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Therapeutics II > Block 5: BPH > Flashcards

Block 5: BPH Flashcards

1
Q

What is PSA?

A

Protease that breaks down HMW protein of the seminal coagulum into smaller polypeptides (liquid)

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2
Q

What is BPH?

A

Enlargement of the prostate gland

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3
Q

What are the causes of BPH?

A

α1-adrenergic receptors in prostate: causes smooth muscle contraction
DHT: Stimulates prostate tissue growth

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4
Q

What are the static factors of BPH?

A
  1. Anatomic enlargement
  2. Physically blocks the bladder neck thus preventing urine flow
  3. Depends on androgen stimulation of epithelial tissue
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5
Q

What are the dynamic factors of BPH?

A
  1. Excessive α1-adrenergic tone of smooth muscle tissue
  2. Contraction around urethra leads to decreased urethral lumen
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6
Q

What are the sx of BPH?

A

Bladder outlet obstruction
Irritative

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7
Q

What are the complications of BPH?

A
  1. Refractory urinary retention
  2. Renal impairment
  3. Urinary tract infections
  4. Gross hematuria
  5. Bladder stones
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8
Q

What are the labs of BPH?

A
  1. Increased BUN and sCr
  2. Elevated PSA level
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9
Q

What produces obstructive voiding sx of BPH?

A
  1. Refractory urinary retention
  2. Renal impairment
  3. Urinary tract infections
  4. Gross hematuria
  5. Bladder stones
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10
Q

What produces irritative voiding sx of BPH?

A
  1. Urinary infection, prostatitis
  2. Bladder cancer
  3. Bladder calculi
  4. Nonspecific cystitis
  5. Uninhibited bladder contractions
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11
Q

How do you diagnose BPH?

A
  1. digital rectal examination
  2. AUA Symptom Score
  3. u/A-screen for hematuria due to bladder cancer, stones, and infection
  4. peak and average urinary flow rate
  5. PVR urine volume
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12
Q

What is the questionaire for BPH?

A

AUA Symptom Index (AUASI)

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13
Q

What are the medications that worsen BPH?

A
  1. Testosterone replacement therapy
  2. α-adrenergic agonists
  3. Antihistamines
  4. caffeine, diuretics
  5. Tri-cyclic/antidepressants/SNRIs/Phenothiazines
  6. Antispasmodics
  7. Anti-parkinson’s medications
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14
Q

What are the tx for BPH?

A
  1. Transurethral resection of the prostate
  2. Open or laser prostatectomy
  3. Balloon dilation of the urethra
  4. Urethral stents

Pharm:
First line: Terazosin (Hytrin)
* Doxazosin (Cardura)
* Tamsulosin (Flomax)

5α-reductase inhibitors:
* Finasteride (Proscar)
* Dutasteride (Avodart)

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15
Q

What are the tx goals for BPH?

A
  1. Relieve bothersome sx
  2. Prevent dx progression
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16
Q

How does one choose tx for BPH?

A
  • Symptom severity
  • Quality of life

Cause of symptoms(prostate size/PSA):
* Dynamic (smooth muscle; α1-Adrenergic Receptor Antagonists)
* Static (enlarged prostate; 5 alpha reductase)

17
Q

What is α1-Adrenergic Receptor Antagonists?

A

Smooth muscle relaxation of bladder neck, prostate capsule and prostatic urethra has NO effect on prostate size =Bothersome symptoms and small prostate or PSA ≤ 1.5 ng/ml

18
Q

Benefits of using α1-Adrenergic Receptor Antagonists?

A
  1. Improve quality of life and decrease symptoms
  2. Non-uroselective: inexpensive and require dose titration
  3. Uroselective: increased cost
19
Q

What are the non-uroselective agents?

A
  1. Prazosin (Minipress®)
  2. Terazosin (Hytrin®)
  3. Doxazosin § (Cardura®)
  4. Doxazosin XL § (Cardura XL®)
20
Q

What are the uroselective agents?

A
  1. AlfuzosinXL (Uroxatral®)
  2. Tamsulosin (Flomax®)
  3. Silodosin (Rapaflo®)
21
Q

Compare and contrast 5a reductase inhibitors?

A
22
Q

Finasteride

ADR, CI

A

ADR: Breast tenderness, gynecomastia, hair growth, rash, impotence/decreased libido
CI: children and women, pregnancy

Reestablish baseline after 3 months of use

23
Q

Dutasteride

MOA, ADR

A

MOA: inhibits both isoforms (type 1 and 2) of the 5-alpha reductase enzyme, lowers serum PSA
ADR: less effects on breast tissue

24
Q

Describe BPH tx algorithm?

A
25
Q

Natural products for BPH?

A

Sawpalmetto, Lycopene, Pygeum

26
Q

Uses on minimal invasive procedures?

A
  1. Less effective than surgery
  2. Fewer complications than surgery
  3. High long-term retreatment rate:
  • Transurethral needle ablation (TUNA)
  • Transurethral microwave thermotherapy (TUMT)
27
Q

What cause the highest rate of sx reduction? Highest rate of complications?

A

Surgery

  1. Open prostatectomy
  2. Partial removal of prostate
  3. Laser Therapy
28
Q

What is the gold standard for tx of pts w/ complications of BPH?

A

Prostatectomy

Therapeutics II (30 decks)

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