First-Dose Terazosin Orthostatic Syncope with Fall-Related Scalp Trauma
First-Dose Terazosin Orthostatic Syncope with Fall-Related Scalp Trauma - Clinical Pharmacology clinical simulation case. A 68-year-old male brought from...
Age: 68 • Gender: Male • Setting: Emergency Triage
Clinical Presentation & History
A 68-year-old male brought from home after a witnessed collapse in the hallway approximately 60 minutes after taking his first dose of terazosin 2 mg at bedtime for benign prostatic hyperplasia. He sustained a 4 cm frontal scalp laceration and has a brief loss of consciousness. Past medical history includes hypertension on lisinopril and amlodipine, and newly diagnosed BPH.
Acute Resuscitation Milestones & Priorities
Clinical phases and key interventions encountered in this emergency module:
First-dose orthostatic hypotension is a class effect of alpha-1 blockers (terazosin, doxazosin, prazosin); always start at the lowest dose at bedtime.
Provoked upright testing is unsafe immediately after traumatic syncope; resuscitate and image first.
Bedtime administration exploits sleep-induced venodilation to mask syncopal symptoms.
Elderly fall patients on dual antihypertensives plus an alpha-1 blocker warrant CT head and medication reconciliation before discharge.
Shared decision-making and a structured titration plan reduce recurrent falls and preserve BPH symptom control.
Test Your Clinical Reasoning in Real Time
Step into the active clinician role for this case. Order diagnostic tests, analyze live laboratory panels, and navigate branching clinical decisions with real-time feedback.