Answer: Given the patient's history of coronary artery disease (CAD) and tachycardia, a beta-adrenergic blocking drug (beta-blocker) would most likely be recommended. Beta-blockers are commonly used in the treatment of CAD because they help reduce the workload on the heart by blocking the effects of adrenaline (epinephrine) and noradrenaline (norepinephrine) on the beta receptors in the heart. By blocking these receptors, beta-blockers can slow down the heart rate, reduce the force of contraction, and lower blood pressure, thereby relieving symptoms and reducing the risk of further complications in patients with CAD.
The nurse would have concerns about giving propranolol (Inderal), a non-selective beta blocker, to a patient with a history of heavy smoking. Non-selective beta blockers can cause bronchoconstriction, narrowing of the airways, and worsening of respiratory symptoms in patients with chronic obstructive pulmonary disease (COPD) or asthma. Smoking is a major risk factor for COPD, and the patient's history of heavy smoking for 45 years suggests a potential underlying respiratory condition. Therefore, the nurse would need to assess the patient's respiratory status carefully before administering propranolol and consider alternative medications if there are significant concerns about potential bronchoconstriction.
The patient's age of 67 years influences his taking beta blockers and going into heart failure (HF) in a couple of ways. First, as individuals age, their cardiovascular system undergoes changes, including decreased elasticity of blood vessels and decreased cardiac reserve. This can make the heart less efficient in pumping blood, and the risk of heart failure increases. Beta-blockers, while beneficial in many cases, can further reduce cardiac output, which may be problematic in older patients with impaired heart function. Therefore, careful monitoring and adjustment of the beta blocker dosage may be necessary in older patients to avoid exacerbating heart failure symptoms.
Secondly, older adults may have a higher risk of adverse effects from beta-blockers, such as orthostatic hypotension (a drop in blood pressure upon standing) and dizziness, which can increase the risk of falls. Close monitoring of blood pressure and cardiac function would be necessary, and a lower initial dose of the beta blocker may be prescribed to minimize these risks.
Overall, while beta-blockers can be effective in managing CAD and tachycardia, the patient's age and specific medical history need to be considered to ensure their safe and appropriate use. Regular monitoring and communication with healthcare professionals are crucial to managing any potential risks and optimizing the benefits of beta-blocker therapy in older adults.
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