McKenna's Pharmacology for Nursing, 2e

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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.

■■ 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. ■ ■ 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). 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. 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 . ■ ■ Monitor laboratory test results, including