You have a 58 year old African American male that is coming in for a follow-up visit after recently having a Myocardial infarction which was successfully treated via angioplasty.  He was started on Metoprolol for his consistently elevated high blood pressure during his hospital stay.

His primary diagnoses include:

• Coronary Artery Disease
• Type 2 diabetes controlled with Metformin 1,000 mg BID and HgA1C of 6.7.
• Asthma- Mild Intermittent- with no recent episodes of wheezing. Albuterol INH as needed.
• All other pertinent labs Within Normal Limits

First consider what clinical guidelines noted below can help us choose the best medication treatment for this patient with diabetes, CAD, Asthma and Hypertension. Coronary Artery Disease Advanced Pharmacology Case Study

Joint National Committee JNC 8 – https://thepafp.org/website/wp-content/uploads/2017/05/2014-JNC-8-Hypertension.pdf

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National Center for Biotechnology Information – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092891/table/T1/?report=objectonly

American Heart Association – https://www.ahajournals.org/doi/epub/10.1161/HYPERTENSIONAHA.120.15026

IHS Division of Diabetes https://www.ihs.gov/sites/diabetes/themes/responsive2017/display_objects/documents/algorithms/AlgorithmHypertension.pdf

Please answer each questions citing your response from evidence based clinical guidelines.  Your response should not be post as “I would recommend”. Example of appropriate reference: The 2020 international Society of Hypertension Global Hypertension Practice Guidelines – recommend the use of selective ß1-receptor agonists in patients diagnosed with coronary heart disease and or heart failure ( Unger, T, et al, 2020).

Reference:
Unger T;Borghi C;Charchar F;Khan NA;Poulter NR;Prabhakaran D;Ramirez A;Schlaich M;Stergiou GS;Tomaszewski M;Wainford RD;Williams B;Schutte AE; (n.d.). 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension (Dallas, Tex. : 1979). Retrieved August 1, 2022, from https://pubmed.ncbi.nlm.nih.gov/32370572/

1. Metoprolol is selective for which adrenoceptor? ( pharmacodynamics)
2. What effects do agents such as metoprolol have on the cardiovascular system? ( pharmacodynamics)
3. In which organ is metoprolol primarily metabolized? (Pharmacokinetics)
4. Why would a provider be cautious when ordering a Beta Blocker in a patient with Asthma