Question

Critical Thinking Case Study

An older adult patient has asthma, and an adrenergic agonist is selected for treatment.

1. What are the drug advantages and disadvantages associated with the use of an adrenergic agonist, such as metaproterenol or albuterol, for this patient? Explain your answer.
2. Is age a factor in drug selection? Explain your answer.

An older adult patient has hypertension and asthma. An adrenergic blocker is selected for treatment.

1. What are the drug advantages and disadvantages associated with the use of doxazosin, prazosin, propranolol, metoprolol, and atenolol for this patient? Explain your answer.
2. What needs to be included when teaching this patient about the use of an adrenergic blocker?

Answer 1

1. Adrenergic agonist drug are of short acting and long acting forms. Albuterol is a commonly used short acting beta adrenergic agonist drug.

Advantages	Disadvantages
Reduces airway hyper responsiveness and inflammation.	Higher dose can lead to systemic adverse effects like tremor,tachycardia,hypokalemia and EKG changes.
Facilitates bronchodialation and improves breathing pattern.	Regular use of inhaled beta 2 agonist can cause bronchial hyperactivity and worsening of disease condition.Patients who use these drugs on long term needs additional corticosteroid therapy for antiinflammatory effect.
Acts as a performance enhancer of pulmonary functions and have down stream actions on cardiovascular and metabolic system	It cause slight rise in blood glucose level and cause risk for kidney and blood vessels damage . It may also cause demineralization of bones.

Choosing a drug for treatment in an elderly, requires close monitoring of individual factors including the comorbidities and possible drug interactions.Pharmacokinetic studies in elderlies suggest that there is impairment in  drug metabolism, volume distribution, protein binding and renal excretion is seen among older clients. These changes may vary as per individual differences and with associated factors like habits (smoking,addictions,life style).In general it can be considered that the drug concentration may be higher and excretion is prolonged in elderly patients. So its important to take into consideration, the patient's age,associated illnesses, medication history and physical status before deciding on the type and dosage of drug.

2. Doxazosin, prazosin are alpha-1 adrenergic blockers, where as propranolol, metoprolol, and atenolol  are beta blockers.

Advantages	Disadvantages
Alpha blockers induces arterial and venous dilation, reduces peripheral vascular resistance and thereby reduces high blood pressure.	They can cause orthostatic hypotension,tachycardia,dysrhythmias and chest pain.
Block stimulation of beta receptors in the sympathetic nervous system	Non selective Beta blockers causes constriction of bronchioles and narrowing of airway and causes shortness of breath.Can also cause vaso constriction.

Health teaching:

• Advice not to take these drugs in case of pre existing COPD, hypotension and cardiac dysrhythmias as these drugs might cause exacerbation.
• Instruct to change the position slowly and take care while mobilizing while taking alpha blockers as it can induce hypotension.
• Advice to avoid stimulants like caffeine or alcohol as they may cause excess irritability and complications.
• Advice to report any adverse symptoms like angina or breathlessness as beta blockers can lead to hypotension, bradycardia,heart failure and broncho constriction.
• Advice the client to avoid any OTC drugs to avoid drug interaction.[interactions can occur with use of antacids,antichollinergics,OHGA,diuretics,cardiovascular drugs and neuromuscular blocking agents]
• Advice to follow the drug regimen strictly and not to stop intake abruptly
• While on beta blockers advice patient to report sudden weight gain(more than 2 pounds a day), edema,fatigue or shortness of breath.