Scribd
Upload
34 views2 pages

2024 PHM202 Assignment #1 Care Plan Template FINAL

Uploaded by

jagbirshoker102
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
34 views2 pages

2024 PHM202 Assignment #1 Care Plan Template FINAL

Uploaded by

jagbirshoker102
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 2

Patient Care Process: The Care Plan

Indication for Drug therapy (Medical condition or present illness/reason for visit): BPH

Goals of therapy (include: clinical parameter, desired value, timeframe): (4 marks)


- Improve Quality of Life with lowered AUA score by at least three points in 6 weeks
- Alleviation of BPH-LUTS (lower urinary tract symptoms (weak urine stream,____ __) in 1-6
weeks
- No complications or symptom progression of BPH in 3 -6 months
- Maintain normal PSA levels <1.2mcg/L in 6-12 months and reassess every 6 months
- Eradicate undesirable side effects (ejaculatory dysfunction) in 1 week

Drug Therapy Problems to be resolved: (1 mark)


- MC is experiencing an adverse drug reaction (ejaculatory dysfunction) from silodosin and
requires alternative therapy.

Assessment of alternatives: (10 marks)


The patient does not have an elevated PSA or significantly enlarged prostate, the use of agents
that interfere with testosterone's stimulatory effect on prostate gland enlargement—such as 5-alpha
reductase inhibitors, which reduce the static factors associated with BPH—can be eliminated.
Additionally, because MC is not experiencing predominant irritative voiding symptoms and responded
well to a1-adrenergic antagonists, the addition of anticholinergics or β3-Adrenergic agonists is ruled out.
Thus the remaining drug class that we must assess are α1-adrenergic antagonists.

In terms of efficacy, both second- and third generation α1-adrenergic antagonists are widely
used for relaxing prostatic smooth muscle, typically improving the AUA Symptom Score by 40% and
reducing scores by three to six points within six weeks. While third-generation drugs exhibit greater
selectivity for the α1A receptor and lower systemic side effects, this pharmacological distinction does
not correlate with significant differences in efficacy.

The key distinction between the 1-adrenergic antagonists drug class lies in their adverse effects,
which must be carefully considered. MC initially started treatment with silodosin, which was effective
but caused undesirable side effects, specifically ejaculatory dysfunction. Since tamsulosin, another third-
generation option, also has a notable incidence of ejaculatory disorders, it is not suitable for MC,
especially given his concerns about sexual function and therefore will be ruled out. As suggested by the
guidelines, if the patient is sexually active and experiences ejaculatory dysfunction, switching the patient
from a third generation to a second-generation α1-adrenergic antagonist has been beneficial.

This narrows our options to second-generation agents Alfuzosin is considered functionally and
clinically uroselective for treating BPH, with fewer cardiovascular adverse effects and no need for dose
titration, unlike terazosin and doxazosin. Alfuzosin is particularly suitable for MC, as he has no history of
hypertension or medications that would interact negatively with antihypertensive agents. Since MC’s
primary concern is ejaculatory dysfunction, alfuzosin is an ideal choice, as it has not been reported to
cause this side effect The convenience of once-daily dosing with alfuzosin is ideal for MC's lifestyle, and
the cost among second-generation options is relatively similar. With MC’s private insurance, medication
coverage should facilitate access to this treatment. Overall, alfuzosin presents as the optimal choice for
managing MC's BPH symptoms effectively while addressing his concerns about side effects particularly
ejaculatory dysfunction.

Interventions: (5 marks)
- Discontinuation of Silodosin (Rapaflo) 8 mg: 1 tablet PO once daily
- Recommend Md to initiate: Alfuzosin 10 mg 1 tablet PO once daily after the same meal each,
For 6 weeks
Non pharmacological
- Reduce Caffeine and Alcohol intake. Caffeine can irritate the bladder and may exacerbate MC’s
urinary symptoms (urgency, frequency, incomplete emptying). Reduce or limit coffee intake to
1 small cup or switch to decaffeinated coffee. Advise MC to monitor if this change leads to
better bladder control
- Regular Physical Activity: MC is already active, which is beneficial for prostate and
cardiovascular health. Regular physical exercise is associated with improved urinary function
and overall health. Encourage him to continue his running/jogging routine 2–3 times per week
- Fluid Management: Reducing fluid intake, particularly in the evening, can minimize nocturia
- Double Voiding: Encouraging patients to attempt to urinate again a few minutes after the initial
void can help empty the bladder more completely.
- Continue to have well balanced healthy diet
Patient Education
- Advice MC to report any severe side effects and maintaining regular follow up appointments to
assess treatment effectiveness and prostate health
- Improvement in urinary symptoms may occur within 1-2 weeks and maximal effect within 4-6
weeks when taking α1-adrenergic antagonists
Schedule to Evaluate Drug Therapy (aka Monitoring Plan):
Effectiveness Parameters: (2 marks)
Parameter Desired Value Timeframe

LUTS and Obstructive AUA symptoms score to be decreased In 1-6 weeks


symptoms by 3 points or less

Complications of Prevent progression of bph disease, 3-6 months


disease progression and minimal to no symptoms and
(UTI, bladder stones complications
etc)
Safety Parameters: (3 marks)

Parameter Desired Value Timeframe

Blood pressure Stable blood pressure readings In 1-6 weeks


( 126/83 mm Hg )without significant
drops or symptoms of orthostatic
hypotension.

Headache ( side No or minimal headache In 1-6 week while on therapy


effect )

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy