Outcome evaluation

O«* the peak effects of dnlg treatment are expected to occur, monUor the drug for effectiveness. Assess symptom improvement using the AUA Symptom Scoring Index. A reduction in symptom score is anticipated with symptom improvement. However, it should be noted that the AUA Symptom Score may not match the patient's perception of the bothersomeness of his voiding symptoms. If the patient perceives his symptoms as bothersome, independent of the AUA Symptom Score, consideration should be given to modifying the patient's treatment regimen. Similarly, a patient may regard his symptoms as not bothersome even though the AUA symptom score is high. In this case, the physician should objectively assess symptoms at baseline and during treatment by performing a repeat uroflowmetry, which can detect an improvement in peak and mean urinary flow rate. If the patient shows a response to treatment, instruct the patient to continue the drug regimen and have the patient return at 6-month intervals for monitoring. If the patient shows an inadequate response to treatment, the dose of a-adrenergic antagonist can be increased (except for extended-release alfuzosin) until the patient's symptoms improve or until the patient experiences adverse drug effects.

For the a-adrenergic antagonists, the severity of hypotensive-related adverse effects, which may manifest as dizziness or syncope, may require a dosage reduction or a slower up-titration of immediate-release terazosin or doxazosin, or halting the up-titration of the a-adrenergic antagonist. If the patient develops adverse effects at this dose, the drug should be discontinued. Other adverse effects of a-adrenergic antagonists are nasal congestion, malaise, headache, and ejaculation disorders. None of these generally require discontinuation of treatment and these often improve as treatment continues. For the 5a-reductase inhibitors, the most bothersome adverse effects are decreased libido, erectile dysfunction, and ejaculation disorders. In sexually active males, erectile dysfunction may be improved with erectogenic drugs; however, this adverse effect may necessitate discontinuation of treatment.

Table 52-8 Summary of Adverse Effects of «-Adrenergic Antagonists and 5a-Reductase Inhibitors and Management Suggestions

Drug Class

Adverse Reaction

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