DRUG DOSAGE THERAPEUTIC ADVERSE CONTRAINDICATION NURSING

ACTION EFFECTS CONSIDERATIONS

finasteride 0.4 mg orally Tamsulosin helps Tamsulosin is Sulfonamide Tamsulosin is used
Proscar once a day; reduce the taken once a day, hypersensitivity to treat BPH.
the dose may symptoms of an usually in the Tamsulosin is a non- Nursing
be increased enlarged prostate morning after arylamine Considerations:
to 0.8 mg gland by relaxing breakfast or the sulfonamide Avoid using with
orally once a the muscles in the first meal of the derivative. In other alpha-
day in patients bladder and day. The main patients with blockers.
who fail to prostate so you side effects of sulfonamide Tamsulosin is
respond to 0.4 can pee more tamsulosin are hypersensitivity, contraindicated
mg once a day easily. When you feeling dizzy and allergic reaction to with strong CYP3A4
within 2 to 4 first take problems when tamsulosin has been inhibitors such as
weeks tamsulosin, it may men ejaculate rarely reported. If a ketoconazole.
make you feel (such as little or patient reports a Assess and monitor
Renal Dose dizzy or no semen). serious or life- blood pressure,
Adjustments lightheaded. If threatening especially after first
Renal this happens it's Dizziness, sulfonamide allergy, dose because
impairment best to sit or lie lightheadedness, the manufacturer tamsulosin may
(CrCl greater down until your drowsiness, advises caution cause orthostatic
than 10 feel better. runny/stuffy when administering hypotension.
mL/min): No nose, or tamsulosin.
adjustment Tamsulosin is in a ejaculation However, What teaching
recommended class of problems may tamsulosin is not needs to be
End-stage medications occur. If any of contraindicated for included to the
renal disease called alpha these effects last use in patients with patient taking
(CrCl less than blockers. It works or get worse, tell sulfonamide allergy. tamsulosin? Take
10 mL/min): by relaxing the your doctor or Based on clinical tamsulosin exactly
Data not muscles in the pharmacist trials and post- as directed. Do not
available prostate and promptly. marketing take more or less of
bladder so that experience with it or take it more
Liver Dose urine can flow To reduce the tamsulosin, the often than
Adjustments easily. risk of dizziness potential for cross- prescribed by your
Mild or and reactivity in patients doctor. Swallow
moderate lightheadedness, with sulfonamide tamsulosin
hepatic get up slowly allergy has not been capsules whole; do
impairment: when rising from established. In post- not split, chew,
No a sitting or lying marketing crush, or open
adjustment position. experience, allergic- them. Your doctor
recommended type reactions (such will probably start
Severe hepatic Remember that as skin rash, you on a low dose
impairment: this medication pruritus, urticaria, of tamsulosin and
Data not has been and angioedema of may increase your
available prescribed the tongue, lips, and dose after 2 to 4
because your face) have been weeks.
Dose doctor has reported in some
Adjustments judged that the cases, and, in very What are the
For patients benefit to you is rare cases, in nursing
who do not greater than the patients who had a considerations and
respond to the risk of side history of sulfa patient teaching for
0.4 mg dose effects. Many allergy acetaminophen?
after 2 to 4 people using this (manufacturer data Instruct patients to
weeks, the medication do on file). According never take more
dose may be not have serious to the than 4,000 mg of
increased to side effects. manufacturer, acetaminophen per
0.8 mg orally clinical trials with 24 hours. This
once a day Rarely, males tamsulosin did not includes all forms
may have a screen for or of acetaminophen
painful or exclude patients and
prolonged with a history of acetaminophen-
erection lasting 4 sulfonamide allergy; containing
or more hours. If therefore, the products. Do not
this occurs, stop actual potential for take
using this drug sulfonamide cross- acetaminophen
and get medical reactivity with with alcohol due to
help right away, tamsulosin is the risk of liver
or permanent unknown. Non- toxicity. Educate
problems could arylamine that
occur. sulfonamide acetaminophen can
derivatives (e.g., increase
tamsulosin) have anticoagulant
been reported to be effects.
proposed to have a
lower risk of allergic
reactions in patients
with sulfonamide
allergy, presumably
due to the lack of
one of the proposed
structural sites of
action for
sulfonamide allergy
(arylamine group in
the N4 position).
One large
retrospective cohort
study has reported
that in patients with
the presence of an
allergic reaction
after exposure to a
sulfonamide
antibiotic, 9.9% had
an allergic reaction
after receiving a
non-antibiotic
sulfonamide
derivative, and 1.6%
of patients who
lacked an allergic
reaction after
sulfonamide
antibiotic exposure
had an allergic
reaction after
administration of a
 non-antibiotic
sulfonamide
derivative (adjusted
odds ratio 2.8; 95%
CI, 2.1—3.7). A
causal relationship
between
sulfonamide
hypersensitivity and
allergic reactions
with non-arylamine
sulfonamide
derivatives has not
been definitively
established and
remains
controversial. In
general, patients
with a documented
sulfonamide allergy
are considered to be
predisposed for
development of
allergic drug
reactions. Until
further data are
available, caution is
prudent when
administering
sulfonamide
derivatives to
patients with a
documented
sulfonamide
hypersensitivity.
Tamsulosin Dosage Forms Finasteride is in a Finasteride can Finasteride is Many people take
Hcl(Tamsulosin & Strengths class of give you side contraindicated in it for many months
) 1mg medications effects such as those with or even years
(Propecia) called 5-alpha not being able to hypersensitivity to without any
5mg (Proscar) reductase get an erection any component of problems.
inhibitors. (impotence) and the formulation. However, there
Benign Finasteride treats having less Finasteride is have been reports
Prostatic BPH by blocking interest in sex. contraindicated in of breast cancer in
Hyperplasia the body's These side children. some men taking
Proscar: 5 mg production of a effects usually Furthermore, finasteride, but this
PO qDay; male hormone pass after a finasteride is is rare. Speak to
assess that causes the while. If these contraindicated in your doctor if you
response after prostate to side effects do pregnant women or get any changes in
12 weeks to 6 enlarge. not go away, are women of your chest area
months Finasteride treats worrying you or childbearing age. such as lumps, pain
male pattern hair affecting your sex or swelling, or
Androgenic loss by blocking life, speak to Women and discharge from
Alopecia the body's your doctor. children should not your nipples.
 (Men Only) production of a use this medicine.
Propecia: 1 male hormone in Women who are
mg PO qDay the scalp that pregnant or may
for at least 3 stops hair growth. become pregnant
months should not handle
crushed or broken
Female tablets. Finasteride
Hirsutism can be absorbed
(Off-label) through the skin
5 mg PO qDay and cause birth
defects in male
Dosage babies.
Modifications
Renal
impairment:
Dose
adjustment
not necessary
Hepatic
impairment:
Caution in
liver
dysfunction;
monitor

trospium Overactive Trospium Dry mouth, General Take tablet 1 hour

chloride Bladder antagonizes the constipation, Information before meals or on
Immediate effect of stomach upset, Trospium is an empty
release: 20 mg acetylcholine on headache, dry contraindicated in stomach at least 1
PO twice daily muscarinic eyes, dizziness, patients who have hour before meal
Extended receptors in blurred vision, or
demonstrated
Release: 60 cholinergic ally drowsiness may Alcohol should not
hypersensitivity to
mg PO qDay innervated occur. If any of be consumed
organs. Its these effects last the drug or its within 2 hours of
Renal parasympatholytic or get worse, tell ingredients. administration.
Impairment action reduces the your doctor or Anticholinergic
CrCl <30 tonus of smooth pharmacist medications Obtain a complete
mL/min: 20 muscle in the promptly. Trospium exhibits health history
mg immediate bladder. anticholinergic including
release PO Trospium activity that may be cardiovascular
qHS; extended chloride, additive to other disease, diabetes,
release not tolterodine anticholinergic and pregnancy.
recommended tartrate,
medications.
CrCl≥30 fesoterodine Evaluate laboratory
Avoid ethanol
mL/min: Dose fumarate and findings such as
ingestion
adjustment propiverine electrolytes,
not provided hydrochloride Avoid ethanol glucose, complete
by seem to have the ingestion within 2 blood count, renal
manufacturer; most unfavorable hours of taking function studies
monitor for properties with trospium extended-
increased regard to release capsules. Obtain baseline
adverse increased heart weight, vital signs
effects rate side effect Prostatic especially blood
when compared hypertrophy, renal pressure and pulse.
Hepatic to the other disease, renal
Impairment antimuscarinic failure, renal Assess for adverse
Use with drugs impairment, urinary effects such as
caution; dose (darifenacin retention, urinary hypotension,
adjustment hydrobromide, tract obstruction palpitations,
not provided solifenacin Due to the dizziness,
by succinate and anticholinergic abdominal cramps,
manufacturer oxybutynin effects, trospium is diarrhea,
hydrochloride). headache, nausea,
contraindicated in
and vomiting.
patients with
urinary retention. Teach the patient
Anticholinergics to rise from lying or
may precipitate sitting, to standing
urinary retention in slowly to avoid
patients with dizziness or falls.
preexisting urinary Teach the patient,
tract obstruction or family, or caregiver
how to monitor
prostatic
pulse and BP,
hypertrophy, so ensure the proper
caution is use and functioning
warranted. In of any home
addition, altered equipment
pharmacokinetics of obtained.
trospium occur in
renal impairment Instruct the patient
to stop taking the
(CrCl < 30 ml/min)
medication if BP is
and renal failure;
90/60 mmHg or
dosages should be below the
adjusted. Use with parameters set by
caution in other the health care
patients with provider. And
significant renal promptly notify the
disease. Extended- provider.
release dosage
Instruct patient
forms (e.g.,
who is taking
Sanctura XR) are not
potassium-wasting
recommended for diuretics (Thiazide),
use in patients with loop-diuretics
severe renal (Furosemide) to
impairment or renal consume foods
failure (CrCl < 30 high in potassium:
ml/min). fresh fruits such as
Closed-angle strawberries and
glaucoma, contact bananas, dried
lenses fruits apricots and
Trospium is prunes, vegetables
such as tomatoes,
contraindicated in dried beans, orange
patients with juice and other
uncontrolled closed- fruit juices.
angle glaucoma.
Trospium may
increase intraocular
pressure and
aqueous outflow
resistance in
patients with
closed-angle
glaucoma (also
called narrow-angle
glaucoma) so
caution is advised in
patients with
treated disease.
Trospium is not
contraindicated in
patients with
chronic open-angle
glaucoma. The
anticholinergic
effects of Trospium
may make the eyes
dry and this can
cause irritation for
wearers of contact
lenses.
Gastroesophageal
reflux disease
(GERD),
gastroparesis, GI
obstruction, ileus,
pyloric stenosis,
toxic megacolon,
ulcerative colitis
Trospium has a
direct
antispasmodic
effect on smooth
muscle that can
delay gastric
emptying and is
therefore
contraindicated in
patients with gastric
retention (e.g.,
gastroparesis, GI
obstruction, pyloric
stenosis). Trospium
is not
recommended for
use in the setting of
ileus, toxic
megacolon, or
severe ulcerative
colitis. In general,
gastroesophageal
reflux disease
(GERD) may be
aggravated using
anticholinergic
medications.
Hepatic disease
Hepatic disease
(e.g., cirrhosis) can
significantly alter
the disposition of
trospium. Caution is
advised by the
manufacturer when
administering
trospium to patients
with moderate or
severe hepatic
disease.
Driving or operating
machinery
Patients should be
advised to use
caution when
driving or operating
machinery while
receiving trospium
until the effects of
the drug are known.
Anticholinergic
drugs in general can
cause blurred vision,
dizziness, or
somnolence in some
patients. However,
CNS related side
effects are expected
to be minimal in
trospium-treated
patients as it does
not cross the blood-
brain barrier; EEG
data before and
after trospium
therapy show no
significant changes.
Continued
precautions with
driving or other
tasks are not
expected.
Autonomic
neuropathy,
myasthenia gravis
Anticholinergics in
general may
exacerbate the
clinical symptoms of
patients with
myasthenia gravis
or autonomic
neuropathy.
Pregnancy
Trospium is
classified in FDA
pregnancy risk
category C. There
are no studies of
trospium in
pregnant women.
Trospium was not
teratogenic at
statistically
significant levels in
rats or rabbits
administered doses
up to 200
mg/kg/day; this
dose corresponds to
systemic exposures
up to approximately
16 and 32 times,
respectively (based
on AUC), the clinical
exposure at the
maximum
recommended
human dose
(MRHD) of 60 mg.
Trospium should
only be used in
pregnancy if the
potential benefit
justifies the
potential risk to the
fetus.