A client with a history of hypertension and diabetes is prescribed a new medication. The LPN notes that the client's blood pressure is 158/92 mmHg and heart rate is 68 beats/min. Which medication would be CONTRAINDICATED for this client?
- ALisinopril (ACE inhibitor)
- BAmlodipine (Calcium Channel Blocker)
- CPropranolol (Non-selective Beta-blocker)
- DMetformin (Biguanide)
Show answer & explanationAnswer & explanation
Correct answer: C. Propranolol (Non-selective Beta-blocker)
Non-selective beta-blockers like propranolol are generally contraindicated or used with extreme caution in clients with diabetes, especially those prone to hypoglycemia. They can mask the adrenergic symptoms of hypoglycemia (e.g., tremor, palpitations, anxiety, tachycardia), making it harder for the client to recognize and treat low blood sugar. They can also impair glycogenolysis, which is the body's mechanism to raise blood sugar.
Why the other options are wrong
- A. Lisinopril is often used in clients with hypertension and diabetes due to its renal protective effects.
- B. Amlodipine is a calcium channel blocker commonly used to treat hypertension and is generally safe for diabetic clients.
- D. Metformin is a first-line medication for type 2 diabetes and is not contraindicated by hypertension.
Non-Selective Beta-Blockers & Diabetes
Non-selective beta-blockers block both beta-1 and beta-2 adrenergic receptors, which can be problematic for diabetic patients by masking hypoglycemia symptoms and impairing glucose recovery.
- Block beta-1 (heart) and beta-2 (lungs, liver) receptors.
- Masks adrenergic signs of hypoglycemia (tremor, tachycardia).
- Can impair glucose production, prolonging hypoglycemia.
Memory trick: BAD COP: Bradycardia, Asthma, Diabetes, COPD, CHF (decompensated), Other heart blocks, Peripheral vascular disease.