Rx Note

Introduction Benign Prostatic Hyperplasia (BPH) is a histologic condition of proliferation of smooth muscle and epithelial cells in prostatic transition zone. The prevalence increases with age , affecting approximately 42% of men between the ages of 51 and 60 years and 82% of men between the ages of 71 and 80 years. BPH may progresses to benign prostatic enlargement (BPE) and subsequent bladder outlet obstruction (BOO), leading to lower urinary tract symptoms (LUTS). Lower tract urinary symptoms (LUTS) may include Storage symptoms : daytime frequency, urgency, nocturia and incontinence Voiding symptoms: weak stream, dribbling, dysuria, straining Symptoms can significantly impact quality of life. Complications include acute urinary retention, urinary tract infection, bladder calculi and renal insufficiency. Treatment Principles The severity of reported BPH symptoms guides selection of treatment. Validated severity and bother scores exist, such as the American Urological Association Sym...

Introduction Last week, I encountered a prescription written: " Terazosin 1 mg OD for 3 days, then followed by 2 mg OD for 10 days ", with the next clinic appointment 2-3 months later. Indications Although terazosin is commonly used for benign prostatic hyperplasia (BPH) management (a long-term management), it can also be used off-label for ureteral stone(s) expulsion . Lexicomp : Consider for use in patients with ureteral stones >5 and ≤10 mm. Additionally, may consider for use after shock wave lithotripsy to help pass stone fragments. Adult, oral, 2 to 5 mg at bedtime until stone passage or for up to 4 weeks. NOTE: Terazosin relaxes the smooth muscle of the bladder, thus reducing bladder outlet obstruction. Among alpha-blockers, silodosin, tamsulosin and alfuzosin have less effect on BP than prazosin or terazosin and may be a better choice for BPH. Dosage Titration Since alpha-blockers may lead to postural hypotension, hence it is a common practice to start it at lo...