Practice Question
A 70-year-old man presents with long-standing lower urinary tract symptoms from benign prostatic hyperplasia (BPH). He reports severe nocturia and weak stream. Physical exam and prior ultrasound show a markedly enlarged prostate. He wishes to avoid surgery. Which pharmacologic regimen is most appropriate?
Answer Choices:
Correct Answer:
tamsulosin plus finasteride
Rationale:
🔹 This patient has severe, long-standing LUTS with marked prostate enlargement, making combination pharmacologic therapy the most appropriate non-surgical option.
🔹 Tamsulosin (α-1 blocker) relaxes smooth muscle in the prostate and bladder neck, leading to rapid improvement in urine flow and reduction in nocturia and weak stream.
🔹 Finasteride (5-α-reductase inhibitor) reduces dihydrotestosterone (DHT) levels, resulting in gradual prostate shrinkage, which is especially beneficial in significantly enlarged prostates.
🔹 Combination therapy is superior to monotherapy in patients with large prostates, as it slows disease progression, reduces the risk of acute urinary retention, and lowers future need for surgery.
🔹 This regimen aligns with the patient’s wish to avoid surgery while still receiving effective, evidence-based management.
❌ Why the other options are not appropriate
❌ Watchful waiting with lifestyle changes only
🔹 Suitable for mild symptoms, but inadequate for severe nocturia, weak stream, and marked enlargement.
❌ Tadalafil monotherapy
🔹 May improve LUTS, particularly with erectile dysfunction, but does not reduce prostate size and is less effective in severe BPH.
❌ Surgical consult is necessary despite patient’s wishes
🔹 Surgery is reserved for complications (e.g., urinary retention, renal impairment), not first-line when effective medical therapy exists
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This question is from ☑️ EXAM 3 2025 which contains 42 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: General Exams
- Domain: 🚑Pharmacology
- Answer Choices: 4