Benign Prostate Hyperplasia Management case study

Benign Prostate Hyperplasia Management Submitted by Shannon Delite Leake The University of Texas at Arlington College of Nursing In partial fulfillment of the requirements of Advanced Pharmacology N5334 Mary Davis, DNP, MSN, RN, APN-BC, CRNP, ADM-BC November 11, 2017 Benign Prostate Hyperplasia Management 1 Benign Prostate Hyperplasia Management CASE SUMMARY: Mr. Jimmy McCracken, a 65-year-old male, presents with complaints of increased urinary hesitancy, dribbling, frequent nighttime urination and erectile dysfunction. Patient states his father had a myocardial infarction, but his mother passed away of natural causes at the age of 91. Primary diagnosis is benign prostate hyperplasia (BPH) with new onset erectile dysfunction. Co-morbid diagnoses include: hypertension, chronic urinary tract infections, urosepsis requiring hospitalization, type II diabetes, obesity, osteoarthritis, with an allergy to cat dander, and a history of a laminectomy ten years ago. Guiac test positive for blood with normocytic anemia secondary to upper gastric bleed. Social history positive for past alcohol use and current 35-year history of smokeless tobacco use. Plan is for patient to discontinue use of ibuprofen, begin taking an over the counter iron supplement, vitamin C, and begin due to his stable use of terazosin will begin Cialis (tadalafil) for treatment of BPH with new onset of erectile dysfunction, further lab for sexually transmitted disease screening, education of safe sex practices, and referral to urologist for further evaluation. Follow-up two weeks. 5334 CASE SUMMARY TABLE 1. Symptoms: List two pertinent signs and symptoms  Increased urinary hesitation  Frequent nighttime urination  Dribbling  Erectile dysfunction 2. Recommended Drugs: **Drug of choice – list at least 3 recommended drugs List recommended drugs as indicated for this diagnosis 2 Benign Prostate Hyperplasia Management  Viagra (sildenafil) 25mg for those 65 and over one hour prior to sexual activity (Vallerand, Deglin, & Sanoski, 2017).  Cialis (tadalafil) 2.5mg orally daily when used with an alpha blocker (Burchum & Rosenthal, 2016).  Flomax (Tamsulosin) 0.4mg orally once a day before a meal, may increase to 0.8mg after two to four weeks (Vallerand, Deglin, & Sanoski, 2017). 3. Drug Categories and Subcategories: Identify the category of each recommended drug.  Viagra (sildenafil) is therapeutically an erectile dysfunction agent and a vasodilator, pharmacologically a phosphodiesterase inhibitor type 5, and a pregnancy category B medication (Vallerand, Deglin, & Sanoski, 2017).  Cialis (tadalafil) is therapeutically an erectile dysfunction agent and a vasodilator, pharmacologically a phosphodiesterase type 5 inhibitor, and a pregnancy category B medication (Vallerand, Deglin, & Sanoski, 2017).  Flomax (Tamsulosin) is pharmacologically a peripherally acting antiadrenergic and a pregnancy category B medication (Vallerand, Deglin, & Sanoski, 2017). 4. Drug(s) of Choice: FOR THE MAIN DIAGNOSIS ONLY, provide the chosen drug(s) of choice for treatment. 5. Rationale: Provide rationale, clinical guidelines, or evidence for the selected drug of choice  Cialis (tadalafil) used originally to treat erectile dysfunction it was discovered that it 3 Benign Prostate Hyperplasia Management also relieves benign prostate hyperplasia symptoms, it was approved for use in 2011 by the Federal Drug Agency (Watson, 2016). 6. Contraindications and or Risks, as appropriate: Identify contraindications and risks as appropriate  Cialis (tadalafil) hypersensitivity, concurrent use of nitrates, , concurrent use of riociguat, history of stroke, unstable angina, history in last six-months of lifethreatening heart failure, stroke within last 60 days, myocardial infarction in last 90 days, uncontrolled hypertension, arrhythmias, any cardiovascular disorder that precludes sexual activity, hereditary degenerative retinal disorders, severe renal or hepatic impairment, congenital or acquired QT interval prolongation, concurrent use of Class IA or III antiarrhythmics, ketoconazole, itraconazole, or rifampin (Adcirca only), women, children, or pediatrics, use caution in penile deformity, left ventricular outflow obstruction, diabetes, patients greater than 50-years-old, bleeding disorders, active peptic ulcer disease, multiple myeloma, sickle cell anemia, leukemia, other disease that may predispose patient to priapism, renal impairment, hypertension, history of sudden vision loss, use of strong inhibitors of the CYP3A4 enzyme system, history of non-arteritic ischemic optic neuropathy, coronary artery disease, patient should have a stable use history if alpha adrenergic blockers prior to starting tadalafil, hyperlipidemia, smoking, use in geriatrics (Vallerand, Deglin, & Sanoski, 2017). 7. What Patients Must Understand: Identify at least 3 appropriate teaching points for the patient and/or family (HINT: 3 teaching points is rarely adequate for good patient care)  Side effects/Adverse reactions include: hearing loss, nasal congestion, headache, 4 Benign Prostate Hyperplasia Management vision loss, hypotension, dyspepsia, flushing, back pain, priapism, myalgia, back pain, limb pain (Vallerand, Deglin, & Sanoski, 2017).  Sexual stimulation is required for erection to occur on tadalafil (Vallerand, Deglin, & Sanoski, 2017).  Take tadalafil at a separate time from your terazosin (Burrow, 2017).  Do not take more than once a day (Vallerand, Deglin, & Sanoski, 2017).  Seek immediate attention if chest pain occurs after taking tadalafil (Vallerand, Deglin, & Sanski, 2017).  Seek medical attention for an erection lasting longer than four hours (Vallerand, Deglin, & Sanoski, 2017).  Report all side effects to the office immediately and stop taking tadalafil (Vallerand, Deglin, & Sanoski, 2017).  Do not take any over-the-counter medications, herbal remedies, or new prescription medications without discussing it with your primary care provider (Vallerand, Deglin, & Sanoski, 2017).  Always use a condom prior to sexual contact (Vallerand, Deglin, & Sanoski, 2017), studies have shown there is a rise in sexually transmitted diseases in your age group (Sexually, n.d.).  Discontinue taking ibuprofen due to your gastrointestinal bleeding (McNance, et al, 2016).  Take an over-the-counter iron to increase your iron levels (McNance, et al, 2016).  Take Vitamin C to increase absorption of iron (McNance, et al, 2017).  Do not consume dairy products when taking your iron as this decreases absorption (McNance, et al, 2017).  Vitamin C may improve your BPH (Nelson, 2017).  A low-fat diet with inclusion of four, or more vegetables daily may improve your BPH (Nelson, 2017).  High levels of activity/exercise may improve your BPH (Nelson, 2017).  Decreasing any “belly-fat” may improve your BPH (Nelson, 2017).  Oysters, lean cuts of beef, duck, crab, baked beans, and lamb are foods that are high in Zinc which may improve your BPH (Nelson, 2017). 5 Benign Prostate Hyperplasia Management 8. The Prescription(s) Shannon Delite Leake, RN, Student FNP 727 I Live Here Lane Mt. Pleasant, TX 75455 Cell #: (903) 867-5301 Fax #: (903) 867-530