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Should also be used carefully in those with diabetes

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Should also be used carefully in those with diabetesbecause it blocks signs of hypoglycemia.Patientshould be taught to recognize other symptoms such as hunger fatigue etc.Metoprolol – Produces selective blockade of beta 1 antagonists thus preferred for diabetic and patientswith asthma. Uses are same as propranolol eg, reduce HR, force of contraction reduces conductionvelocity through the V=AV node. Primary indication is hypertension. It also is approved for MI, Anginapectoris and Heart failure. Adverse Effects include bradycardia, reduced cardiac output, AV heart block,
rebound cardiac excitation by abrupt withdrawal. *If diabetic person needs to be on a beta blocker, abeta1 selective agent should be chosen.4 Pharmacokinetics in ElderlyWhat are the special considerations one needs to know when prescribing drugs for the elderly(Drugtherapy in older adults represents a special therapeutic challenge. As a rule, older patients are moresensitive to drugs than are younger adults, and they show wider individual variation. In addition, olderadults experience more adverse drug reactions and drug-drug interactions. The principal factorsunderlying these complications are (1)altered pharmacokinetics(secondary to organ systemdegeneration), (2)multiple and severe illnesses, (3)multidrug therapy, and (4)poor adherence. To helpensure that drug therapy is as safe and effective as possible, individualization of treatment is essential:Each patient must be monitored for desired and adverse responses, and the regimen must be adjustedaccordingly. Because older adults typically suffer from chronic illnesses, the usual objective is to reducesymptoms and improve quality of life, because cure is generally impossible.)Pharmacokinetic changes in older adults.Absorption;Altered GI absorption is not a major factor in drug sensitivity in older adults. As a rule, thepercentage of an oral dose that becomes absorbed does not usually change with age. However, the rateof absorption may be slowed (because of delayed gastric emptying and reduced splanchnic blood flow).As a result, drug responses may be somewhat delayed. Gastric acidity is reduced in older adults and mayalter the absorption of certain drugs. For example, some drug formulations require high acidity todissolve, and hence their absorption may be reduced.Distribution: Four major factors can alter drug distribution in older adults: (1) increased percentage ofbody fat, (2) decreased percentage of lean body mass, (3) decreased total body water, and (4) reducedconcentration of serum albumin. The increase in body fat seen in older adults provides a storage depotfor lipid-soluble drugs (e.g., propranolol). As a result, plasma levels of these drugs are reduced, causing areduction in responses. Because of the decline in lean body mass and total body water, watersolubledrugs (e.g., ethanol) become distributed in a smaller volume than in younger adults. As a result, theconcentration of these drugs is increased, causing effects to be more intense. Although albumin levelsare only slightly reduced in healthy older adults, these levels can be significantly reduced in older adultswho are malnourished. Because of reduced albumin levels, sites for protein binding of drugs decrease,causing levels of free drug to rise. Accordingly, drug effects may be more intense.

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Term
Summer
Professor
Crisp
Tags
Pharmacology, Muscarinic acetylcholine receptor, propranolol

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