- Unfortunately for men, “BPH is the most common benign neoplasm in men who are at least 40 yrs of age,” Pharmacology text. Benign prostatic obstructions help slow all flow through the urinary tract system by blocking the bladder neck, therefore causing LUTS. “Two-thirds of males reported at least one LUTS complaint during their lifetime. They are directly related to the aging process, and influence patients’ lives to various degrees” (Dimitropoulos & Gravas, 2016, para. 1). research is ongoing Silva, Silva & Cruz (2014) suggest “a combination of PDE5i with alpha-blockers provides better symptomatic control than alpha-blockers alone.” PDE5’s assist with side effects of alpha-blockers such as erectile dysfunction, low sex drive, and retrograde ejaculation, an example being Sildenafil while alpha-blockers assist with BPH symptoms such as urinary hesitancy, nocturia, and urinary frequency an example being Tamsulosin. According to Chisholm-Burns, Schwinghammer, Malone, Kolesar, & Bookstaver (2019),s all patients should be treated individually per their signs and symptoms and severity of BPH. Patients with mild BPH need comparative assessment but no medication regiment in this stage (Chisholm-Burns, 2019). Patients with moderate to severe BPH should be treated with Tadalafil or Tadalafil and an adrenergic antagonist if the prostate is less than 30g (Chisholm-Burns, 2019). If the prostate is more significant than 30 g, treat a with reductase inhibitor or a reductase inhibitor and adrenergic antagonist (Chisholm-Burns, 2019).
- This patient would like to get pregnant and is taking metformin 2000mg PO daily, Lisinopril 10mg PO daily, Rosuvastatin 5mg PO daily, and a multivitamin. This patient has several comorbidities, and she would like to get pregnant. Metformin 2000mg is ok to take during pregnancy, and she can remain on the multivitamin. Metformin has a side effect of weight loss, so it is essential to monitor the patient for too much weight loss when pregnant. The concerns are Lisinopril and Rosuvasatatin since both are contraindicated during pregnancy. According to Podymow & August (2008), “Labetalol, a nonselective β-blocker with vascular α1-receptor blocking capabilities, has gained wide acceptance in pregnancy.” Another medication that has gained acceptance is Methyldopa and to use labetalol as a second-line agent. Taking Rosuvastatin during pregnancy can be dangerous because cholesterol is essential to fetal development and statins inhibit cholesterol production, it is hazardous to take statins during pregnancy (Ofori, Rey, Berard, 2007) NSG-533-Advanced Pharmacology Module III – Men’s and Women’s Health Discussion.
- Pharmacology Discussion 3
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- Dianne Cohen posted Sep 17, 2020 6:51 PM
- 32-year-old female patientFirst, her daily multivitamin should be replaced with prenatal vitamins that also supply the necessary amounts of folic acid to prevent neural tube defects in the baby (Moore et al., 2020). Next, I would address the Lisinopril which is an angiotensin enzyme converting inhibitor (ACE inhibitor). Magee and von Dadelszon write that due to its toxic renal effects during pregnancy, a safer alternative such as methyldopa with a proven research-based safety record warrants its use(2018). In conclusion, the medical management of women attempting to become pregnant is often complicated by an extensive medical history. Whenever possible, it is best to use evidenced-based research when prescribing medications and consult with the obstetrician in order to provide the best possible care for mother and baby.References I would begin my evaluation of my male patient with a complete medical history including all current prescription and non-prescription medications. For example, an over the counter diuretic may increase urgency, and antihistamines commonly found in allergy medicines can lead to urinary retention thus both mimicking lower urinary tract symptoms (LUTS) (Alcarez et al., 2016). Appropriate labs based on patient history include a urinalysis and culture to rule out an infection that also causes LUTS. According to Carbone et al., blood work should include the prostate-specific antigen (PSA) especially if the patient refused a DRE which can also identify an enlarged prostate and other underlying conditions (2016). In conclusion, selecting a medication to treat BPH requires careful consideration and periodic reevaluation especially in the elderly population. Initially, Terazosin probably was an appropriate choice but due to the patients advanced age and presenting symptoms it requires a vigorous and thorough reevaluationReferences https://docs.google.com/document/d/1hVA1-Kcbb-g-sCVdViw0Izuyy3e8DVsJ_7BqvMFMUeU/edit?usp=sharing
- Woodard, T., Manigault, K., McBurrows, N., Wray, T., Woodard, L., (2016). Management of Benign Prostatic Hyperplasia in Older Adults. The Consultant Pharmacist, 31(8).
- Yuan, J. Q., Mao, C., Wong, S. Y., Yang, Z. Y., Fu, X. H., Dai, X. Y., & Tang, J. L. (2015). Comparative Effectiveness and Safety of Monodrug Therapies for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: A Network Meta-analysis. Medicine, 94(27), e974. https://doi.org/10.1097/MD.0000000000000974
- Carbone, A., Fuschi, A., Al Rawashdah, S. F., Al Salhi, Y., Velotti, G., Ripoli, A., Autieri, D., Palleschi, G., & Pastore, A. L. (2016). Management of lower urinary tract symptoms associated with benign prostatic hyperplasia in elderly patients with a new diagnostic, therapeutic, and care pathway. International Journal of Clinical Practice, 70(9), 734–743. https://doi-org.wilkes.idm.oclc.org/10.1111/ijcp.12849
- Alcaraz, A., Carballido-rodríguez, J., Unda-urzaiz, M., Medina-lópez, R., Ruiz-cerdá, J.,L., Rodríguez-rubio, F., García-rojo, D., Brenes-bermúdez, F.,J., Cózar-olmo, J.,M., Baena-gonzález, V., & Manasanch, J. (2016). Quality of life in patients with lower urinary tract symptoms associated with BPH: change over time in real-life practice according to treatment–the QUALIPROST study. International Urology and Nephrology, 48(5), 645-656. https://dx.doi.org.wilkes.idm.oclc.org/10.1007/s11255-015-1206-7
- At this point, if I successfully ruled out all possible explanations for the patient’s current condition, I would turn my focus to the Terazosin. Terazosin is a nonselective alpha 1 receptor antagonist which was originally developed as an antihypertensive agent. It has the ability to block a wide distribution of alpha receptors in the vascular and central nervous system which in elderly individuals can cause hypotension, fatigue, and dizziness (Yuan et al., 2015) A more appropriate choice based on the patient’s age and symptoms is Tamsolosin which has less effect on blood pressure possibly due to its higher selectivity for alpha 1 receptors (Woodard, 2016). It works by relaxing the muscles in the prostate and bladder allowing urine to flow easily. My recommendation is Tamsulosin 4mg, daily taken thirty minutes after eating NSG-533-Advanced Pharmacology Module III – Men’s and Women’s Health Discussion.
- Next, a complete physical exam facilitates a correct diagnosis and should include a digital rectal exam (DRE) since there is suspected prostate involvement. Benign prostatic hyperplasia is a nonmalignant overgrowth of the prostate gland that is commonly seen in aging men. An enlarged prostate impairs the bladder’s ability to fully empty and contributes to LUTS (Carbone et al., 2016).
- 82-year-old male patient
- Shun Zhang, Haoyan Tu, Jun Yao, Jianghua Le, Zhengxu Jiang, Qianqian Tang, Rongrong Zhang, Peng Huo, & Xiaocan Lei. (2020). Combined use of Diane-35 and metformin improves the ovulation in the PCOS rat model possibly via regulating the glycolysis pathway. Reproductive Biology and Endocrinology, 18(1), 1–11. https://doi.org/10.1186/s12958-020-00613-z
- Moore, C. J., Perreault, M., Mottola, M. F., & Atkinson, S. A. (2020). Diet in Early Pregnancy: Focus on Folate, Vitamin B12, Vitamin D, and Choline. Canadian Journal of Dietetic Practice & Research, 81(2), 58–65. https://doi-org.ezproxy.fau.edu/10.3148/cjdpr-2019-025
- Magee, L. A., & von Dadelszen, P. (2018). State-of-the-Art Diagnosis and Treatment of Hypertension in Pregnancy. Mayo Clinic Proceedings, 93(11), 1664–1677. https://doi.org/10.1016/j.mayocp.2018.04.03
- Lundberg, G., & Mehta, L. (2018). Familial Hypercholesterolemia and Pregnancy. American College of Cardiology. https://www.acc.org/latest-in-cardiology/articles/2018/05/10/13/51/familial-hypercholesterolemia-and-pregnancy
- Berry, D., Thomas, S., Dorman, K., Ivins, A., Abreu, M., Young L., & Boggess, K. (2018). Rationale, design, and methods for the medical optimization and management of pregnancies with overt Type 2 Diabetes (MOMPOD) study. BMC Pregnancy and Childbirth, 18(1), 1–12. https://doi-org.ezproxy.fau.edu/10.1186/s12884-018-2108-3
