Benign Prostatic Hyperplasia

Question 1

Etiology of BPH

Answer 1

Overgrowth of stroll and epithelial cells of the prostate due to the over metabolism of testosterone to DHT by alpha-5 reductase

Question 2

Drugs that can worsen BPH

Answer 2

Centrally acting anticholinergics
Anticholinergics
Caffeine
Diuretics
SNRIs
Testosterone

Question 3

How to diagnose BPH

Answer 3

DRE and th PSA (to rule out other conditions)

Question 4

Sx of BPH

Answer 4

1. Hesitancy, intermittent urine flow, straining or a weak stream
2. Urinary urgency, leaking, driblling
3. Urinary frequency
4. Incomplete voiding

Question 5

Natural products for BPH

Answer 5

Saw palmetto
Lycopene

Question 6

MOA of alpha-1 bliockers

Answer 6

Inhibit a-1 adrenergic receptors → relaxation of smooth muscle in bladder and prostate to reduce obstruction and improve urinary flow

Question 7

What receptors are found on the prostate?

Answer 7

Alpha-1A

Question 8

Non selective alpha blockers

Answer 8

Terazosin and doxazosin

Question 9

Selective alpha blockers

Answer 9

Tamsulosin, alfuzosin, silodosin

Question 10

Doxazosin

Answer 10

Cardura

Question 11

Dosing of non-selective alpha blockers

Answer 11

Take at bedtime and titrate slowly to avoid othostasis

Question 12

Starting dose of tamsulosin

Answer 12

0.4 mg QD

Question 13

Warning of alpha-blockers

Answer 13

Orthostatic hypotension/syncope if HTN or PDEI was started

IFIS: hold alpha-blocker prior to cataract surgery

Question 14

ADR of alpha-blocker

Answer 14

DZ, fatigue, HA, abnormal ejaculation

Question 15

Drug that is a ghost tablet

Answer 15

Cardura XL

Question 16

Drug that causes retrograde ejaculation

Answer 16

Silodosin

Question 17

How long does it take to see effect for alpha-blockers?

Answer 17

4-6 wks, however is used for lower urinary tract sx but doesn’t shrink or change prostate levels

Question 18

MOA of 5-alpha recutase inhibitors

Answer 18

Blocks the conversion of testosterone to DHT

Question 19

What is the difference between finasteride and dutasteride

Answer 19

Finasteride: TypeII enzyme selective

Dutasteride: Type 1 and 2 nonselective

Question 20

Surgery for severe BPF

Answer 20

TURP, prostactemoy

Question 21

CI of 5-alpha reductase inhibitors

Answer 21

Women of child bearing potential, pregnancy

Question 22

ADR of 5-alpaha reductase

Answer 22

Impotence, decreased libido, ejaculation disturbances, breast enlargement and tenderness

Question 23

How long does it take for 5ARI to work

Answer 23

6 month for maximal effect but shrinks and reduces PSA levels

Question 24

FInasteride

Answer 24

Proscar

Question 25

Dutasteride

Answer 25

Avodart

Question 26

Tadalafil

Answer 26

Cialis

Question 27

PDE5I that is indicated for BPH

Answer 27

Tadalafil

Question 28

CI for tadalafil

Answer 28

Nitrates

Question 29

ADR of tadalafil

Answer 29

Color discrimination, hearing loss, vision loss, hypotension, priapism, HA, flushing, dz, dyspepsia, back pain