reduce the patient’s blood pressure | My Assignment Tutor

Case Study:1.How will metoprolol help to reduce the patient’s blood pressure? (Hint: mechanism ofaction). Metoprolol is a cardio selective beta-1 adrenergic receptor inhibitor. Metoprolol clocksthe beta 1-receptors with minimal or no effects on beta -2 receptors at oral doses of lessthan 100mg in adults (Moris & Dunham,2020). Metoprolol binds to beta-1 receptorssites selectively and inhibit the action of epinephrine and norepinephrine (Alhayek &Preuss, 2017). The mechanism by which beta blockers lower blood pressure is notknown however it has been proposed that it could lower the blood pressure bydecreasing the cardiac output, reducing renin production, modulating the sympatheticnervous system or other mechanisms. The combination of these mechanism leads toblood pressure lowering effect (Wong, Boyda & Wright, 2016).2.What adverse reactions should the patient be aware of? Link the adverse reactions tothe mechanism of action. Some of the common adverse effects due to beta-1 blockers includesbradycardia, hypotension, atrioventricular nodal (AV) block, decreased physical activityand heart failure. Whereas vomiting, nausea, dizziness, weakness, headache,abdominal discomfort, dry mouth and eyes can be experienced by patient (Tucker etal., 2021). However, Bradycardia and hypotension are two most common adverseeffects which are of great concern (Farzam & Jan, 2021). The beta-blocker havenegative chronotropic and inotropic effects and targets central nervous system. Betablockers can cause bradycardia by antagonizing the actions of catecholamine whichare produced by the sympathetic nerves at the receptor cells (Kawabat et al., 2014).3.Metoprolol is a negative chronotrope. Explain what this means and link this to themode of action of metoprolol. Beta-1 receptor along with beta-2, alpha-1 and alpha-2 receptors are adrenergicreceptors responsible for signalling sympathetic nervous system. Beta-1 receptors arepredominantly present in heart, kidney and fat cells. The activation of beta-1 receptor inheart increases sinoatrial (SA) nodal, atrioventricular (AV) and ventricular muscularfiring which increases the heart rate and the contractility. Thus when both heart rate andstroke volume is increased the cardiac output will also increase (Alhayek & Preuss,2017). Metoprolol blocks the beta-1 receptor. The blockage of beta-1 receptors in thesino-atrial node reduces the heart rate thus is a negative chronotope. (British and IrishHypertension Society [BIHS], 2017).4.David remains on metoprolol, but is later also prescribed a calcium-channel blocker.Explain what could possibly go wrong with this combination of medications (hint: whatare the possible drug-drug interactions with these two medications).There are two types of Calcium channel blockers (CCB), the dihydropyridine(DHP) and Non-DHB CCBs. Although the combination of DHP CCBs and betablockers produce reductions in BP that are greater than when either agent is usedalone. However, non DHP CCBs combine well with Beta-blockers increases the risk ofatrioventricular block and bradycardia (Richards and Tobe, 2013). One of the causeidentified is that nonDHP CCB like verapamil can cause inhibition of organic cationtransporter OCT1 leading to reduced uptake of metoprolol into hepatocytes, thisfurther causes reduced metabolism (Saeddar et al., 2019). Moreover, it has beenfound in few patients combining CCB and beta-blocker may cause a second degreeAV block.References:Alhayek, S., & Preuss, C. V. (2021). Beta 1 Receptors. In StatPearls. StatPearlsPublishing.British and Iris Hypertension Society.(2017). Drug Classes.https://bihsoc.org/wp-content/uploads/2017/11/Beta-adrenoceptor-AntagonistsFinal-2017.pdfFarzam, K., & Jan, A. (2021). Beta Blockers. In StatPearls. StatPearls Publishing.https://www.ncbi.nlm.nih.gov/books/NBK532906/Kawabata M, Yokoyama Y, Sasaki T, Tao S, Ihara K, Shirai Y, Sasano T, Goya M,Furukawa T, Isobe M, Hirao K. Severe iatrogenic bradycardia related to thecombined use of beta-blocking agents and sodium channel blockers. ClinPharmacol. 2015;7:29-36https://doi.org/10.2147/CPAA.S77021Morris, J., & Dunham, A. (2021). Metoprolol. In StatPearls. StatPearls Publishing.https://europepmc.org/article/NBK/nbk532923Richards, T. R., & Tobe, S. W. (2014). Combining other antihypertensive drugs with β-blockers in hypertension: a focus on safety and tolerability. The Canadian journalof cardiology, 30(5 Suppl), S42–S46.https://doi.org/10.1016/j.cjca.2013.08.012Saedder, E. A., Thomsen, A. H., Hasselstrøm, J. B., & Jornil, J. R. (2019). Heartinsufficiency after combination of verapamil and metoprolol: A fatal case reportand literature review. Clinical case reports, 7(11), 2042–2048.https://doi.org/10.1002/ccr3.2393Tucker, W.D., Sankar, P. & Kariyanna T.P., Selective Beta-1-Blockers.(2021). InStatPearls. StatPearls Publishing.https://www.ncbi.nlm.nih.gov/books/NBK499982/Wong, G. W., Boyda, H. N., & Wright, J. M. (2016). Blood pressure lowering efficacy ofbeta-1 selective beta blockers for primary hypertension. The Cochrane databaseof systematic reviews, 3(3), CD007451.https://doi.org/10.1002/14651858.CD007451.pub2