BENIGN PROSTATIC HYPERTROPHY (BPH)

Question 1

BPH
- RFs
- role of dihydrotestosterone

Answer 1

• MC benign tumor in men
  RFs
• age, genetic predisp

dihydrotestosterone
- DHT promotes prostate growth, inhib cell death and stims stroma collagen production
- can block it in BPH

Question 2

tx approaches

Answer 2

• watchful waiting
  drug tx
• alpha blockers
• 5a reductase inhibitors
• tadalafil (PDE5i)
• herbal tx–> saw palmetto
• surgical tx

Question 3

which tx option is category X

Answer 3

5 alpha reductase inhibitors
NEVER give to pregnant women

Question 4

alpha 1 blockers
- MOA
- indications
- pharmacokinetics (ADME)

Answer 4

MOA
- relax smooth musc of bladder neck + prostate

indications
- HTN, BPH

Pharmacokinetics
- absorp: PO
- distribution: highly protein bound
- metab: no cyp450 DDI
- elimination: excrete in bile, urine, feces

Question 5

alpha blockers
- ADRs
- dosing
- drug names

Answer 5

ADRs
- CNS, CVS effects, sexual dysfunc (ejaculatory)

dosing
- QHS (except prazosin TID)

drug names
- prazosin, doxasozin, terazosin, tamsulosin, silodosin, alfluzosin

Question 6

alpha blockers

tamsulosin
- pro and con

Answer 6

use for BPH ONLY

• less CVS effects
• more ejac dysfunc

Question 7

alpha blockers

silodosin
- pros and cons
- DDI

Answer 7

use for BPH ONLY
- less dizziness than tamsulosin
- MOST ejac dysfunc of all a1 blockers
- lot of CYP450 DDIs

Question 8

alpha blockers

alfuzosin

Answer 8

use for BPH ONLY
- best tolerated

Question 9

5a reductase inhibitors
- MOA
- indications
- pharmacokinetics (A, M)

Answer 9

MOA
- testosterone derivative blocks 5a reductase–> dec DHT synth in prostate, skin, other target tissues

indications
- BPH, male pattern baldness

pharmacokinetics
- Absorp: PO
- metab: hepatic

Question 10

5a reductase inhibitors
- ADRs
- DDIs
- drug names

Answer 10

ADRs
- sexual dysfunc (dec libido, ED, testicular pain)

DDIs
- CYP450 substrate

drug names (-steride)
- finasteride, dutasteride

Question 11

5a reductase inhibitors

finasteride v. dutasteride
- use

Answer 11

finasteride
- use for BPH AND male pattern baldness

dutasteride
- newer drug blocks type I and II 5a reductase, not approv yet for baldness

Question 12

PDE5i- tadalafil
- use
- MOA (3 ways)

Answer 12

mostly used for erectile dysfunction
MOA
- smooth muscle relax in urethra, bladder, prostatic stroma + capsule —> relieve BPH Sx
- inc vasc perfusion lower urinary tract (relieve pelvic arterial insuff+ischemia–change prostatic structure)
- modify afferent nerve signal from bladder, urethra, prostate

Question 13

herbal tx- saw palmetto
- MOA
- CI
- ADRs
- DDIs

Answer 13

MOA
- inhibit 5a reductase enzyme

CI
- pregnancy, women child bearing effects (hormonal effect)

ADRs
- HA, HTN, GI effect, back pain

DDIs
- anticoag, antiplatelet drugs (inc bleed risk), OCs