Question

Lillian has been on her medication for pneumonia for 24 hours. The MD says the pneumonia is improving, but she also is having an acute exacerbation of her COPD and a chronic irregular heart rate. Her vital signs are T 37C, B/P 140/87, P 82 and irregular, R 12, and pulse oximetry 92% on 2L O2 per nasal cannula. The physician is concerned about her blood pressure and wants to continue to watch it. She feels that Lillian will benefit from regular medication for her COPD while in the hospital and when she goes home. Lillian also is complaining of cigarette cravings and constipation. The MD is urging her to quit smoking.

The physician leaves the following orders.

Albuterol MDI 2 puffs every 6 hours

Ipratropium MDI 2 puffs every 6 hours

Nicoderm 7mg/24hr transdermal patch daily

Bisacodyl 10 mg suppository now x1 then 10 mg po daily

Bathroom privileges

Respiratory therapist to determine need for O2 at home

Cardiologist, Dr. B, to consult for irregular heart rate

The patient will probably will need an anti-hypertensive medication added to her list of medications. What are some anti-hypertensive medications the physician will probably avoid and why?

Answer 1

COPD and Systemic hypertension  frequently coexist in the same patient .presently, a wide variety of anti hypertensive drugs with various mechanisms of action are available . In addition, combination drugs for hypertension are becoming popular. some antihypertensive drugs can affect pulmonary function.

The antihypertensive agents reviewed include aldosterone receptor blockers,diuretics , beta blockers, combined alpha and beta blockers, angiotensin II antagonists , angiotensin-converting enzyme inhibitors,alpha-1 blockers ,calcium channel blockers , centrally acting drugs, direct vasodilators, and combinations of these drugs.

Of Such classes, angiotensin II antagonists & calcium channel blockers appear to be the best initial choices if hypertension is the only indication for treatment.

some anti-hypertensive medications the physician will probably avoid because it affects pulmonary function