Question 1

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:

Accepted Answer

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.

Question 2

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:

Accepted Answer

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.

Question 3

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]?

Accepted Answer

Tadalafil should be taken no more than once a day and without regard to meals. Tadalafil has a half-life of 17.5 hours and should not be taken twice a day. Men with moderate renal or hepatic insufficiency should take a reduced dosage. This patient may be confusing the actions of tadalafil and prazosin.

Question 4

Which are contraindications for taking sildenafil [Viagra]?

Accepted Answer

Men who take nitroglycerin should not take sildenafil, because at least 24 hours should elapse between taking nitroglycerin and taking sildenafil. Because sildenafil is associated with the development of NAION, patients with that disorder in one eye should not take sildenafil. Patients with low blood pressure should use caution in taking sildenafil, but it is not contraindicated. Patients who have had an MI in the past 6 months should use caution in taking sildenafil.

Question 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:

Accepted Answer

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.

Question 6

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?

Accepted Answer

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.

Question 7

A healthy male patient who does not have erectile dysfunction asks about medications to improve sexual stamina. What will the nurse tell this patient?

Accepted Answer

Medications for ED will have little or no effect on erection quality or duration in otherwise healthy men who do not have ED. These medications will not cause priapism in otherwise healthy men.

Question 8

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 3 or 4 times a week. What should the nurse tell the patient?

Accepted Answer

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.

Question 9

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?

Accepted Answer

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.

Question 10

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?

Accepted Answer

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.

Question 11

A patient who has erectile dysfunction asks about medications to treat this disorder, but tells the nurse he does not want to have to plan sexual activity several hours in advance. Which medication will the nurse expect the provider to order for this patient?

Accepted Answer

Avanafil is used to treat ED and, unlike the other agents, has a shorter onset of action, with effects occurring in 15 minutes after taking the drug and may be taken 30 minutes prior to intercourse. The other agents must be taken 2 hours prior to intercourse.

Quiz 66: Drugs for Erectile Dysfunction and Benign Prostatic Hyperplasia