BPH

Question 1

what subjective tool is used to classify degree of BPH

Answer 1

american urological association symptom score (AUASS)

Question 2

mc herbal therapy used for bph that is not recommended

Answer 2

saw palmetto

others: beta-sitosterol, cermilton, pygeum africanum

Question 3

what 4 procedures are used for bph

Answer 3

TURP (transurethral resection of prostate)
transurethral ablation
simple prostatectomy
prostatic arterial embolization

Question 4

when is sx recommended for bph

Answer 4

when COBMO therapy is persistent after 12-24 months of tx

Question 5

what 4 med classes are used for bph

Answer 5

-a-adrenergic antagonists (a-blockers): tamsulosin, doxazosin
-5 alpha reductase inhibitors: finasteride, dutaseride
-anticholinergics: tolterodine, oxybutynin, fesoterodine
-pde5 inhibitors: tadalafil, sildenafil

Question 6

first line med for bph w. ed

Answer 6

pde5 inhibitors: sildenafil, tadalafil

Question 7

first line med for bph w. urge incontinence

Answer 7

beta-3 adrenergic agonists: mirabegron, vibegron

Question 8

what med prevents progression of bph

Answer 8

5 alpha reductase inhibitors

Question 9

moa of alpha blockers

Answer 9

antagonize alpha adrenergic receptors -> relaxation of bladder neck, prostatic urethra, and prostate smooth muscle

Question 10

what do you tell your pt who says alpha blockers are not working after 1 week of treatment

Answer 10

it takes days to weeks to become effective

Question 11

who are alpha blockers recommended for

Answer 11

first line tx for pt’s with normal prostate size AND psa

Question 12

mc dose limiting s.e of alpha blockers

Answer 12

hypotn
syncope

mc w. terazosin and doxazosin (immediate-release)

Question 13

when combined w. antihypertensives and pde5 inhibitors, alpha blockers can cause

Answer 13

hypotn

less w. tamsulosin

Question 14

alpha blockers should be titrated up q

Answer 14

2 weeks

Question 15

when should pt take alpha blocker

Answer 15

bedtime

Question 16

alpha blockers are not recommended as monotherapy for patients with bph and

Answer 16

htn

Question 17

what 2 alpha blocker require dose titration

Answer 17

doxazosin
terazosin

older and cheaper

Question 18

moa for 5 alpha reductase inhibitors

Answer 18

inhibit 5 alpha reductase -> inhibits conversion of testosterone to dihydrotestosterone -> inhibits prostate tissue growth -> shrinks enlarged prostate

Question 19

5 alpha reductase inhibitors result in shrinkage of prostate __% x __ months

and can decrease psa by __%

Answer 19

20-25%
6 months
50%

Question 20

how long do 5 alpha reductase inhibitors take to work

Answer 20

minimum of 6 mo

Question 21

benefits of alpha reductase inhibitors over alpha blockers

Answer 21

5 alpha reductase inhibitors:
prevent bph-related complications
prevent disease progression

Question 22

5 alpha reductase inhibitors are first line tx for patients with

Answer 22

enlarged prostate AND/OR elevated psa

Question 23

s.e of 5 alpha reductase inhibitors (5)

Answer 23

decreased libido
ed
ejaculation d.o
gynecomastia
breast tenderness
orthostatic hypotn (not as severe as alpha blockers)

Question 24

what 3 s.e of 5 alpha reductase inhibitors may persist after drug is stopped

Answer 24

decreased libido
ed
ejaculation d.o

Question 25

when would combo therapy of alpha blockers and 5 alpha reductase inhibitors be considered (2)

Answer 25

-symptomatic pt who have not responded to monotherapy -high risk of bph complications

Question 26

t/f: alpha blockers are contraindicated in pt w. htn

Answer 26

f!

Question 27

how would you adjust dosing for pt on alpha blocker plus htn meds

Answer 27

take antihypertensives in the AM take alpha blocker in the PM

Question 28

management of bph w. mild sx

Answer 28

watchful waiting

Question 29

when would you start a pt on a 5 alpha reductase inhibitor

Answer 29

mod-severe sx w.o bph complications AND prostate >/= 30 g if prostate < 30 g -> watchful waiting

Question 30

how would you manage a pt w. severe bph sx and compications

Answer 30

surgery

Question 31

what 2 bph drugs relax prostatic smooth muscle

Answer 31

alpha blockers pde 5 inhibitors

Question 32

what bph drug reduces the size of the prostate

Answer 32

5 alpha reductase inhibitors

Question 33

what bph drug is most useful for relieving voiding sx and improving flow rate

Answer 33

alpha blockers

Question 34

when are anticholinergics used for bph

Answer 34

overactive bladder

Question 35

5 chronic conditions associated w. ed

Answer 35

htn DM BPH CAD CKD

Question 36

4 lifestyle factors associated w. ed

Answer 36

smoking etoh obesity reduced PA

Question 37

first line tx for bph

Answer 37

manage comorbidities lifestyle factors

Question 38

4 meds commonly associated w. ED

Answer 38

bb TCAs 5 alpha reductase inhibitors HCTZ

Question 39

8 classes of drugs associated w. ED

Answer 39

antihypertensives CNS depressants lipid meds antidepressants/antipsychotics anticonvulsants GI agents antiandrogens and hormones recreational drugs

Question 40

what must you do before initiating drugs for ED

Answer 40

-medical, social, med hx w. emphasis on cardiac conditions -assess ability to have sex -assess ddi -address reversible/modifiable factors first

Question 41

what bph drug inhibits cGMP degradation, which causes smooth muscle relaxation

Answer 41

pde-5 inhibitors

Question 42

what needs to be present in order for pde 5 inhibitors to work

Answer 42

sexual stimulation

Question 43

s.e of pde 5 inhibitors

Answer 43

hypotn ha facial flushing nasal congestion dyspepsia myalgia back pain priaprism (rare)

Question 44

most concerning s.e of pde5 inhibitors

Answer 44

priaprism medical attention needed if erection > 4-6 hr

Question 45

what pde5 inhibitor can be used concurrently for symptomatic tx of bph

Answer 45

tadalafil (cialis)

Question 46

absolute contraindication for pde5 inhibitors

Answer 46

nitrates

Question 47

drugs to be cautious w. when taking pde 5 inhibitors

Answer 47

alpha 1 blockers erythromycin antifungals

Question 48

what pde5 inhibitor interacts w. antiarrhythmics

Answer 48

levitra

Question 49

up to __ of patients will not respond to pde5 inhibitors, but __ attempts may be needed for success

Answer 49

1/3 6-8

Question 50

alternative medication to pde5 inhibitors for ed

Answer 50

alprostadil

Question 51

moa for alprostadil

Answer 51

prostaglandin E1 analog stimulates adenyl cyclase -> increased cAMP, smooth muscle relaxation, increased penile rigidity

Question 52

dosing for cialis if used as adjunctive sx tx for bph

Answer 52

must be daily