Terazosin

INTRODUCTION

Indications

Mild-to-moderate hypertension (alone or with other agents). Urinary outflow obstruction in patients with prostatic hyperplasia.

Action

Dilates both arteries and veins by blocking postsynaptic alpha₁-adrenergic receptors. ↓ contractions in smooth muscle of the prostatic capsule. Therapeutic Effects: Lowering of blood pressure. ↓ symptoms of prostatic hyperplasia (urinary urgency, hesitancy, nocturia).

Adverse Reactions/Side Effects

CNS: dizziness, headache, weakness, drowsiness, nervousness. EENT: nasal congestion, blurred vision, conjunctivitis, sinusitis. Resp: dyspnea. CV: first-dose orthostatic hypotension, arrhythmias, chest pain, palpitations, peripheral edema, tachycardia. GI: nausea, abdominal pain, diarrhea, dry mouth, vomiting. GU: erectile dysfunction, urinary frequency. Derm: pruritus. Metab: weight gain. MS: arthralgia, back pain, extremity pain. Neuro: paresthesia. Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). Document whether drug therapy is successful in controlling hypertension. Also, be alert for a fall in BP and related symptoms (dizziness, syncope) that occurs when the patient changes position (orthostatic hypotension), especially after the initial doses. Document orthostatic hypotension and contact physician when systolic BP falls >20 mm Hg or diastolic BP falls >10 mm Hg.

• If treating benign prostate hypertrophy (BPH), monitor signs 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 BPH symptoms to help determine the effects of drug therapy.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Assess dizziness and weakness 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.

• Assess any breathing problems, and report signs of difficult or labored breathing.

• Be alert for signs of depression, nervousness, or other changes in mood and behavior. Notify health care professional if these changes become problematic.

• Assess any back or joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess signs of paresthesia including numbness, tingling, and muscle weakness. Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic ...