Patient Care and Monitoring

• Monitor the patient for the drug's effectiveness in relieving symptoms by using the AUA Symptom Scoring Index. Monitor to ensure that the score improves and that the patient subjectively feels that symptoms have improved. If the patient has no improvement after several weeks of a therapeutic dose of a-adrenergic antagonist or after 6 months of a 5a-reductase inhibitor, consider surgical intervention. Alternatively, if the patient was on a 5a-reductase inhibitor alone, it may be reasonable to consider adding an a-adrenergic antagonist.

• If the patient is started on an a-adrenergic antagonist, monitor the patient for hypotension, dizziness, or syncope. If present, assess the severity of each symptom. Reduce the drug dose, switch to a uroselective a-adrenergic antagonist, or discontinue the drug, as necessary. If the patient has malaise or rhinitis, reassure the patient that these are usual, but bothersome, adverse effect, that often improve with continued therapy.

• If the patient is started on a 5a-reductase inhibitor, monitor the patient for drug-induced decreased libido, erectile dysfunction, or ejaculation disorders. If severe, discontinue the drug.

Table 52-8 summarizes the adverse effects of the agents used to treat BPH and includes management suggestions for these situations.

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