A patient who has been taking propranolol (Inderal) for 18 months ...

[misspop]

A patient who has been taking propranolol (Inderal) for 18 months reports, I stopped taking the medication yesterday, because my blood pressure has been normal for the past 3 months.
 
  The most appropriate response by the nurse would be which of the following statements?
  a. Keep an accurate record of your blood pressure and come to the clinic next week.
  b. Have you had any chest pain or palpitations?
  c. You should come to the emergency department immediately. The drug should be tapered over 2 weeks to prevent rebound hypertension.
  d. Continue taking the medication until another can be started to prevent withdrawal symptoms.

Question 2

A type I diabetic patient comes to the clinic for a follow-up appointment. The patient is taking NPH insulin, 30 units every day. A nurse notes that the patient is also taking metoprolol (Lopressor).
 
  What education should the nurse provide to the patient?
  a. You need to increase your insulin to allow for the agonist effects of metoprolol.
  b. Metoprolol may potentiate the effects of the insulin, so the dose should be reduced.
  c. Metoprolol has no effects on diabetes mellitus or on your insulin requirements.
  d. Metoprolol may mask signs of hypoglycemia so you need to monitor your blood glucose
  closely.

[elizabethrperez]

Answer to Question 1

ANS: C
The patient should come to the emergency department immediately, because rebound hypertension can occur when propranolol is stopped without weaning or tapering.
The patient should not wait until next week to be seen, because rebound hypertension can become life-threatening. The patient should be instructed to come to the emergency department immediately.
Although asking about chest pain and palpitations may be important, sudden withdrawal from propranolol can lead to rebound hypertension, and the patient should be seen immediately.
The patient states that he has already stopped taking the medication, and having him resume taking it is not going to make up for the adverse effects that may occur from sudden withdrawal. The patient should be seen immediately.

Answer to Question 2

ANS: D
Metoprolol may mask the signs of hypoglycemia, therefore the patient should monitor the blood glucose closely and report changes to the prescriber.
The patient should not increase the insulin, because metoprolol will cause a decrease in blood glucose, increasing the risk of a hypoglycemic reaction.
The patient should not reduce the dose of insulin when taking metoprolol, because this might alter serum glucose levels.
Metoprolol does have an indirect effect on diabetes mellitus and/or insulin requirements in that it may mask the signs of hypoglycemia, causing the patient to make a health care decision based on the drug-to-drug interaction rather than actual physiological factors.

[misspop]

Thanks

[elizabethrperez]

Welcome