Advanced Pharmacology NSG 533

5 alpha reductase inhibitors - Management of moderate to severe BPH in patients with enlarged prostate glands. Management of patients who desire medical therapy but cannot tolerate alpha-1- adrenergic antagonists and do not have predominately irritant symptoms or concomitant erectile dysfunction (Symptoms are non-bothersome, so the delay in onset would not interfere with Qol) Reduce prostate size (and PSA) and thus outlet obstruction Reverse / Slow disease progression Decrease the risk of disease complications Note: although dutasteride blocks both the Type I and Type II iso-enzymes of 5-alpha reductase while finasteride only blocks Type II, there is not a clinically significant difference in outcomes when either is used Peak effect 6-12 months, effect is only durable as long as drug is continued (prostate will return to pre-treatment size (or larger) when / if 5ARIs are stoppedFinasteride & Dutasteride reduces, but does not stop the prostate from producing PSA If PSA fails to decline by 50% after 6-12 months or an increase of 0.3 ng/L or more above the baseline nadir level, patient should be evaluated for prostate cancer. May also indicate worsening condition or non-compliance with 5 a-reductase inhibitors A patient with type 1 diabetes reports taking propranolol for hypertension. What concern does this information present for the provider? - A patient with Type 1 DM is insulin dependent for glucose control and at high risk for hypoglycemic episodes. Propanolol causes prolonged hypoglycemic episodes. Needs to switch to ACE or ARB. A provider teaches a patient who has been diagnosed with hypothyroidism about a new prescription for levothyroxine. Which statement by the patient indicates a need for further teaching? a. "I should not take heartburn medication without consulting my provider first." b. "I should report insomnia, tremors, and an increased heart rate to my provider." c. "If I take a multivitamin with iron, I should take it 4 hours after the levothyroxine." d. "If I take calcium supplements, I may need to decrease my dose of levothyroxine." - D. Calcium may reduce levothyroxine absorption. Further education is needed if the patient feels she can take half of a prescribed medication. ADRs - (androgen insufficiency) decreased libido, impotence & ejaculatory disorder, breast tenderness & enlargement Alpha-blockers - fairly rapid onset (2-4 weeks) with relatively rapid symptom resolution , durable effect (years) with AUA symptom index (AUASI) improving 30-45%. No effect on prostate size (PSA) or disease progression