In an older adult with a common cold and a history of glaucoma, hypertension, COPD, and hyperlipidemia, which agent is safe to use?

• A. Diphenhydramine
• B. Pseudoephedrine
• C. Guaifenesin
• D. Oxymetazoline nasal spray

Answer: (C)

When treating a cold in an older adult with glaucoma, hypertension, COPD, and hyperlipidemia, the safest choice is an agent that has minimal systemic effects and does not worsen eye pressure or cardiovascular status. Guaifenesin works as an expectorant to thin and loosen mucus, helping to clear the airways without significant anticholinergic activity or cardiovascular stimulation. This makes it generally well tolerated in the elderly and less likely to worsen glaucoma, raise blood pressure, or impact COPD.

Diphenhydramine has strong anticholinergic effects, which can raise intraocular pressure and worsen glaucoma, and it can cause confusion or sedation in older adults. Pseudoephedrine is a decongestant that can raise blood pressure and increase heart rate, posing risks for hypertension and COPD. Oxymetazoline nasal spray is a vasoconstrictor with potential for rebound congestion and, with overuse, possible systemic effects that can affect blood pressure.