A Pharmacological Treatment Options Used to Treat a Disease Process - Essay Example

Benign Prostate Hypertrophy Author’s Name: Instructor’s Name: Course Details: Institutional Affiliation: Date of Submission: Benign prostate hypertrophy is a disease characterized by the proliferation of the smooth muscles and the epithelial cells that lie within the prostatic transition zone. The enlargement of the prostate results from the elevation of circulating androgens. The occurrence of benign prostate hypertrophy is associated with advancement in age. The disease affects the male population and has immense repercussions not only to the health of the individuals but also on the economy (Abrams, 2005). The proliferation of the smooth muscles and epithelial cells within the prostate leads to the formation of large and discrete nodules being found within the peri-urethral region of the prostate. When the nodules increase in size, they bring about the occurrence of lower urinary tract obstruction. The flow of urine from the bladder is thus interfered with. The interference of urine flow occurs due to the prostate having two capsules which compress the prostatic urethra on enlarging. This leads to the occasioning of storage and voiding symptoms. The storage symptoms include urinary frequency, urgency, incontinence and nocturia. On the other hand, the voiding symptoms include hesitancy, intermittency, poor stream, and terminal dribbling (Blaivas & Weiss, 2009). The diagnosis of benign prostatic hypertrophy is made based on the clinical examinations, medical imaging or tests and the clinical presentation of the patient. The clinical presentation of the patients with benign prostate hypertrophy will be characterized by features of bladder dysfunction and the obstructive symptoms. The clinical examination will entail conducting a palpation of the bladder and a digital rectal examination. Bladder palpation will be conducted to rule out the presence of acute urine retention which is a common feature and is characterized by tense, tender bladder that is dull to percussion. The digital rectal examination will entail examination of the prostate for consistency and estimation of prostates relative size. In benign prostate hypertrophy, nodules will be palpated since mucosa of the rectum moves over the prostate. The medical imaging techniques used entail the use of trans-rectal ultrasound to show the size of the prostate as well as a guide while conducting biopsy. An abdominal ultrasound will also provide insight on the size of the prostate as well as the residual urine within the prostate. The prostatic surface antigen will also be conducted to rule out the presence of a malignancy with the prostate since it is a surface maker for prostate cancer (Bolland, 2008). Various complications are associated with benign prostate hypertrophy. Examples of the complications of benign prostate hypertrophy include bladder hypertrophy, hydroureatus or hydronephrosis, renal hypertension, renal failure, recurrent urinary tract infections and urinary stone disease (Chapple, 2004). Based on Abrams (2005), the management of benign prostate hypertrophy is broadly categorized into medical and surgical forms of management. The medical therapy is most common form of management. Surgery is only conducted in incidences where the medical management fails to work. The surgical management is conduced when medical therapy fails and it entails the use of open surgery techniques such as trans-vessicular prostatectomy, retro-pubic prostatectomy, and perineal prostatectomy. Other surgical techniques used entails conducting a transurethral resection of the prostate. However, the surgical management of benign prostate hypertrophy includes erectile dysfunction, retrograde ejaculation and incontinence. Pharmacological management has undergone transformations over the years. The medication used in the management of benign prostate hypertrophy ought to be effective and has limited adverse effects. The pharmacological management provides the best non-operative option used in the management of benign prostate hypertrophy. The use of benign prostate hypertrophy is based on the knowledge of the pathological process of the disease. The medical therapy is aimed at relieving the symptoms which are associated with the enlargement of the prostate and progression of the disease (Han, Black, & Lavelle, 2007). According to McVary (2004), the current medical therapy used in the management of benign prostate hypertrophy employs the use of either adrenorecpetors or hormonal (5-alpha reductase inhibitor) mechanisms. However, the medical therapy could also involve the combination of both the adrenoreceptor and hormonal strategies. In The pharmacological management of benign prostate hypertrophy involves the use of either alpha blockers such as alfuzosin or 5-alpha reductase inhibitors which include dexozacin and datastaride (American Urologic Association Foundation, 2005). The use of alpha blockers is intended to reduce the symptoms that come with benign prostate hypertrophy as well as limiting the progression of the disease (American Urologic Association Foundation, 2005). The alpha adrenergic blockers mediate their functions by antagonizing the adrenergic receptors. The adrenergic receptors are found within the smooth muscles of the prostate, urethra and the neck of the bladder. The blockage of the adrenal receptors results in the relaxation of the smooth muscles within the prostate. There are two types of adrenergic receptors within the prostatic smooth muscles which include the alpha 1 and the alpha 2 receptors. It is the antagonistic effect of the drug on the alpha-1 receptors that relaxes the smooth muscles within the prostate. This results in the increase in the caliber outlet for the passage of urine (American Urologic Association Foundation, 2005). Based on the American Urologic Association Foundation (2005), the use of 5-alpha reductase inhibitors restrains the progression of the disease by diminishing the prostate size. In addition, 5-alpha reductase inhibitors eliminate symptoms of benign prostate hypertrophy. 5-alpha reductase is accountable for the conversion of testosterone to dihydrotestosterone. 5-alpha reductase inhibitors restrain production of dihydrotestosterone that is responsible for the androgenic effects. Inhibition of dihydrotestosterone prevents production of testosterone which plays a role in benign prostate hypertrophy development. The use of combination of both the alpha blockers and the 5 alpha reductase inhibitors is thought to be more effective than the use of the drugs separately. The medical management of benign prostate hypertrophy has been observed to offer better outcomes when the two drugs are combined. This is because the combination not only goes ahead to alleviate the symptoms associated with benign prostate hypertrophy but also brings about the involution of the prostate. However, combination therapy posses greater pharmacological risks than when the drugs are used separately (Bullock, 2006). According to the American Urologist Association Foundation (2005), benign prostate hypertrophy is well managed through the use of medical management. Medical therapy is used is the most common method that is used to control the symptoms of benign prostate hypertrophy. One of the commonly used group of drugs are the alpha blockers. The alpha-blockers which were initially being used in the management of high blood pressure are now used in benign prostate hypertrophy. The alpha-blockers mediate their functions by relaxing the smooth muscles. This tremendously improves urinary flow and at the same time the obstruction at the bladder outlet is avoided. According to Han, Black, & Lavelle (2007), even though the alpha-blockers are effective in relieving the symptoms associated with benign prostate hypertrophy, they do not cause the involution of the prostate. In addition, the side effects of the alpha blockers such as difficulty in breathing, fatigue, headaches and dizziness reduce its effectiveness in the management of benign prostate hypertrophy. The 5-alpha reductase inhibitors on the other hand are more advantageous when compared to alpha blockers since they facilitate the shrinkage of the prostate. The 5-alpa reductase inhibitors mediate the shrinking of the prostate by lowering the levels of the major male hormones which are found within the prostate. In addition, the 5–alpha reductase inhibitors also bring about the reduction of symptoms associated with benign prostate hypertrophy. However, the use of 5-alpha reductase inhibitors takes a longer time for the effects to be exhibited after being administered. Furthermore, the 5 alpha reductase inhibitors have side effects which are related to its use which include a decrease in libido, erectile and ejaculation dysfunctions (American Urologic Association Foundation, 2005). The American urologist association Foundation (2005), suggests that a combination of both the alpha blockers and drugs that shrink the prostate can also be effective in the management of benign prostate hypertrophy. It is believed the combination of the drugs prevents the progression of symptoms associated with benign prostate hypertrophy as well as preventing the occurrence of acute urinary retention. Medical therapy targets to relieve symptoms associated with benign prostate hypertrophy and its progression. Bullock (2006), suggests that the medical therapies that are presently being used in the management of benign prostate hypertrophy. The drugs used in managing benign prostate hypertrophy mainly mediate their functions by antagonizing the effects of alpha-adrenergic receptors found in the prostate and the bladder neck. This brings about relaxation of the smooth muscles. Bullock also suggests that the 5 alpha reductase enzyme brings prostates size reduction (Bullock, 2006). According to Bullock (2006) points out that the most commonly used form of medical therapy entail the use of alpha antagonists. The increased world wide use of the alpha antagonists is attributed to its selectivity to the prostate and the bladder. The alpha antagonists are very selective since they specifically act on the alpha -1- adreno-receptors. This means that minimal side effects are realized. The 5-alpha reductase inhibitors are also used in the management of benign prostate hypertrophy. The 5-alpha reductase inhibitors increase the flow rates and decrease prostate hypertrophy. The use of 5-alpha reductase inhibitors has adverse effects like loss of libido, importance and ejaculatory complications. Bullock (2006), points out that even though the 5-alpha reductase are used in the management of benign prostate hypertrophy, they are not as effective as the alpha antagonists in terms of the time of onset of action, the relieving of symptoms and increasing the flow rate. Bullock (2006), suggests that a combination therapy is more effective than when the alpha blockers are used alone. The combination therapies bring tremendous improvement in the occurrence of symptoms and the flow rates. However, the use of combination therapy is hampered by the side effect profiles and the costs incurred (Bullock, 2006). Conclusion Various forms of management are available for benign prostate hypertrophy which can be categorized broadly into the surgical and the non surgical options. However, the use of medication still provides the best avenue for non-surgical management of benign prostate hypertrophy. The medical management of benign prostate hypertrophy involves the use of either the adrenoreceptor antagonist, hormonal manipulation or a combination of the two. The alpha adrenoreceptor antagonists act quickly in providing symptomatic relief (Bullock, 2006). In addition, the alpha adrenoreceptor antagonist reduces the progression of the benign prostate hypertrophy. The hormonal manipulation strategy on the other hand employs the use of 5–alpha reductase inhibitors. The 5-alpha reductase inhibitors avert progression of the disease and cause involution of the prostate. The combination of both the adrenoreceptor antagonist and the 5–alpha reductase is associated with better outcomes of patients. The combination not only relieves the patient’s symptoms but also reduces the size of the prostate. The adverse effects associated with the combination still not yet proven or established and this discourages its use (American Urologic Association Foundation, 2005). However, the adrenoreceptor antagonists still provides the best form of pharmacological management due to its rapid effects and low incidences of adverse effects. The use of 5-alpha reductase inhibitors has reduced significantly due to the increase in cancer incidences since it interferes with the establishment of the accurate levels of tumor maker such as the protein surface antigen hence this limits the use of 5-alpha reductase inhibitors. The strategy of using the combination of both the adreno-receptors antagonist and the 5-alpha reductase inhibitor is still not being fully utilized since the effects associated with its use have not yet been established. Even though the medical therapy has some side effects, it still is the best form of management that is currently available for benign prostate hypertrophy (American Urologic Association Foundation, 2005). References Abrams, P. (2005). "Book Review Management of Benign Prostatic Hypertrophy (Current Clinical Urology.), Humana Press, 2004. New England Journal of Medicine 352.2: 211-12. American Urologic Association Foundation, (2005). Benign Prostate Hyperplasia. Journal on Treatment Choices. 1: 1-28. Blaivas, G., and Weiss, J. (2009). Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms. Philadelphia, Pa: Saunders. Bolland, W. (2008). "Benign Prostatic Hypertrophy." InnovAiT 1.9: 631-41. Bullock, T. (2006). Current Drug Therapies in the Treatment of Benign Prostatic Hyperplasia. Journal of Geriatric Health Care, Washington University. Chapple, RC. (2004). Pharmacological therapy of benign prostatic hyperplasia/lower urinary tract symptoms: An overview for the practicing clinician. British Journal Urology International 94:738-744. Han, E., Black, E. and Lavelle, E. (2007). "Incontinence Related to Management of Benign Prostatic Hypertrophy." The American Journal of Geriatric Pharmacotherapy 5.4: 324-34. McVary, T. (2004). Management of Benign Prostatic Hypertrophy. Totowa, NJ: Humana. Miller, J. and Tarter, T. (2007). "Update on the Use of Dutasteride in the Management of Benign Prostatic Hypertrophy." Clinical Interventions in Aging 2.1: 99-104. Parker, N., and Parker, P. (2002). The Official Patient's Sourcebook on Prostate Enlargement. San Diego, CA: Icon Health Publications. Read More

The medical imaging techniques used entail the use of trans-rectal ultrasound to show the size of the prostate as well as a guide while conducting biopsy. An abdominal ultrasound will also provide insight on the size of the prostate as well as the residual urine within the prostate. The prostatic surface antigen will also be conducted to rule out the presence of a malignancy with the prostate since it is a surface maker for prostate cancer (Bolland, 2008). Various complications are associated with benign prostate hypertrophy.

Examples of the complications of benign prostate hypertrophy include bladder hypertrophy, hydroureatus or hydronephrosis, renal hypertension, renal failure, recurrent urinary tract infections and urinary stone disease (Chapple, 2004). Based on Abrams (2005), the management of benign prostate hypertrophy is broadly categorized into medical and surgical forms of management. The medical therapy is most common form of management. Surgery is only conducted in incidences where the medical management fails to work.

The surgical management is conduced when medical therapy fails and it entails the use of open surgery techniques such as trans-vessicular prostatectomy, retro-pubic prostatectomy, and perineal prostatectomy. Other surgical techniques used entails conducting a transurethral resection of the prostate. However, the surgical management of benign prostate hypertrophy includes erectile dysfunction, retrograde ejaculation and incontinence. Pharmacological management has undergone transformations over the years.

The medication used in the management of benign prostate hypertrophy ought to be effective and has limited adverse effects. The pharmacological management provides the best non-operative option used in the management of benign prostate hypertrophy. The use of benign prostate hypertrophy is based on the knowledge of the pathological process of the disease. The medical therapy is aimed at relieving the symptoms which are associated with the enlargement of the prostate and progression of the disease (Han, Black, & Lavelle, 2007).

According to McVary (2004), the current medical therapy used in the management of benign prostate hypertrophy employs the use of either adrenorecpetors or hormonal (5-alpha reductase inhibitor) mechanisms. However, the medical therapy could also involve the combination of both the adrenoreceptor and hormonal strategies. In The pharmacological management of benign prostate hypertrophy involves the use of either alpha blockers such as alfuzosin or 5-alpha reductase inhibitors which include dexozacin and datastaride (American Urologic Association Foundation, 2005).

The use of alpha blockers is intended to reduce the symptoms that come with benign prostate hypertrophy as well as limiting the progression of the disease (American Urologic Association Foundation, 2005). The alpha adrenergic blockers mediate their functions by antagonizing the adrenergic receptors. The adrenergic receptors are found within the smooth muscles of the prostate, urethra and the neck of the bladder. The blockage of the adrenal receptors results in the relaxation of the smooth muscles within the prostate.

There are two types of adrenergic receptors within the prostatic smooth muscles which include the alpha 1 and the alpha 2 receptors. It is the antagonistic effect of the drug on the alpha-1 receptors that relaxes the smooth muscles within the prostate. This results in the increase in the caliber outlet for the passage of urine (American Urologic Association Foundation, 2005). Based on the American Urologic Association Foundation (2005), the use of 5-alpha reductase inhibitors restrains the progression of the disease by diminishing the prostate size.

In addition, 5-alpha reductase inhibitors eliminate symptoms of benign prostate hypertrophy. 5-alpha reductase is accountable for the conversion of testosterone to dihydrotestosterone. 5-alpha reductase inhibitors restrain production of dihydrotestosterone that is responsible for the androgenic effects.

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