Pharmacology Case Studies 2024 Latest Update
Brian explains to you that he takes metoprolol to protect him from further heart attacks and his bendroflumethiazide is to stop his heart failure from getting any worse.
Outline the rationale for Brian to be prescribed metoprolol. (Why using metoprolol...
Brian explains to you that he takes metoprolol to protect him from further heart
attacks and his bendroflumethiazide is to stop his heart failure from getting any
worse.
Outline the rationale for Brian to be prescribed metoprolol. (Why using
metoprolol?) - ✔✔✔ANSWER-• Myocardial infarction occurs when a portion of
the heart is deprived of oxygen due to blockage of a coronary artery. Coronary
arteries supply the heart muscle (myocardium) with oxygenated blood. Without
oxygen, muscle cells served by the blocked artery begin to die (infarct).
• Metoprolol is a beta-1 selective blocker.
• It works by reducing the myocardial oxygen demand, by inhibiting the
sympathetic stimulation of the heart caused by stress and exercise- and reducing
the entry of calcium in the myocardial cells.
• This decreases Heart Rate and Contractility, decreasing the Cardiac Output and
decreases Workload resulting in a lowering of Blood Pressure.
,• Lower Blood pressure leads to a decrease in the risk of sudden cardiac death post
a Myocardial infarction (Heart attack) incident.
• Decreases ischaemia
• Decreases heart rate in AF (Atrial Fibrillation), improving patient heart function.
• Reduces risk of sudden cardiac death post-Heart Attack and decreases incidence
of it recurring.
• Thus improves survival rates and decreases episodes in Heart failure, reduces
Cardiac Remodelling and enlarging of the heart muscle.
Describe 2 potential adverse effects of metoprolol that have significance for his
care at the clinic today.( ADRs associated with metoprolol?) - ✔✔✔ANSWER-•
Xerostomia (dry mouth )
- Can lead to an increased risk of dental caries
- Saliva flow helps to remove plaque and food debris from sitting around the tooth
structures.
- Reduced saliva flow leads to a decrease in lubrication within the oral cavity, this
can lead to difficulty with chewing, swallowing and speech.
- Reduced saliva flow has also been linked to a reduction in taste perception.
- Also affect the retention of dentures.
- Brian's diuretic therapy may worsen xerostomia, as he is losing more bodily fluid
via excretion.
• Postural hypotension dizziness
- Postural hypotension may result when changing positions of the dental chair from
lying down to sitting up too quickly
- Cardiac output reduced - blood flow to extremities reduced- results in postural
hypotension
- Due to Brian's age, leads to a slow reflex of his baroreceptors, detecting blood
pressure changes
- Also his heart rate is unable to increase due to effects of beta blockers being taken
, - Blood will not be circulated as fast as in normal health
- In a clinical environment, make sure you advice Brian to sit up slowly; leave
sufficient time to leave chair/bed
• Local Anaesthetic without adrenaline
- Local anaesthetic can be synergistic with beta blockers causing enhanced cardio
vascular & blood pressure effects, causing bradycardia, vasodilation &
hypotension
- A decrease in heart rate and decrease in heart contraction, which can cause
symptoms of dizziness.
• Adrenaline in Local Anaesthetic may causing severe hypertension
- Is non-selective and reacts with Alpha 1 receptors, only at high dosages or if
injected into the systemic circulation with it affect the Beta 1 receptors
- At large doses, and if there is systemic absorption it can increase heart rate and
contractibility - causing hypertension.
- This is contra-indicated in a patient like Br
Brian has been warned not to stop taking his metoprolol abruptly. Explain the
reason(s) for this advice - ✔✔✔ANSWER-• Prolonged beta-blocking medication
can lead to the up-regulation of the beta-1 receptors in the myocardium.
• If the drug is withdrawn suddenly there will be an exaggerated response to
adrenaline/ Nor adrenaline
• Causing an Increase in Heart rate and contractility, Increasing Blood pressure
• Worsening the symptoms of heart failure
• Increase in cardiac workload (on already narrow arteries) will increase the risk of
MI (heart attack)
• Increased risk of a heart attack & sudden cardiac death
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