AANP Family Nurse Practitioner (FNP) Certification ExamEvaluationMedium
A 72-year-old male with hypertension and benign prostatic hyperplasia (BPH) is prescribed tamsulosin. He reports feeling dizzy upon standing, particularly in the mornings. His blood pressure is 118/72 mmHg sitting and 98/60 mmHg standing. Which of the following modifications to his treatment plan is most appropriate?
- AAdd a low-dose beta-blocker to his regimen.
- BDiscontinue tamsulosin and switch to finasteride.
- CAdvise him to take tamsulosin at bedtime.
- DDecrease the dose of tamsulosin by half.
Show answer & explanationAnswer & explanation
Correct answer: C. Advise him to take tamsulosin at bedtime.
Tamsulosin is an alpha-1 blocker that can cause orthostatic hypotension, especially with the first dose or upon standing. Taking it at bedtime can help mitigate the morning dizziness by allowing the body to adjust to the medication's effects during sleep, reducing the risk of symptomatic hypotension when arising.
Why the other options are wrong
- A. Adding a beta-blocker would further lower blood pressure and exacerbate the orthostatic hypotension, which is contraindicated in this scenario.
- B. Switching to finasteride would address BPH but not the immediate symptomatic orthostatic hypotension, and finasteride has a slower onset of action for symptom relief.
- D. While dose reduction could help, taking it at bedtime is often sufficient and allows for maintaining efficacy at the prescribed dose for BPH symptoms.
Tamsulosin Administration for Orthostasis
To minimize orthostatic hypotension with tamsulosin, advise patients to take the medication at bedtime.
- Tamsulosin is an alpha-1 blocker used for BPH.
- Orthostatic hypotension is a common side effect.
- Taking at bedtime allows the body to acclimate during sleep.
Memory trick: Alpha-blocker makes you fall, bedtime dose saves you all!