Alpha Blockers and 5-Alpha-Reductase Inhibitors

Every question here, with the answer

1. A client with benign prostatic hyperplasia is prescribed tamsulosin. He also takes a PDE5 inhibitor for erectile dysfunction. What is the nurse's main concern?

   1. Acute urinary retention
   2. Gynecomastia
   3. Increased PSA level
   4. A severe drop in blood pressure

   Answer: A severe drop in blood pressure

   Taking an alpha blocker together with a PDE5 inhibitor can cause a severe drop in blood pressure. Urinary retention is a complication of BPH itself, and PSA changes and gynecomastia are linked to 5-alpha-reductase inhibitors, not this interaction.

2. A client is being evaluated for new urinary symptoms before starting an alpha blocker for suspected BPH. Which is the priority before the drug is started?

   1. Checking for male pattern baldness
   2. Ruling out prostate cancer as the cause of the symptoms
   3. Teaching the client to take the drug at bedtime only
   4. Starting a PDE5 inhibitor at the same time

   Answer: Ruling out prostate cancer as the cause of the symptoms

   Prostate cancer and BPH have similar signs and symptoms, so ruling out cancer is the priority before an alpha blocker is started. The other options are not priorities named in the section, and combining with a PDE5 inhibitor is a dangerous interaction.

3. A client started finasteride for BPH two weeks ago and says, "My urine stream is no better. This pill doesn't work." Which response by the nurse is accurate?

   1. "It only works if you take it with an alpha blocker."
   2. "Take a double dose to get results faster."
   3. "Improvement takes several weeks, and the full effect comes at about 6 months."
   4. "You should stop it and ask for a different drug."

   Answer: "Improvement takes several weeks, and the full effect comes at about 6 months."

   With 5-alpha-reductase inhibitors, improvement is not seen for several weeks and maximum results occur about 6 months after starting. Stopping or doubling the dose is not supported, and the drug does not require an alpha blocker to work.

4. The nurse is teaching a client who is starting an alpha blocker for BPH. Which instructions should the nurse include? Select all that apply.

   1. Use caution when driving until you know how the drug affects you.
   2. Take the medication after the same meal each day.
   3. Take the medication only when urinary symptoms are bad.
   4. Change position slowly, especially when getting up.
   5. Stop the drug if you notice retrograde ejaculation, because it is dangerous.

   Answer: Use caution when driving until you know how the drug affects you., Take the medication after the same meal each day., Change position slowly, especially when getting up.

   Alpha blockers are taken daily after the same meal, and clients should change position slowly and use caution when driving because of hypotension, dizziness and somnolence. Retrograde ejaculation is described as harmless, and the drug is taken daily, not only when symptoms flare.

5. A client taking dutasteride for BPH says his pregnant wife sometimes splits his tablets for him. What should the nurse teach?

   1. This is safe as long as she washes her hands afterward.
   2. The tablets should be crushed and mixed with food instead.
   3. She should not handle the tablets, especially if they are crushed or broken.
   4. Splitting the tablets makes the drug work faster.

   Answer: She should not handle the tablets, especially if they are crushed or broken.

   Females, especially pregnant females, should not handle 5-alpha-reductase inhibitors, particularly crushed or broken tablets, because of the risk to them. The other options expose her to the drug or make unsupported claims.

6. A client takes dutasteride combined with an alpha blocker for BPH. Which effects should the nurse monitor for more closely because of the combination? Select all that apply.

   1. Hypertension
   2. Weakness
   3. Orthostatic hypotension
   4. Dizziness
   5. Increased urine output

   Answer: Weakness, Orthostatic hypotension, Dizziness

   When dutasteride is combined with an alpha blocker, the client has a greater chance of orthostatic hypotension, dizziness and weakness. Hypertension and increased urine output are not the risks described.