A client diagnosed with Addison's disease is being treated with prednisone. The nurse must educate the patient about which of the following side effects of prednisone? Select all that apply.

Choice A reason:

Propranolol, a non-selective beta-blocker, can mask the symptoms of hypoglycemia, such as tachycardia, which can be dangerous for diabetic patients. Patients may not recognize they are experiencing low blood sugar, which can delay appropriate treatment. Therefore, educating patients about this risk is crucial, especially those with diabetes.

Choice B reason:

Bronchoconstriction is a significant side effect of non-selective beta-blockers like propranolol, especially for individuals with asthma or other respiratory conditions. Propranolol can block beta-2 receptors in the lungs, leading to narrowed airways and difficulty breathing. Patients with respiratory issues should be closely monitored or may need an alternative medication.

Choice C reason:

Bradycardia, or a slower-than-normal heart rate, is a common side effect of beta-blockers. Propranolol reduces heart rate by blocking beta-1 receptors in the heart, which can be therapeutic for hypertension but may lead to excessively slow heart rates in some patients. Monitoring heart rate and educating patients about this possibility are essential parts of propranolol therapy.

Choice D reason:

Coughing spells are not a typical side effect associated with propranolol. While respiratory issues like bronchoconstriction can occur, coughing is not a direct result of beta-blocker therapy. Other medications, such as ACE inhibitors, are more commonly linked to persistent coughing.

Choice E reason:

Hypertension, or high blood pressure, is not a side effect of propranolol; rather, it is an indication for its use. Propranolol is prescribed to lower blood pressure, and if hypertension persists, it may indicate inadequate dosage or the need for additional medications, but it is not a side effect of the drug itself.

Choice A reason:

The term "empiric" refers to treatment based on clinical experience rather than laboratory results, and it does not represent a step in pharmacokinetics. Pharmacokinetics involves four primary processes: absorption, distribution, metabolism, and excretion. Therefore, empiric treatment is not relevant to the discussion of pharmacokinetics in this context.

Choice B reason:

Metabolism is a critical step in pharmacokinetics that is significantly affected by liver function. The liver is the primary organ responsible for the metabolism of most drugs. In cases of chronic liver failure, the liver's ability to metabolize drugs is compromised, which can lead to altered drug levels, increased risk of toxicity, or reduced therapeutic effects. Understanding the impact of liver failure on drug metabolism is crucial for adjusting medication dosages and preventing adverse effects.

Choice C reason:

Absorption is the process by which a drug enters the bloodstream from its site of administration. While liver failure can affect overall pharmacokinetics, it primarily impacts drug metabolism rather than absorption. Absorption issues are more commonly related to gastrointestinal conditions rather than liver function directly. Therefore, absorption is not the primary concern in this context.

Choice D reason:

Efficacy refers to the ability of a drug to produce the desired therapeutic effect, but it is not a step in pharmacokinetics. Efficacy is a result of pharmacokinetics and pharmacodynamics interactions but does not directly describe a process within pharmacokinetics. The question focuses on the pharmacokinetic steps, and efficacy, while important, is not one of them.