Following a myocardial infarct, a 40-year-old man is being treated prophylactically with propranolol. You would be concerned about the use of this drug if the patient also had what comorbid condition
**Core Concept**
Propranolol is a non-selective beta-blocker that can mask the symptoms of hypoglycemia and worsen the outcome of a patient with diabetes. Beta-blockers inhibit the release of glucose from the liver, decrease the release of insulin from the pancreas, and can cause an increase in blood glucose levels.
**Why the Correct Answer is Right**
In a patient with diabetes, the use of propranolol can lead to unmasked or undiagnosed hypoglycemia, which can be severe and life-threatening. This is because beta-blockers can block the epinephrine-mediated symptoms of hypoglycemia, such as tachycardia and tremors, making it difficult to diagnose and treat hypoglycemia. Additionally, beta-blockers can worsen the metabolic effects of diabetes, including hyperglycemia and ketoacidosis.
**Why Each Wrong Option is Incorrect**
**Option A:** Glaucoma is not directly related to the use of propranolol, which can actually lower intraocular pressure. However, non-selective beta-blockers like propranolol can exacerbate bronchospasm in patients with asthma, which is not mentioned in this question.
**Option B:** Essential tremor is actually a contraindication for the use of propranolol, which can exacerbate tremors. However, this is not the correct answer because the question asks about a comorbid condition that makes propranolol use concerning.
**Option D:** Supraventricular tachycardia is actually a condition that can be treated with propranolol, which can slow the heart rate and convert the arrhythmia to a normal sinus rhythm.
**Clinical Pearl / High-Yield Fact**
Beta-blockers can mask the symptoms of hypoglycemia in patients with diabetes, making it essential to monitor blood glucose levels closely in these patients.
**✓ Correct Answer: C. Diabetes. The use of propranolol in a patient with diabetes can lead to unmasked or undiagnosed hypoglycemia and worsen the outcome of the patient.**