 2017). Beta-blockers are likely to elevate concentrations of blood glucose and antagonize the mechanism of action of oral hypoglycemic agents. Beta-blockers inhibit insulin secretion, which is highly likely to cause hyperglycemia in T2DM patients, with abnormal production of insulin in the event of hyperglycemia. Tsujimoto et al. (2017) established that administration of beta-blockers is connected with a high risk for cardiovascular disorder to some degree. The cardiovascular risk was due to a high incidence of severe low blood sugar level. The risk can prevail over the benefit of reducing the side effects after an episode of severe low blood sugar.

The different types of beta-blockers cause complications in different degrees. Non-selective beta-blockers have the highest concern of hyperglycemia in type 2 diabetic patients. They block catecholamine-induced arterial vasodilation, which is mediated by Beta-2 receptors (Tsujimoto et al., 2017). This contributes to unopposed stimulation of alpha-receptors during hypoglycemia. However, nonselective beta-blockers such as carvedilol, has been demonstrated to avert the anticipated altered autonomic response to low blood sugar known to occur after an incident of hypoglycemia.

According to Dungan et al. (2019), propranolol, a nonselective beta-blocker, has been found to cause undesirable hemodynamic effects during hypoglycemia. The effects are probably a result of unopposed activity of alpha-1 receptors than in selective beta-blockers. In addition, the use of carvedilol is connected with better low blood sugar symptom scores and a better metabolism profile than metoprolol. This impacts the amount of insulin administered and prevents hypoglycemia episodes.

References

Dungan, K., Merrill, J., Long, C., & Binkley, P. (2019). Effect of beta blocker use and type on hypoglycemia risk among hospitalized insulin requiring patients. Cardiovascular diabetology, 18(1), 1-9.

Tsujimoto, T., Sugiyama, T., Shapiro, M. F., Noda, M., & Kajio, H. (2017). Risk of Cardiovascular Events in Patients With Diabetes Mellitus on β-Blockers. Hypertension (Dallas, Tex. : 1979), 70(1), 103–110. https://doi.org/10.1161/HYPERTENSIONAHA.117.09259