RG, a 55-year-old male presents to your pharmacy with a new prescription. He tells you about his recent problems that resulted in his urologist prescribing Uroxatral for the treatment of Benign Prostatic Hyperplasia (BPH).

PMH: T2DM, HTN, hyperlipidemia, depression

Current medication list

• Metformin ER 750 PO mg BID
• Mounjaro 2.5 mg SQ once weekly
• Lotensin 20 mg PO QD
• Microzide 12.5 mg PO QD
• Livalo 2 mg PO QD
• Sertraline 50 mg PO QD

Which of the following statements are correct regarding Uroxatral? Select all that apply. 

A. Take with food to increase absorption

B. Monitor blood pressure while on uroxatral therapy, as it can decrease blood pressure

C. Uroxatral is a 5-alpha reductase inhibitor that works by shrinking the size of the prostate to relieve BPH symptoms

D. There is a significant interaction with sertraline that can possibly lead to serotonin syndrome

E. Uroxatral tablets may be chewed or swallowed.

Rationale:

The prostate is a heart shaped gland below the bladder. Benign Prostatic Hyperplasia (BPH) describes the proliferative process of cells within the prostate that lead to lower urinary tract symptoms (LUTS). BPH is very common with 50% of men having BPH by the age of 60. Symptoms of BPH are caused by two components: enlarged prostate tissue (due to effects of dihydrotestosterone (DHT)) and the contraction of the prostate gland (due to excessive adrenergic tone). Diagnosis of BPH is critical as there are several complications that can arise if left untreated. The main goals of therapy are to improve symptoms, halt disease progression, and prevent complications.

Answer A is correct: Taking Uroxatral with food allows for increased absorption of the medication.

Answer B is correct: Monitoring blood pressure is important for Uroxatral as it can cause decreased blood pressure especially if taken with other anti-hypertensive medications. The effect on blood pressure should be less than more nonspecific alpha-1 antagonists, such as doxazosin or prazosin. 

Answer C is incorrect: Uroxatral is an Alpha-1 Adrenergic Antagonist. It works to relax smooth muscle muscle tone to allow improved urinary flow and improve LUTS. Alpha blockers do not reduce the size of the prostate, but 5-alpha reductase inhibitors (dutasteride and finasteride) do decrease prostate size in the treatment of BPH.

Answer D is incorrect: There is not a clinically significant drug interaction between sertraline and Uroxatral.

Answer E is incorrect: Uroxatral comes in an extended release tablet and cannot be chewed or crushed.

Brand/Generics covered: Metformin ER (Glucophage ER), Tirzepatide (Mounjaro), Benazepril (Lotensin), Hydrochlorothiazide (Microzide), Pitavastatin (Livalo), Sertraline (Zoloft), Alfuzosin (Uroxatral)

NAPLEX Competencies covered:

Area 1 – Obtain, Interpret, or Assess Data, Medical, or Patient Information

1.4 - From medical records: treatment adherence, or medication-taking behavior; chief complaint, medication history, medical history, family history, social history, lifestyle habits, socioeconomic background

Area 2 – Identify Drug Characteristics

2.1 - Pharmacology, mechanism of action, or therapeutic class

2.2 - Commercial availability; prescription or non-prescription status; brand, generic, or biosimilar names; physical descriptions; or how supplied

Area 3 – Develop or Manage Treatment Plans

3.5 - Drug route of administration, dosage forms, or delivery systems

3.7 - Adverse drug effects, toxicology, or overdose

3.8 - Drug interactions

3.9 - Therapeutic monitoring parameters, monitoring techniques, monitoring tools, or monitoring frequency

 See everyone next week as you continue to prepare for the exam!

Dr. B