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Medications
Published in Henry J. Woodford, Essential Geriatrics, 2022
Alpha-blockers are associated with a high risk of orthostatic hypotension, may precipitate stress urinary incontinence in older women, and are neither a first- nor second-line drug for managing hypertension (see page 380).
Conservative Treatment
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Samer Shamout, Lysanne Campeau
α-Adrenergic antagonists facilitate bladder emptying by reducing bladder outlet resistance and detrusor pressure and are useful in the prevention of autonomic dysreflexia.86–89 In patients with multiple sclerosis, comparing tamsulosin to placebo improved the maximum and average flow rate and residual volume significantly after treatment.90 When given in combination with anticholinergic therapy, alpha-blockers act in a synergistic pathway and have proven to be more effective than monotherapy with either agent.91–93 Commonly used alpha-blockers are listed in Table 27.6. Table 27.7 summarizes key points related to use of oral pharmacology for NLUTD.
Common cardiac conditions, drugs and methods of assessment
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Alpha blockers (e.g., prazosin, terazosin and doxazosin) reduce peripheral arterial resistance and thereby blood pressure without increasing heart rate or decreasing output. Side effects include dizziness, postural hypotension and headache. These drugs are not commonly used in pregnancy.
Adherence and blood pressure control in patients with primary aldosteronism
Published in Blood Pressure, 2022
Thi Minh Phuong Nikrýnová Nguyen, Branislav Štrauch, Ondřej Petrák, Zuzana Krátká, Robert Holaj, Ivana Kurcová, Věra Marešová, Alena Pilková, Jan Hartinger, Petr Waldauf, Tomáš Zelinka, Jiří Widimský
Our study indicated very good blood pressure control in conservatively treated patients with PA which is also related to excellent adherence. These data correspond with previous data showing effective blood pressure reduction and correction of hypokalaemia in patients with PA [29,30]. Average dose of spironolactone in our study was 46 ± 21 mg/d and thus a marked proportion of PA patients were treated with low dose spironolactone in agreement with previous observation [30]. Prescription of eplerenone to our patients was common, mainly in males. Due to shorter half-life and inferior antihypertensive efficacy in comparison with spironolactone [31], we had to administer eplerenone twice a day and in higher doses (average dose was 80 ± 31 mg). In contrast with other studies, we were unable to manage hypertension in our patients with MR antagonist monotherapy [30]. Combination antihypertensive therapy was necessary in all patients. One of the potential explanations could be relatively higher age of our patients and/or presence of comorbidities like obesity, diabetes mellitus and/or renal dysfunction. Calcium-channel blockers and thiazide/thiazide-like diuretics were mainly used in combination with MR antagonists which is in accordance with other data [32]. Other antihypertensive classes were also used (RAS blockers, beta-blockers, alpha-blockers and centrally acting agents) depending on blood pressure values and/or individual clinical profile of our patients (for example presence of coronary artery disease, prostatic hyperplasia).
Results of purified micronized flavonoid fraction in the treatment of categorized type III chronic pelvic pain syndrome: a randomized controlled trial
Published in The Aging Male, 2020
Aytac Sahin, Musab Ali Kutluhan, Caglar Yildirim, Ahmet Urkmez, Serkan Akan, Ayhan Verit
RCTs do not support the fact that antibiotics or alpha-blockers are the primary treatment option in this patient group (Type III CPPS). However, it is considered that alpha-blockers may be part of multimodal therapy. Furthermore, it is reported that anti-inflammatory or immunomodular drugs are not effective in monotherapy, hormonal drugs cannot be offered as a primary treatment option in this group of patients, and some patients in this group have been reported to benefit from physiotherapy (perineal ESWL, acupuncture, aerobic exercise) [20]. In our study, we also think that purified micronized flavonoid fraction may be a part of Type III CPSI treatment and should be preferred as the first option especially in patients with comorbidities such as hemorrhoids and varicocele. As a matter of fact, in the study conducted by Pavone et al., patients who were admitted to urology outpatient clinic were divided into 2 groups. The study group consisted of chronic prostatitis patients and the control group consisted of patients without chronic prostatitis. Varicocele and hemorrhoids were significantly more common in the study group, (14.9–8.5% and 5.02–5.8%), respectively.
Pharmacologic therapies for the management of non-neurogenic urinary incontinence in children
Published in Expert Opinion on Pharmacotherapy, 2019
Tiernan Middleton, Pamela Ellsworth
The International Children’s Continence Society (ICCS) defines dysfunctional voiding as habitual contraction of the urethral sphincter or pelvic floor muscles during voiding. Dysfunctional voiding may result in incomplete bladder emptying, incontinence, and urinary tract infections. Dysfunctional voiding may co-exist with overactive bladder. The first-line therapy for dysfunctional voiding is behavioral with the use of biofeedback in select individuals. Pharmacologic therapy, anticholinergic agents, may be useful in those individuals with co-existent overactive bladder. The role of alpha-blockers in the management of dysfunctional voiding is not FDA approved. Limited studies have, however, evaluated the role of alpha-blockers in children with non-neurogenic bladder dysfunction. Alpha-blockers block the alpha-adrenergic receptors of the bladder neck. Alpha-blockers are thought to decrease obstruction-related detrusor over activity, by decreasing bladder outlet resistance and lowering voiding pressure. Currently, the ICCS does not recommend the use of alpha-blockers for dysfunctional voiding.