Lehne CH 66 - mens health, Lehne 9th Edition
Chapter 80: Other Gastrointestinal Drugs, Lehne
9th Edition Chapter 79: Laxatives, Chapter 14,
Muscarinic Agonists and Antagonists, Chapter
66, Drugs for Erectile Dysfunction and Benign
Prostatic Hyperplas
1. A male patient is being treated for benign prostatic hyperplasia (BPH) by another provider but
cannot remember which drug he is taking. He comes to the clinic seeking treatment for erectile
dysfunction and receives a prescription for sildenafil [Viagra]. What will the nurse teach this
patient?
a.
"Sildenafil is not safe to take in conjunction with finasteride [Proscar]."
b.
"Sildenafil is safe with any medication for benign prostatic hyperplasia."
c.
"To be safe, you should have a transurethral resection before starting sildenafil."
d.
"You should not take sildenafil if you are taking silodosin [Rapaflo]." ANS: D
Sildenafil should not be taken with alpha1-adrenergic antagonists, such as silodosin, because of
the risk of severe decreases in blood pressure. Finasteride is not an alpha1-adrenergic antagonist
and may be taken with sildenafil. Not all medications for BPH are safe to take with sildenafil.
Invasive treatments for BPH are used when symptoms are severe.
2. A nurse is teaching a patient about the use of sildenafil [Viagra] for erectile dysfunction.
Which statement by the patient indicates understanding of the teaching?
a.
"If my erection lasts longer than 4 hours, I should contact my provider."
b.
"I should not use nitroglycerin within 12 hours of using sildenafil."
c.
"I should take this drug about 15 minutes before sexual activity."
d.
"This drug may cause me to have an erection when I don't want one." ANS: A
Priapism can occur and can cause tissue damage to the penis, so an erection lasting longer than 4
hours should be reported. Patients who use nitroglycerin should not use sildenafil within 24
hours of taking this drug. Patients should be advised to take sildenafil 30 minutes to 4 hours
before anticipated sexual activity. Sildenafil does not cause an erection without sexual stimuli.
3. A 68-year-old male patient receives a prescription for 25-mg tablets of sildenafil [Viagra] for
erectile dysfunction. When he asks the nurse how to take the medication, the nurse will tell him
to:
a.
,begin taking one tablet twice daily, 12 hours apart.
b.
start with one tablet about 1 hour before anticipated sexual activity.
c.
take 25 to 100 mg per dose 30 minutes to 4 hours before sexual activity.
d.
take two tablets 1 hour before sexual activity with a high-fat meal. ANS: B
Patients older than 65 years should start with a low dose of 25 mg and may take the drug 1 hour
before anticipated sexual activity. Sildenafil is taken when needed and not on a routine basis.
Dosing at 25 to 100 mg per dose 30 minutes to 4 hours before sexual activity is the standard
recommendation for men younger than 65 years. Two tablets is a high dose; consumption of a
high-fat meal would interfere with absorption of sildenafil.
4. A nurse is obtaining a history from a patient who will receive tadalafil [Cialis] for erectile
dysfunction. The patient reports that he expects to have sexual activity three or four times a
week. What should the nurse tell the patient?
a.
Adverse effects of tadalafil resolve more quickly than those of sildenafil.
b.
There is an increased risk of priapism with frequent sexual activity.
c.
He should take tadalafil 30 to 60 minutes before sexual activity.
d.
He should talk to his provider about daily dosing of tadalafil. ANS: D
Tadalafil is approved for daily dosing and can be given daily for men who anticipate sexual
activity twice a week or more. Tadalafil has longer effects—up to 36 hours—than sildenafil, and
adverse effects take longer to resolve. There is no increased risk of priapism associated with an
increase in sexual activity. Because tadalafil has longer effects, dosing and sexual activity do not
have to be closely timed.
5. A male patient tells the nurse he awakens once or twice each night to void and has difficulty
starting his stream of urine. He describes these symptoms as "annoying." The patient's provider
examines him and notes that the prostate is moderately enlarged. The patient is sexually active
and tells the nurse that he does not want to take any medication that will interfere with sexual
function. The nurse anticipates the provider will order:
a.
doxazosin [Cardura].
b.
finasteride [Proscar].
c.
silodosin [Rapaflo].
d.
a transurethral prostatectomy. ANS: A
Nonselective alpha1-adrenergic antagonists do not commonly affect sexual function and are
useful in patients with mild to moderate symptoms, so doxazosin would be a drug of choice for
this patient. Finasteride is a 5-alpha-reductase inhibitor and is used for patients with more severe
, enlargement of the prostate; it also reduces ejaculate volume and libido. Silodosin is a selective
alpha1-adrenergic antagonist and can cause abnormal ejaculation. Transurethral prostatectomy is
reserved for patients with more severe enlargement of the prostate.
6. A patient who has erectile dysfunction asks a nurse whether sildenafil [Viagra] would be a
good medication for him to take. Which aspect of this patient's history would be of most
concern?
a.
Benign prostatic hypertrophy
b.
Mild hypertension
c.
Occasional use of nitroglycerin
d.
Taking finasteride ANS: C
Patients taking nitroglycerin should not take sildenafil. Having BPH is not a contraindication.
Mild hypertension requires caution but is not a contraindication. Patients with BPH taking
finasteride may take sildenafil.
7. A patient with a history of benign prostatic hyperplasia is admitted to the unit. The patient is
taking multiple medications, including terazosin [Hytrin]. During the evening rounds, the patient
begins to complain of dizziness and nasal congestion. Upon assessment, the patient is somnolent
and has a blood pressure of 101/42 mm Hg. The nurse is correct to suspect:
a.
priapism.
b.
sinus infection.
c.
allergic reaction.
d.
adverse effects. ANS: D
The principal adverse effects of terazosin and doxazosin are hypotension, fainting, dizziness,
somnolence, and nasal congestion. No evidence indicates priapism, sinus infection, or an allergic
reaction.
8. Tadalafil [Cialis] was prescribed 4 weeks ago for a patient with erectile dysfunction. The
patient also takes prazosin [Minipress] for hypertension. Which statement by the patient best
demonstrates understanding of the use of tadalafil [Cialis]?
a.
"I can take this up to 2 times a day, just before intercourse."
b.
"I have a little renal trouble, so I should take a higher dose."
c.
"I should take this medication with food."
d.
"I should take this medication no more than once a day." ANS: D
Chapter 80: Other Gastrointestinal Drugs, Lehne
9th Edition Chapter 79: Laxatives, Chapter 14,
Muscarinic Agonists and Antagonists, Chapter
66, Drugs for Erectile Dysfunction and Benign
Prostatic Hyperplas
1. A male patient is being treated for benign prostatic hyperplasia (BPH) by another provider but
cannot remember which drug he is taking. He comes to the clinic seeking treatment for erectile
dysfunction and receives a prescription for sildenafil [Viagra]. What will the nurse teach this
patient?
a.
"Sildenafil is not safe to take in conjunction with finasteride [Proscar]."
b.
"Sildenafil is safe with any medication for benign prostatic hyperplasia."
c.
"To be safe, you should have a transurethral resection before starting sildenafil."
d.
"You should not take sildenafil if you are taking silodosin [Rapaflo]." ANS: D
Sildenafil should not be taken with alpha1-adrenergic antagonists, such as silodosin, because of
the risk of severe decreases in blood pressure. Finasteride is not an alpha1-adrenergic antagonist
and may be taken with sildenafil. Not all medications for BPH are safe to take with sildenafil.
Invasive treatments for BPH are used when symptoms are severe.
2. A nurse is teaching a patient about the use of sildenafil [Viagra] for erectile dysfunction.
Which statement by the patient indicates understanding of the teaching?
a.
"If my erection lasts longer than 4 hours, I should contact my provider."
b.
"I should not use nitroglycerin within 12 hours of using sildenafil."
c.
"I should take this drug about 15 minutes before sexual activity."
d.
"This drug may cause me to have an erection when I don't want one." ANS: A
Priapism can occur and can cause tissue damage to the penis, so an erection lasting longer than 4
hours should be reported. Patients who use nitroglycerin should not use sildenafil within 24
hours of taking this drug. Patients should be advised to take sildenafil 30 minutes to 4 hours
before anticipated sexual activity. Sildenafil does not cause an erection without sexual stimuli.
3. A 68-year-old male patient receives a prescription for 25-mg tablets of sildenafil [Viagra] for
erectile dysfunction. When he asks the nurse how to take the medication, the nurse will tell him
to:
a.
,begin taking one tablet twice daily, 12 hours apart.
b.
start with one tablet about 1 hour before anticipated sexual activity.
c.
take 25 to 100 mg per dose 30 minutes to 4 hours before sexual activity.
d.
take two tablets 1 hour before sexual activity with a high-fat meal. ANS: B
Patients older than 65 years should start with a low dose of 25 mg and may take the drug 1 hour
before anticipated sexual activity. Sildenafil is taken when needed and not on a routine basis.
Dosing at 25 to 100 mg per dose 30 minutes to 4 hours before sexual activity is the standard
recommendation for men younger than 65 years. Two tablets is a high dose; consumption of a
high-fat meal would interfere with absorption of sildenafil.
4. A nurse is obtaining a history from a patient who will receive tadalafil [Cialis] for erectile
dysfunction. The patient reports that he expects to have sexual activity three or four times a
week. What should the nurse tell the patient?
a.
Adverse effects of tadalafil resolve more quickly than those of sildenafil.
b.
There is an increased risk of priapism with frequent sexual activity.
c.
He should take tadalafil 30 to 60 minutes before sexual activity.
d.
He should talk to his provider about daily dosing of tadalafil. ANS: D
Tadalafil is approved for daily dosing and can be given daily for men who anticipate sexual
activity twice a week or more. Tadalafil has longer effects—up to 36 hours—than sildenafil, and
adverse effects take longer to resolve. There is no increased risk of priapism associated with an
increase in sexual activity. Because tadalafil has longer effects, dosing and sexual activity do not
have to be closely timed.
5. A male patient tells the nurse he awakens once or twice each night to void and has difficulty
starting his stream of urine. He describes these symptoms as "annoying." The patient's provider
examines him and notes that the prostate is moderately enlarged. The patient is sexually active
and tells the nurse that he does not want to take any medication that will interfere with sexual
function. The nurse anticipates the provider will order:
a.
doxazosin [Cardura].
b.
finasteride [Proscar].
c.
silodosin [Rapaflo].
d.
a transurethral prostatectomy. ANS: A
Nonselective alpha1-adrenergic antagonists do not commonly affect sexual function and are
useful in patients with mild to moderate symptoms, so doxazosin would be a drug of choice for
this patient. Finasteride is a 5-alpha-reductase inhibitor and is used for patients with more severe
, enlargement of the prostate; it also reduces ejaculate volume and libido. Silodosin is a selective
alpha1-adrenergic antagonist and can cause abnormal ejaculation. Transurethral prostatectomy is
reserved for patients with more severe enlargement of the prostate.
6. A patient who has erectile dysfunction asks a nurse whether sildenafil [Viagra] would be a
good medication for him to take. Which aspect of this patient's history would be of most
concern?
a.
Benign prostatic hypertrophy
b.
Mild hypertension
c.
Occasional use of nitroglycerin
d.
Taking finasteride ANS: C
Patients taking nitroglycerin should not take sildenafil. Having BPH is not a contraindication.
Mild hypertension requires caution but is not a contraindication. Patients with BPH taking
finasteride may take sildenafil.
7. A patient with a history of benign prostatic hyperplasia is admitted to the unit. The patient is
taking multiple medications, including terazosin [Hytrin]. During the evening rounds, the patient
begins to complain of dizziness and nasal congestion. Upon assessment, the patient is somnolent
and has a blood pressure of 101/42 mm Hg. The nurse is correct to suspect:
a.
priapism.
b.
sinus infection.
c.
allergic reaction.
d.
adverse effects. ANS: D
The principal adverse effects of terazosin and doxazosin are hypotension, fainting, dizziness,
somnolence, and nasal congestion. No evidence indicates priapism, sinus infection, or an allergic
reaction.
8. Tadalafil [Cialis] was prescribed 4 weeks ago for a patient with erectile dysfunction. The
patient also takes prazosin [Minipress] for hypertension. Which statement by the patient best
demonstrates understanding of the use of tadalafil [Cialis]?
a.
"I can take this up to 2 times a day, just before intercourse."
b.
"I have a little renal trouble, so I should take a higher dose."
c.
"I should take this medication with food."
d.
"I should take this medication no more than once a day." ANS: D
