Older man with nocturia, hesitancy, and uncontrollable leaking after the end of urination who is found to have an enlarged prostate on exam, most consistent with benign prostatic hyperplasia
2 potential treatments are (1) 5-alpha reductase inhibitors (finasteride, dutasteride): Lead to reduced conversion of testosterone โ> DHT โ> Less BPH over the course of months (2) Alpha-1 selective inhibitors (-zosin and tamsulosin): Relaxation of the bladder internal sphincter โ> less urethral resistance when voiding
Key idea: -zosin drugs (NOT TAMSULOSIN) also have blood pressure effects (because alpha-1 receptors lead to arteriolar constriction) and commonly lead to orthostatic hypotension and dizziness, so in this patient with orthostatic hypotension due to autonomic dysfunction, we would opt for tamsulosin or a 5-alpha reductase inhibitor
submitted by โyotsubato(1208)
Doxazosin is not given because he has a history of orthostatic hypotension.