A patient with excruciating back pain that has been getting worse over the past few months comes to the Emergency Department

Question

His chief complaint is excruciating back pain that has been getting worse over the past few months. He has also noticed decreased sensation in his lower extremities, some urinary incontinence, and feels like he never really empties his bladder all the way after voiding. Following diagnostic testing, the patient is diagnosed with advanced prostate cancer with spinal cord compression. The nurse should anticipate administering which medications to this patient? Select all that apply.
A)
Ketoconazole, a fungicide, to lower serum testosterone levels.
B)
Bisphosphonates, such as pamidronate, to inhibit bone loss
C)
Phosphate-binding agents such as aluminum hydroxide
D)
Sulfonamides with trimethoprim (Bactrim) to treat the urinary tract infection (UTI)
E)
Calcium carbonate to prevent osteoporosis

Answer 1

Ans:
A, B

Feedback:

Inhibitors of adrenal androgen synthesis (ketoconazole) are used for treatment of patients with advanced prostate cancer who present with spinal cord compression. This is because these men need rapid decreases in their testosterone levels. The bisphosphonates (pamidronate) act by inhibiting osteoclastic activity. They prevent osteopenia, prevent and delay skeletal complications in patients with metastatic bone involvement, and provide palliation of bone pain. There is no indication that this patient has a UTI. Patients with this malignancy usually have hypercalcemia, and therefore administration of calcium supplements would be contraindicated.