McKenna's Pharmacology for Nursing, 2e

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P A R T 9  Drugs acting on the renal system

Evaluation

■ ■ 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. ■ ■ 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. 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. ■ ■ Provide thorough teaching, including drug Implementation with rationale

■■ 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. 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 ■ ■ 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. KEY POINTS