Question

M.P., age 45, works as an accountant in a busy firm. He is of African-American descent. He and his wife have been married for 25 years and have two children, ages 21 and 18. His father is alive and well at age 68 but was diagnosed with BPH 5 years ago. M.P. considers himself to be in good health and has no allergies; he is approximately 15% overweight. His wife insisted that he seek medical intervention because of urinary symptomatology; he has difficulty starting his stream of urine, burning on urination, nocturia, and lower back and pelvic discomfort. The result of a PSA test, his first in over 2 years, is 3.1.

1. List the specific goals for treatment for M.P.
2. What drug therapy would you prescribe? Why?
3. What are the parameters for monitoring the success of therapy?
4. Discuss specific patient education based on the prescribed therapy.
5. List one or two adverse reactions for the selected agent that would cause you to change therapy.
6. What would be the choice for second-line therapy?
7. What over-the-counter and/or alternative medications would be appropriate for this patient?
8. What dietary and lifestyle changes should be recommended for this patient?
9. Describe one or two drug-drug or drug-food interactions for this patient.
10. Write your prescription for this patient.

Answer 1

1) The specific goals for treatment of M.P is to prevent the rising PSA level which will lead to BPH .

2) Drug therapy that would be prescribed are :-

Alpha-1 Adrenergic Blocking Agents

cause muscle relaxation allowing more urine to come out when they void, they don't affect prostrate size. Used for mild to moderate urinary obstructions.

Antiandrogen Agents Uses

Treat symptoms of BPH, reduce risks of urinary retention, minimize need for surgery for BPH, may affect the size of the prostrate gland

3) The parameters for monitoring the success of therapy are :-

In men with symptoms of BPH, a digital rectal examination and urinalysis should be performed to screen for other urologic disorders. Watchful waiting with annual follow-up is appropriate for men with mild BPH. Alpha blockers provide symptomatic relief of moderate to severe BPH symptoms.

4) Patient education :-

Patient Teaching about Generaldisorder, diagnosis, and treatment, including possible surgeryprescribed medication therapy, including drugs, dosages, frequency of administration, possible adverse reactions, and reasons to notify a practitioneravoidance of fluids for a few hours before going to bed or going out to reduce episodes of nocturia or frequency; avoidance of alcohol and caffeine, which contribute to frequency ,signs and symptoms of UTI that should be reported immediatelycommon problems that can occur after surgery, such as retrograde ejaculation after TURP reasons to seek medical care (fever, inability to void, and passage of bloody urine)importance of follow-up and monitoring every 3 to 12 monthsneed for digital rectal examination and PSA level evaluation every year.