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Monday, February 7, 2011

finasteride

Posted by Sampil 5:33 PM, under | No comments

finasteride
(fin as' teh ride)
PropeciaProscar

Pregnancy Category X

Drug class
Androgen hormone inhibitor

Therapeutic actions
Inhibits the intracellular enzyme that converts testosterone into a potent androgen (DHT); does not affect androgen receptors in the body; the prostate gland depends on DHT for its development and maintenance.

Indications
·        ProscarTreatment of symptomatic BPH; most effective with long-term use; reduces the need for prostate surgery and reduces the risk of urinary retention; with doxazosin, to reduce the risk of progression of BPH symptoms
·        Propecia: Prevention of male pattern baldness in patients with family history or early signs of loss
·        Unlabeled uses: Adjuvant monotherapy following radical prostatectomy; prevention of the progression of first-stage prostate cancer; hirsutism; male chronic pelvic pain syndrome

Contraindications and cautions
·        Contraindicated with allergy to finasteride or any component of the product, pregnancy, lactation.
·        Use cautiously with hepatic impairment.

Available forms
Tablets—1 mg (Propecia), 5 mg (Proscar)

Dosages
ADULTS
·        BPH: 5 mg daily PO with or without meals; may take 6–12 mo for response.
·        Male pattern baldness: 1 mg/day PO.
PEDIATRIC PATIENTS
Safety and efficacy not established.
GERIATRIC PATIENTS OR PATIENTS WITH RENAL INSUFFICIENCY
No dosage adjustment is needed.

Pharmacokinetics
Route
Onset
Peak
Duration
Oral
Rapid
8 hr
24 hr
Metabolism: Hepatic; T1/2: 6 hr
Distribution: Crosses placenta; may enter breast milk (not used in women)
Excretion: Feces, urine

Adverse effects
·        GI: Abdominal upset
·        GU: Impotence, decreased libido, decreased volume of ejaculation
·        Other: Gynecomastia

Interactions
·        Decreased PSA levels when measured; false decrease does not mean patient is free of risk of prostate cancer

Nursing considerations
Assessment
·        History: Allergy to finasteride or any component, hepatic impairment, pregnancy, lactation
·        Physical: Liver evaluation, abdominal examination; renal function tests, normal urine output, prostate examination

Interventions
·        Confirm that problem is BPH, and other disorders (prostate cancer, infection, strictures, hypotonic bladder) have been ruled out.
·        Administer without regard to meals; protect container from light.
·        Arrange for regular follow-up, including prostate examination, PSA levels, and evaluation of urine flow.
·        Monitor urine flow and output; increase in urine flow may not occur in all situations.
·        WARNING: Do not allow pregnant women to handle crushed or broken tablets because of risk of inadvertent absorption, adversely affecting the fetus.
·        Alert patient that libido may be decreased as well as the volume of ejaculate; usually reversible when the drug is stopped.

Teaching points
·        Take this drug once a day without regard to meals; protect from light.
·        Have regular medical follow-up to evaluate your response. Your health care provider will monitor your liver and kidney function as well as prostate-specific antigen (PSA) levels.
·        This drug has serious adverse effects on unborn babies. Do not allow a pregnant woman to handle the tablet if it is crushed or broken.
·        You may experience these side effects: Loss of libido, impotence, decreased amount of ejaculate (usually reversible when the drug is stopped); breast enlargement, tenderness.
·        Report inability to void, groin pain, sore throat, fever, weakness.

Adverse effects in Italic are most common; those in Bold are life-threatening.

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