This is an NCLEX pharmacology (pharm) practice question. This question provides a scenario about the drug Propranolol and wants you to correctly identify which statement by the patient indicates they understood the education provided.
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NCLEX Pharmacology Practice Question
A patient, who has a health history of uncontrolled hypertension, coronary artery disease, and diabetes mellitus, is prescribed to take Propranolol. You have provided the patient with education about this new medication. Which statement by the patient indicates your teaching was effective?
A.“I will take this medication every morning with grapefruit juice.”
B. “If I miss a dose, it is important that I double the next dose to prevent potential side effects.”
C. “It is important that I monitor my blood glucose levels very closely while taking this medication.”
D. “I will immediately stop taking this medication if I experience cold hands or feet.”
To answer this question correctly, you will need to identify the CORRECT statement made by the patient about the drug Propranolol. Therefore, 3 of the statements will be false and 1 will be true, which will be the correct answer.
First, let’s analyze the scenario! Somethings that should be popping out at you are the patient’s health history and the drug name. The patient has uncontrolled hypertension (which is probably why the patient is prescribed this medication because it will help lower the blood pressure) along with CAD, and diabetes mellitus.
Now, the drug…Propranolol. What is Propranolol? It is a beta blocker. Need a way to remember the drugs that are beta blockers? The generic names for beta blockers tend to end in “OLOL“. Propranolol, also known as Inderal (brand name), is a NON-SELECTIVE beta blocker.
Remember, there are several groups of beta blockers such as selective and non-selective. Each group of beta blockers act on various areas of the body. For example, selective beta blockers, like Atenolol or Metoprolol, block beta 1 receptors which are found in the cardiac tissue….so, in other words, the heart is affected rather than other systems such as the lungs, liver, skeletal muscles etc. However, Propranolol is NON-SELECTIVE and it blocks Beta 1 and Beta 2 receptors.
How do beta blockers work? In a nutshell, they decrease the response of the sympathetic nervous system (fight or flight system). The neurotransmitters, norepinephrine and epinephrine, will be blocked from binding to the receptors. Therefore, the patient will experience bradycardia rather than tachycardia, bronchoconstriction rather than bronchodilation (especially with the non-selective beta blockers, which can cause respiratory distress in patients with COPD or asthma) etc.
Now, let’s back up and discuss some pharmacology concepts about non-selective beta blockers (remember they block beta 1 and beta 2 receptors) because this will help you understand why we care about the patient’s health history, especially the diabetes mellitus.
Where are beta 1 receptors mainly located? In the cardiac tissue! Therefore, when the receptors are blocked the patient will experience bradycardia rather than tachycardia. Hence, the patient’s blood pressure will be lowered and the work load on the heart becomes decreased.
Now, why is this significant for a patient who has diabetes? Ask yourself, what are the classic signs and symptoms of HYPOGLYCEMIA? Tachycardia, sweating, cold, clammy, confusion…right?! Many of my patients who have experienced a drop in blood sugar will experience tachycardia as the first sign of hypoglycemia. Therefore, they are able to verbalize their “sugar” has dropped and treat it accordingly. But when a patient is taking beta blockers this is prevented from happening, so the patient may discover the hypoglycemia when it is too late.
Where are beta 2 receptors mainly located? In various places such as the lungs, liver, skeletal muscle etc.! Beta 2 receptors work in the liver and skeletal muscles to perform an important process called GLYCOGENOLYSIS. What does this word mean? It is a process that kicks in when the body experiences hypoglycemia. It causes glycogen to be breakdown into glucose so the low blood glucose levels in the body can be corrected…hence it helps increase the blood sugar levels.
Now, why is this significant for a patient who has diabetes? Glycogenolysis is significantly decreased in a patient taking a non-selective beta blocker. Therefore, if the diabetic patient experiences hypoglycemia their body isn’t able to correct it properly with this natural process. So, in a sense, it is a dangerous situation for the diabetic patient because they won’t have the sign of tachycardia during hypoglycemic state AND will be unable to perform glycogenolysis normally.
Therefore, it is VERY important that a patient who is taking a non-selective beta blocker like Propranolol monitors their blood glucose closely.
So, the answer is C: “It is important that I monitor my blood glucose levels very closely while taking this medication.”
But let’s look at why the other options are wrong:
Option A: Grapefruit contains chemicals that alter the absorption of many types of drugs including beta blockers. Therefore, the patient should always take beta blockers with water.
Option B: If the patient misses a dose they should never double it. Instead, they should take it right when they remember unless the other dose is due, but they should never double the dose. Cardiac medications are dangerous and should be taken exactly as prescribed.
Option D: Remember Propanolol is a type of beta blocker that is NON-SELECTIVE. Therefore, it affects various types of tissue in the body, not just cardiac tissue. So, the patient can experience cold hands and feet because it affects the arterioles by causing decreased dilation. In addition, a patient should never abruptly quit taking a beta blocker. It must be tapered off to prevent sudden cardiac death.
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