pharm 3/20/25

Metformin and Kidney Function

• Metformin is commonly prescribed for diabetes management.

• Contrast agents used in imaging (like CT scans) can negatively affect kidney function.

• The risk of acute kidney injury increases significantly when a patient on metformin receives contrast, elevating toxicity levels in the kidneys.

• Key Consideration: Always check if a patient is on metformin before scheduling a CT scan involving contrast.

Guidelines for Metformin During Hospitalization

• If a patient is hospitalized:

  • Do not restart metformin until certain precautions are met to avoid kidney damage.

  • Hold metformin 48 hours before and 24 hours after using contrast.

  • Be aware that delays in discharge might require additional monitoring before resuming metformin.

Pain and Inflammation

• Understanding medications related to pain and inflammation is essential in clinical settings.

Sildenafil and Drug Interactions

• Sildenafil (Viagra) is used to treat erectile dysfunction but interacts with certain medications.

• Contraindicated Drug Class: Nitrates (like isosorbide) should not be used with sildenafil due to the risk of severe hypotension.

• Important Note: Educate patients on the signs of priapism, a surgical emergency associated with sildenafil use, highlighted in advertisements that stress urgency to seek medical attention.

Benign Prostatic Hyperplasia (BPH)

• BPH refers to the enlargement of the prostate gland, often leading to:

  • Urinary retention or difficulty urinating.

  • Frequent nighttime urination (nocturia).

• Medications: Finasteride is used for BPH; it works by blocking the conversion of testosterone to DHT (dihydrotestosterone), which reduces prostate enlargement.

  • Unlike sildenafil, finasteride is not a vasodilator and functions differently.

Differentiating Symptoms of BPH and UTIs

• Some overlapping symptoms may exist between BPH and urinary tract infections (UTIs), but:

  • UTIs are characterized by bacterial presence and may present with fever or altered mental status, which BPH does not.

  • Key differences include:

    • BPH usually involves full bladder discomfort and difficulty voiding, while UTIs typically involve burning sensation and urgency due to infection.

Patient Education for BPH Management

• Educate patients on lifestyle adjustments:

  • Hydration Tips: Encourage adequate hydration throughout the day, but advise against overdrinking before bedtime to minimize nighttime urination.

  • Limit Alcohol and Caffeine: Both can worsen BPH symptoms by increasing urine production and bladder spasms. Alcohol suppresses ADH (antidiuretic hormone), leading to increased urination.

• Encourage patients to discuss their symptoms and any medication adjustments with healthcare providers to best manage BPH symptoms.