Jason James is taking ß blockers, all of the following should be included in his assessment except:
A. Pulmonary function tests
B. Baseline ECG
C. Glucose level
D. Blood pressure
Correct Answer: A. Pulmonary function tests
Unless the client has a history of pulmonary disease and pulmonary function tests are indicated, there is no need to include this in the routine assessment of the client taking ß blockers. Beta-blockers, as a class of drugs, are primarily used to treat cardiovascular diseases and other conditions.
Option B: Sotalol blocks the potassium channels in the heart and thereby induces QT prolongation. It increases the risk of torsades de pointes. Specific beta-blockers are contraindicated depending on the patient’s past medical history. Patients diagnosed with long QT syndrome or who have had torsades de pointes in the past should not use the drug sotalol. When using sotalol, the clinician must monitor the QTc interval as sotalol has QT-prolonging effects.
Option C: Beta-blockers can induce both hyperglycemia and mask the hemodynamic signs, usually seen in a hypoglycemic patient, such as tachycardia. The catecholamines, epinephrine, and norepinephrine bind to B1 receptors and increase cardiac automaticity as well as conduction velocity. B1 receptors also induce renin release, and this leads to an increase in blood pressure. In contrast, binding to B2 receptors causes relaxation of the smooth muscles along with increased metabolic effects such as glycogenolysis.
Option D: The patient’s heart rate and blood pressure require monitoring while using beta-blockers. Beta receptors are found all over the body and induce a broad range of physiologic effects. The blockade of these receptors with beta-blocker medications can lead to many adverse effects. Bradycardia and hypotension are two adverse effects that may commonly occur.