1. 1 Alfuzosin 用於治療女性 case 之討論 適應症 AlfuzosinBenign prostatic hyperplasia Tamsulosin BPH 所伴隨的排尿障礙 TerazosinHypertension.BPH DoxazosinHypertension.BPH Alfuzosin,tamsulosin,terazosin and doxazosin are antihypertensive agents with an affinity for postsynaptic α- 1adrenergic reptors.Theseα-1 receptor antagonists relax the smooth muscle of human urethra.They have similar efficacy for the treatment of lower urinary tract symptoms suggestive of BPH.

2. 2 Machenism 1 Most men over age 50 experience enlargement of the prostate gland(benign prostatic hyperplasia [BPH]),which is characterized by urinary hesitancy, incomplete bladder emptying,incontinence, or nocturia. The selective alpha-1 adrenergic blockers have been shown to significantly increase urinary flow rates and decrease outflow obstruction and irritation symptoms, such as frequency, nocturia, urgency, and urge incontinence, associated with BPH. Alfuzosin is a selective α-1 adrenoceptor antagonist. Alfuzosin bears structural similarity to prazosin, and both are quinazoline derivatives. In vitro and in vivo studies have demonstrated potent and selective α-1 adrenoceptor antagonistic effects of alfuzosin in the genitourinary tract(proximal urethral, bladder base, prostatic, and prostatic capsule smooth muscle).

3. 3 Machenism 2 α-1 adrenergic receptor blockers may provide prompt relief of BPH symptoms,but don’t reduce prostate size. These drugs also have an antihypertensive effect. Terazosin and doxazosin, like other α-1 adrenergic blocking agents, can cause marked hypotension( especially postural hypotension) and syncope with sudden loss of consciousness with the first few doses.

4. 4 排尿障礙 以功能上來分類： ( 一 ) 儲存功能失調，如膀胱容積變小， 逼尿肌不穩定，尿道括約肌鬆弛。 ( 二 ) 排空功能失調，如逼尿肌無力，前 列腺肥大，尿道狹窄，括約肌痙攣。

5. 5 正常排尿功能 排尿過程包括了尿液注入膀胱及排出兩階 段。尿液自輸尿管慢慢注入膀胱時，交感 神經使膀胱迫肌放鬆，但膀胱頸及括約肌 收縮，因此膀胱可在低壓狀態容納更多尿 液而又不會流出體外。當儲存尿量到一定 程度，我們可感覺到尿意。在接近膀胱容 積之上限時，膀胱內之壓力升高，尿意也 增強，但成熟的膀胱括約肌可阻止尿液流 出，直到在適合的地點 ( 如廁所 ) ，膀胱迫肌 收縮，括約肌放縮，在短時間內排出絕大 部分的尿液。

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8. 8 Compare Like tamsulosin, alfuzosin is more selective for α-1 adrenergic receptors in the lower urinary tract than other drugs in its class. Although alfuzosin is less selective than tamsulosin, both drugs have a less pronounced effect on blood pressure than the other α-blockers and neither is labeled to treat hypertension. Decreases in symptom scores seemed most favorable with terazosin treatment. Adverse effect profiles of alfuzosin SR and tamsulosin are superior to the side effect profiles of doxazosin and terazosin. Sustained-release alfuzosin compares favorably with other α-1 blockers(ie,tamsulosin,terazosin,doxazosin),both in symptom and flow rate improvement and adverse effect profile.

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17. 17 Reference Micromedex Ovids 仿單 Drug fact