NURS 133 Finasteride and Terazosin

jasmine's version from 2016-04-25 22:46

Section 1

Question Answer
Propecia, Proscar (Finasteride) Therapeutic hair regrowth stimulants; Used to treat male pattern hair loss in men, and also used to treat symptoms of benign prostatic hyperplasia (the enlargement of an organ or tissue caused by an increase in the reproduction rate of its cells, often as an initial stage in the development of cancer) in men with an enlarged prostate such as urinary problems
Finasteride actions Blocks the enzyme 5-alpha-reductase, which is responsible for converting testosterone to its potent metabolite 5-alpha-dihydrotestosterone in prostate, liver, and skin; 5-alpha-sihydrotestosterone is partially responsible for prostatic hyperplasia and hair loss
Finasteride therapeutic effects Reduced prostate size with associated decrease in urinary symptoms; decreases hair loss; promotes hair growth
Metabolism and excretion of Finasteride Mostly metabolized 39 percent excreted in urine as metabolites and 57 percent excreted in feces
Contraindications of Finasteride Hypersensitivity; women
Adverse/Side effects of Finasteride Prostate cancer (high grade), breast cancer, decrease libido and increase volume of ejaculate, erectile dysfunction, infertility
Drug-drug interactions of Finasteride None noted
Route administration of Finasteride PO
Nursing assessment of Finasteride Assess for symptoms of prostatic hyperplasia (urinary hesitancy, feeling of incomplete bladder emptying, interruption of urinary stream, impairment of size and force of urinary stream, terminal urinary dribbling, straining to start flow, dysuria, urgency) before and periodically during therapy; Digital rectal examinations should be performed before and periodically during therapy for BPH; Lab test considerations: serum prostate-specific antigen (PSA) concentrations, which are used to screen for prostate cancer, may be evaluated before and periodically during therapy; may cause decrease in serum PSA levels
Patient/family teaching of Finasteride Instruct patient to take as directed; Inform patient the volume of ejaculate may be decreased and erectile dysfunction and decreased libido may occur during therapy and after therapy is completed; Advise patient to notify health care professional promptly if changes in breasts (lumps, pain, nipple discharge) occur; Inform patient that there is an increased risk of high grade prostate cancer in men taking this drug; Caution patient that it poses a potential risk to a male fetus; Women, who are pregnant or may become pregnant, should avoid exposure to semen of a partner taking it and should not handle the drug crushed because of the potential for absorption; Emphasize the importance of periodic follow up exams to determine whether a clinical response has occurred
Evaluation/Desired outcomes of Finasteride Decrease in urinary symptoms of benign prostatic hyperplasia; hair growth in androgenetic alopecia; Evidence of hair growth usually requires 3 mo or longer; Continued use is recommended to sustain benefit; Withdrawal leads to reversal of effect within 12 mo
Potential nursing diagnoses of Finasteride Impaired urinary elimination (indications)

Section 2

Question Answer
Hytrin (Terazosin) Alpha-adrenergic blockers; Used to treat hypertension (high blood pressure), or to improve urination in men with benign prostatic hyperplasia (enlarged prostate); It relaxes veins and arteries so that blood can more easily pass through, and also relaxes the muscles in the prostate and bladder neck, making it easier to urinate
Terazosin actions Dilates both arteries and veins by blocking post-synaptic alpha, -adrenergic receptors; decreases contractions in smooth muscle of the prostatic capsule
Terazosin therapeutic effects Lowering of BP; decreased symptoms of prostatic hyperplasia (urinary urgency, hesitancy, nocturia)
Metabolism and excretion of Terazosin 50 percent metabolized by the liver; 10 percent excreted unchanged by the kidneys; 20 percent excreted unchanged in feces; 40 percent eliminated in bile
Contraindications of Terazosin Hypersensitivity
Use Terazosin cautiously inLactation; dehydration, volume or sodium depletion (increase risk of hypotension); Patients undergoing cataract surgery (increase risk of intraoperative floppy iris syndrome
Adverse/Side effects of Terazosin Dizziness, headache, weakness, nasal congestion, first-dose orthostatic hypotension, nausea
Drug-drug interactions of Terazosin Increase risk of hypotension with sildenafil, tadalafil, vardenafil, other anti-hypertensives, nitrates, or acute ingestion of alcohol; NSAIDs, sympathomimetics, or estrogens may decrease effects of anti-hypertensive therapy
Route administration of Terazosin PO; First dose should be taken at bedtime
Nursing assessment of Terazosin Assess for first-dose orthostatic reaction (dizziness, weakness) and syncope (temporary loss of consciousness caused by a fall in blood pressure); Volume-depleted or sodium-restricted patients may be more sensitive; monitor intake and output ratios and daily weight; assess for edema daily, especially at beginning of therapy; monitor frequency of prescription refills to determine adherence; rule out prostatic carcinoma before therapy-symptoms are similar; if hypertension, monitor BP and pulse frequently during initial dose and periodically throughout therapy; if benign prostatic hyperplasia, assess patient for symptoms of prostatic hyperplasia before and periodically during therapy
Patient/family teaching of Terazosin Instruct patient to take at same time each day, and not to double dose; Advise patient to weigh self twice weekly and assess feet and ankles for fluid retention; Advise patient to avoid driving or other activities requiring alertness until response to medication is known; Alcohol, CNS depressants, standing for long periods, hot showers, and exercising in hot weather should be avoided due to possible enhanced orthostatic effects; Advise patient to notify health care professional of frequent dizziness, fainting , or swelling of feet or lower legs occurs; Emphasize the importance of follow up exams to evaluate effectiveness; Encourage patient to comply with additional interventions for hypertension (weight reduction, low-sodium diet, smoking cessation, moderation of alcohol consumption, regular exercise, and stress management); Instruct patient and family on proper technique for BP monitoring, and advise to check BP at least weekly and to report significant changes; Medication controls yet does not cure hypertension
Evaluation/Desired outcomes of Terazosin Decrease in BP without appearance of side effects; Decreased symptoms of prostatic hyperplasia; May require 2-6 wk of therapy before effects are noticeable
Potential nursing diagnoses of Terazosin Risk for injury (side effects); Non-compliance (patient/family teaching)

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