828
P A R T 9
Drugs acting on the renal system
■■
Pentosan is a bladder protectant. It is a heparin-like
drug that protects the inner lining of the bladder
from irritation by solutes in the urine. Because it
is a heparin-like drug, the risk of bleeding must be
considered.
DRUGS FOR TREATING BENIGN PROSTATIC
HYPERPLASIA
Benign prostatic hyperplasia (BPH), also called benign
prostatic hypertrophy or enlarged prostate, is a common
problem in men, and it increases in incidence with
age. The prostate completely encircles the urethra.
The enlargement of the gland surrounding the urethra
leads to discomfort, difficulty in initiating a stream of
urine, feelings of bloating and an increased incidence of
cystitis.
Two types of drugs are used to relieve the symptoms
of BPH. These drugs include the alpha-adrenergic
blockers alfuzosin (
Xatral SR
), tamsulosin (
Flomaxtra
)
and terazosin (
Hytrin
) and drugs that block testoster-
one production—dutasteride (
Avodart
) and finasteride
(
Proscar, Propecia
). Box 52.2 discusses an alternative
therapy used to treat BPH.
KEY POINTS
■
■
Perform a physical assessment before therapy
to establish baseline data
and during therapy
to
determine the effectiveness of the drug and the
occurrence of any adverse effects associated with
drug therapy.
■
■
Inspect the skin for colour and note any evidence
of petechiae or bruising
that may suggest
coagulation problems and possible hypersensitivity
reactions.
■
■
Assess vital signs for changes
to provide early
evidence of bleeding.
■
■
Assess the urinary elimination pattern
to evaluate
the effects of the underlying condition and the
effectiveness of therapy.
■
■
Monitor laboratory test results, including liver
function tests and coagulation studies,
to establish
a baseline for monitoring safe use of the drug and
the occurrence of adverse effects.
Implementation with rationale
■
■
Assist with establishing the presence of interstitial
cystitis by biopsy or cystoscopy before beginning
therapy
to ensure that appropriate therapy is being
used.
■
■
Administer the drug on an empty stomach,
1 hour before or 2 hours after meals,
to relieve
GI discomfort and improve absorption.
■
■
Obtain specimens for coagulation studies as
ordered
to assess for excessive heparin-like effect.
■
■
Monitor urinary elimination for amount and
characteristics and person’s complaints of pain or
difficulty voiding
to evaluate the effectiveness of
therapy.
■
■
Arrange for a wig or appropriate head covering
if
alopecia develops as a result of drug therapy.
■
■
Inspect the skin frequently for evidence of
petechiae, bruising or oozing from insertion sites
to
identify increased risk for bleeding.
■
■
Institute safety precautions such as minimising
invasive procedures and protection from injury
to
minimise the person’s risk for injury.
■
■
Provide thorough teaching, including drug
name, dosage, rationale for use and schedule for
administration; signs and symptoms of adverse
effects; measures to alleviate or prevent adverse
effects; danger signs and symptoms to report
immediately; comfort measures, such as taking
the drug on an empty stomach, use of a wig if
alopecia occurs, and analgesics for headache;
measures to prevent or reduce the risk of recurrent
interstitial cystitis; and the importance of periodic
monitoring, including laboratory testing and
evaluation,
to enhance knowledge about drug
therapy and to promote compliance.
Evaluation
■
■
Monitor response to the drug (relief of bladder
pain and discomfort).
■
■
Monitor for adverse effects (skin evaluation, GI
upset and complaints, headache, coagulation
studies).
■
■
Evaluate the effectiveness of the teaching plan
(person can name drug, dosage, adverse effects to
watch for and specific measures to avoid them).
■
■
Monitor the effectiveness of comfort measures and
compliance with the regimen.
Saw palmetto is a herbal therapy that has been used
very successfully for the relief of symptoms associated
with benign prostatic hyperplasia (BPH). People with BPH
should be cautioned not to combine saw palmetto with
finasteride because serious toxicity can occur. People
should also be cautioned that random studies of various
saw palmetto products have shown a huge variation in
contents and activity of the tablets. If people choose to
use this alternative therapy, they should be cautioned to
check products carefully and to avoid switching products
once they have success with one.
Herbal and alternative therapies
BOX 52.2
