Introduction
Sildenafil Citrate, commonly known as Viagra, is a phosphodiesterase type 5 (PDE5) inhibitor used to treat erectile dysfunction (ED) and pulmonary arterial hypertension (PAH). By increasing blood flow to specific areas of the body, it helps men with ED achieve erections and reduces pulmonary pressure in PAH patients. Nurses are pivotal in managing Sildenafil therapy, ensuring patient safety through careful assessment, administration, monitoring, and education.
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Indications
Sildenafil Citrate is prescribed for:
- Erectile Dysfunction (ED): Enhances erectile function in response to sexual stimulation.
- Pulmonary Arterial Hypertension (PAH): Improves exercise capacity by dilating pulmonary blood vessels.
Note: It is not indicated for ED in women or children but is used for PAH across genders.
Nursing Assessment
Before administering Sildenafil, nurses should evaluate:
- Medical History:
- Cardiovascular disease (e.g., recent myocardial infarction, stroke)
- Hypotension or uncontrolled hypertension
- Hepatic or renal impairment
- History of priapism or penile deformities
- Eye conditions (e.g., retinitis pigmentosa)
- Medication Review:
- Contraindications: Nitrates (e.g., nitroglycerin) due to risk of severe hypotension.
- Caution: Alpha-blockers, antifungals, or protease inhibitors, which may alter Sildenafil levels.
- Psychosocial Assessment: For ED, explore psychological factors like stress or depression.
Administration and Dosage
Dosage varies by condition:
- Erectile Dysfunction (ED):
- Form: Oral tablets (25 mg, 50 mg, 100 mg)
- Dose: 50 mg taken 1 hour before sexual activity; adjustable to 25 mg or 100 mg.
- Frequency: Once daily maximum.
- Pulmonary Arterial Hypertension (PAH):
- Form: Oral tablets (20 mg) or IV
- Dose: 20 mg three times daily (4-6 hours apart); IV: 10 mg bolus if oral not feasible.
Tips:
- Food may delay absorption; high-fat meals should be avoided for ED use.
- Ensure consistent timing for PAH.
Monitoring
Nurses should monitor:
- Vital Signs: Blood pressure and pulse, especially with cardiovascular risks.
- Side Effects:
- Common: Headache, flushing, indigestion, dizziness.
- Serious: Priapism (>4 hours), sudden vision/hearing loss, chest pain.
- Efficacy: Improved erectile function (ED) or exercise tolerance (PAH).
Patient Education
Key points to teach patients:
- Usage:
- ED: Take 1 hour before activity; limit to one dose daily.
- PAH: Adhere to scheduled doses.
- Side Effects: Report prolonged erections or sensory changes immediately.
- Interactions: Avoid nitrates; disclose all medications to providers.
- Lifestyle: Limit alcohol; seek support for psychological ED factors.
Special Considerations
- Elderly: Start with lower doses (e.g., 25 mg for ED).
- Renal/Hepatic Impairment: Adjust doses; use cautiously.
- Cardiovascular Risk: Assess heart health prior to ED treatment due to physical demands of sexual activity.
Conclusion
Sildenafil Citrate is effective for ED and PAH, but its management requires diligent nursing care. Through comprehensive assessments, precise administration, vigilant monitoring, and robust patient education, nurses ensure safe and successful therapy, addressing both physical and psychosocial needs.
