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P A R T 9
Drugs acting on the renal system
with any other antihypertensives. The person should be
monitored and appropriate dose adjustments made to
the antihypertensive agent if this combination is used.
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Benign prostatic hyperplasia (BPH) is a common
enlargement of the prostate gland in older men.
■■
Drugs frequently used to relieve the signs and
symptoms of prostate enlargement include alpha-
adrenergic blockers, which relax the sympathetic
effects on the bladder and sphincters, and finasteride
and dutasteride, which block the body’s production
of a powerful androgen. The prostate is dependent
on testosterone for its maintenance and development;
blocking the androgen leads to shrinkage of the gland
and relief of symptoms.
CHAPTER SUMMARY
■■
Urinary tract anti-infectives include two groups
of drugs: antibiotics that are particularly effective
against gram-negative bacteria, and drugs that work
to acidify the urine, ultimately killing the bacteria
that might be in the bladder.
■■
Many activities are necessary to help decrease the
bacteria in the urinary tract (e.g. hygiene measures,
proper diet, forcing fluids) to facilitate the treatment
of UTIs and help the urinary tract anti-infectives to
be more effective.
KEY POINTS
Care considerations for people receiving
drugs to treat benign prostatic hypertrophy
Assessment: History and examination
■
■
Assess for
contraindications or cautions
: history
of allergy to the drug
to prevent hypersensitivity
reaction
; renal or hepatic failure,
which could
alter the metabolism and excretion of the drug
; or
history of heart failure or coronary heart disease
(with alpha-adrenergic blockers), which could
be
exacerbated by the effects of the alpha-adrenergic
blockers.
■
■
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
to evaluate for the development of
rash or hypersensitivity reactions.
■
■
Assess cardiopulmonary status, including vital
signs especially blood pressure and pulse rate, and
auscultate heart sounds and assess tissue perfusion,
to determine possible cardiovascular effects of
alpha-adrenergic blockade.
■
■
Assess urinary elimination pattern and renal
function
to assure adequate kidney function and
evaluate for potential changes in drug excretion.
■
■
Assist with prostate examination and palpation
to
establish hyperplasia and rule out other potential
medical problems.
■
■
Monitor laboratory test results, including
urinalysis,
to evaluate for possible changes
; renal
and hepatic function tests
to determine the need
for dose adjustment
; and prostate-specific antigen
(PSA) levels
to eliminate the diagnosis of prostate
cancer.
Implementation with rationale
■
■
Determine the presence of BPH and periodically
evaluate through prostate examination and
measurement of PSA levels
to reconfirm that no
other problem is occurring.
■
■
Administer the drug without regard to meals, but
give with meals
if GI upset is a problem.
■
■
Arrange for analgesics,
if needed, for headache
.
■
■
Encourage the person to change positions slowly
and to sit at the edge of the bed or chair for a
few minutes before rising
if low blood pressure
becomes a problem
.
■
■
Offer support and encouragement and refer for
counselling if appropriate
to help the person cope
with potential decreases in sexual functioning.
■
■
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, such as changing positions slowly and
taking drug with food if GI upset occurs; 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 signs and
symptoms of BPH, improved urine flow, decrease
in discomfort).
■
■
Monitor for adverse effects (skin evaluation, GI
upset and complaints, headache, cardiovascular
effects).
■
■
Monitor the effectiveness of comfort measures and
compliance with the regimen.
■
■
Evaluate the effectiveness of the teaching plan
(person can name drug, dosage, adverse effects to
watch for and specific measures to avoid them).
