Benign Prostatic Hypertrophy (BPH): Treatment (Nursing)

00:00 That's the symptoms of BPH. Now we're going to look at how we try to fix it. I'm going to show you 3 methods but there is a 4th one we'll talk about after these 3. We can do surgery, that's called a transurethral resection of the prostate and you'll study that in med surg and how we irrigate that and how you care for a patient following that procedure. We can use laser or we can do a prostatectomy. Now remember ectomy means removal. So that means we just remove the prostate and that 4th one, watch and see. That's what we do. They'll do an annual re-evaluation of the patient, meaning we know you got a problem, we'll just see how it progresses and then each healthcare appointment we'll keep an eye on where that progress has gone. Now let's zero in to pharmacology, what we're here for. We're going to look at the 2 drug groups that are used to treat BPH. First group, 5-alpha reductase inhibitors takes a longer onset for these guys, maybe like months before you see some kind of result from the medication, but alpha-1 adrenergic antagonist then you might see results within days to weeks. So they're much faster. So which one do you use? Should you use the first group or the second group? The answer is both. Because combined therapy is usually more effective in this particular option than monotherapy, picking one or the other. You've already seen this picture, I just want to put it up again as a quick reminder. Compare the differences in the two. Look at the difference between the bladders in both sides. Look at the prostate and the urethra. So this is what we're trying to help patients with BPH deal with. Clearly, the obstruction of the urethra is what is the most problematic. Now, the 5-alpha reductase inhibitors, these are drug names known as finasteride or dutasteride, those are the drug names that you should look for. What they can do is shrink the prostate epithelial tissue. Now looking at the graphic you can see why that would be helpful. That prostate is what's giving you trouble in emptying your bladder because that urethra has been compressed so it doesn't drain well. This group of drugs is best for people who have the mechanical obstruction. So it's most effective for those who need it most. The more severe the mechanical obstruction, those are the patients who are going to see the biggest impact. So let's look at that second group of drugs. The alpha-1 adrenergic antagonist, this means they are blockers. Right? So the drug name is tamsulosin. That's the generic one.

02:38 Now this works because it relaxes the smooth muscle in the prostate. I got more specific for you there and listed them out, the prostate's capsule and the urethra, the bladder neck, we've got those there for you but main take away concept is it relaxes the smooth muscle in the prostate.

02:54 So it helps with dynamic obstruction. The other group work with mechanical obstruction. This medication works with dynamic obstruction. So it doesn't decrease the prostate size and it also has this issue with first dose effect. For the first 8 weeks that the patient is taking this medication, we recommend that they take it at bedtime. Why? Well, first dose effect means drop in blood pressure. Like we see with blood pressure medications but this one in particular has the same effect. So that's a key point you may see come up on an exam but more importantly it's important to teach your patient "take this medication at night and know that you could experience a pretty good drop in your blood pressure so for your safety it would be better for you to lie down." Okay, inhibitors and antagonists, we've got this listed here in a great summary slide for you. So I put a star by this one because I love this format with charts for help you reviewing information and making sure it's solid in your mind. Now let me ask you a question. Why would a healthcare provider recommend the patient take an alpha-1 adrenergic antagonist at bedtime? Right, you know this one.

04:08 Because of the risk of falling due to hypotension. So that's a key patient education point and nursing intervention point for you to remember.