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INTRODUCTION

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HIGH ALERT

alfuzosin (al-fyoo-zo-sin)

Uroxatral

Classification

Therapeutic: urinary tract antispasmodics

Pharmacologic: peripherally acting antiadrenergics

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Indications
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Management of symptomatic benign prostatic hyperplasia (BPH).

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Action
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Selectively blocks alpha1-adrenergic receptors in the lower urinary tract to relax smooth muscle in the bladder neck and prostate. Therapeutic Effects: Increased urine flow and decreased symptoms of BPH.

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Adverse Reactions/Side Effects
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CNS: dizziness, fatigue, headache. Resp: bronchitis, sinusitis, pharyngitis. CV: orthostatic hypotension. GI: abdominal pain, constipation, dyspepsia, nausea. GU: erectile dysfunction.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess blood pressure when patient assumes a more upright position (lying to standing, sitting to standing, lying to sitting). Document orthostatic hypotension and contact physician when systolic blood pressure (BP) falls >20 mm Hg, or diastolic BP falls >10 mm Hg.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • Monitor signs of prostate hypertrophy such as difficulty starting a urine stream, painful urination, weak urine flow, feeling that the bladder is not completely empty, frequent nighttime urination, and an urge to urinate again soon after urinating. Document any change in symptoms to help assess the effects of drug therapy.

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Interventions
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  • To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

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Patient/Client-Related Instruction
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  • Advise patient that sexual function may be affected, and to consult physician if erectile dysfunction becomes problematic.

  • Instruct patient or family/caregivers to report other troublesome side effects such as severe or prolonged headache, fatigue, respiratory irritation, or GI problems (nausea, constipation, abdominal pain, indigestion).

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Pharmacokinetics
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Absorption: 49% absorbed following oral administration; food enhances absorption.

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Distribution: Unknown.

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Metabolism and Excretion: Mostly metabolized by the liver (CYP3A4 enzyme system); 69% eliminated in feces, 24% in urine.

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Half-life: 10 hr.

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TIME/ACTION PROFILE

ROUTE ONSET PEAK DURATION
PO-ER within hr 8 hr 24 hr

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Moderate to severe hepatic impairment; Potent inhibitors of the CYP3A4 enzyme system; Concurrent use of other alpha-adrenergic blocking agents; Severe renal impairment; OB/Pedi: No indications for women and children.

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Use Cautiously in: Congenital or acquired QTc prolongation or concurrent use of other drugs known to prolong QTc; Mild hepatic impairment; Geri: Consider age-related changes in body mass, cardiac, renal and hepatic function when prescribing.

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Interactions
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Drug-Drug: Ketoconazole, itraconazole, and ritonavir ↓ metabolism and significantly ↑ ...

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