BPH Flashcards
(13 cards)
1
Q
- testosterone is metabolized to ___ by ___
- BPH results from ?
-this causes what symptoms?
-This leads to ___ - What are some 9 drug classes/drugs that can worsen BPH?
A
- DHT, 5 alpha reductase
- OVERGROWTH of the stromal and epithelial cells of the prostate gland
-lower urinary tract sx’s
-frequent urination - Centrally acting anticholinergics (Benztropine)
Drugs w/anticholinergic effects:
a. antihistamines (Benadryl)
b. decongestants (pseudophed)
c. phenothiazines (prochlorperazine)
d. TCA’s (Amitriptyline)
caffeine
diuretics
SNRIs
testosterone products
2
Q
Diagnosis :
- Requires in one part a physical exam that should include a ___
- A urinalysis and serum ___ are used to rule out conditions other than BPH?
A
- digital rectal exam (DRE)
- prostate specific antigen (PSA)
3
Q
Symptoms:
- H, intermittent ___, s__ or a weak ___
- Urinary ___ and __ or __
- Urinary ___ especially ____
- BPH rarely causes more ___ but if the blockage is severe, urine could back up into the kidneys and result in ____
- Symptoms could be similar to ___
A
- hesitancy, urine flow, straining, stream of urine
- urgency, leaking, dribbling
- frequency, nocturia
- severe sx’s , renal failure
- prostate cancer
4
Q
- What guides the selection of treatment?
- Mild disease is generally treated with?
- Mod/severe disease?
- Which natural product has been used for BPH?
- What natural product is used for prostate cancer prevention?
A
- severity of reported BPH symptoms
- watchful waiting
- meds, or minimally invasive procedure or surgery such as TURP (transurethral resection of prostate)
- Saw palmetto
- lycopene
5
Q
Drug Treatment Options:
- Medicactions include ___ used alone or in combo with ?
- How does the 5 alpha reductase inhib work?
-note that they have a ___ onset - Who should they NOT be used in?
- Whats another treatment option?
-This is an attractive treatment option for who?
A
- alpha blockers, 5 alpha reductase inhibitor
- decr prostate size
-delayed onset - Men who have bladder outlet obstruction symptoms without prostate enlargement
- PDE5 Inhibitor (tadalafil) WITH or WITHOUT Finasteride
- men with both BPH and ED
6
Q
- Whats the first line treatment for moderate to severe sx’s?
- MOA?
- What does this do?
- Which alpha 1 receptors r commonly found in the prostate?
- Which r the NON selective alpha 1 blockers?
-What do they have?
A
- alpha 1 blockers
- Inhibit Alpha 1 adrenergic receptors causing relaxation of smooth muscle in the prostate and bladder neck
- Reduces bladder outlet obstruction and improves urinary flow
- Alpha 1 A
- terazosin and doxazosin
-more side effects (orthostasis, dizzi, HA)
7
Q
- Patients using Alpha blockers are at risk of developing?
- If a patient has cataract surgery and also is on an alpha blocker… what should be done?
A
- Intraoperative floppy iris syndrome during cataract surgery
- alpha blocker treatment should be delayed until surgery is completed
8
Q
NON Selective Alpha 1 Blockers:
- Doxazosin
a. brand name?
b. Dosing for IR? - Terazosin
a. Dosing?
SELECTIVE ALPHA 1A Blockers:
- Tamsulosin
a. brand name?
b. dosing?
A
1a. cardura, cardura XL
b. start 1 mg AT BEDTIME; titrate SLOWLY
2a. 1 mg at bedtime; TITRATE SLOWLY
3a. Flomax
b. 0.4 mg daily (30 min after the same meal each day)
9
Q
Alpha 1 Blockers:
- Warnings?
- Side effects (4)
- Why r the non selective ones given at bedtime?
- How long does it take to assess if beneficial effects have been achieved?
- these meds will not ___ and do not change ___
- Cardura XL is a oros formulation so it can?
- What can silodosin cause?
A
- ortho hypo/syncope; can happen with first dose or if PDE5 INHIBITOR IS STARTED !!!
-Intraoperative floppy iris syndrome can occur in cataract surgery
- Dizziness, fatigue, headache, abnormal ejaculation
- to help minimize the initial first dose effect of orthostasis/dizziness
- up to 4-6 wks! but LUTS will be worked on quickly by the drug
- shrink the prostate, change PSA levels
- Leave a ghost tablet in the stool
- retrograde ejaculation
10
Q
Alpha Blocker DDI’s:
1. Use caution when co admin with ___ for ED due to additive ___ effects
- If Tadalafil (Cialis) is being used to treat BPH, DO NOT USE IN COMBO with?
A
- PDE5 inhibs used , hypotensive
- Alpha 1 blockers
11
Q
5 Alpha Reductase Inhibs:
- They inhibit the 5 alpha reductase enzyme which does what?
- For which pt’s is this class of medications indicated for?
- These meds r used in combo with alpha blockers to do what?
A
- blocks the conversion of testosterone to dihydrotestosterone (DHT)
- tx of symptomatic BPH in men with AN ENLARGED PROSTATE
- improve sx’s, decr the risk of acute urinary retention and decr the need for surgery
12
Q
FINASTERIDE:
- Whats the brand name for usage in BPH?
- Brand name for alopecia?
- Contraindications? (2)
- Side effects? (4)
- Pregnant women and this drug?
- duration of treatment that may be needed for maximal efficacy?
- 5 alpha reductase inhibs do what to the prostate and what to the PSA levels?
A
- proscar
- propecia
- women of child bearing potential; pregnancy
- impotence, decr libido, ejaculation disturbances, breast enlargement + tenderness
- preg women should NOT take or handle these medications
- 6 months (or longer)
- SHRINK the prostate and DECR PSA levels
13
Q
PDE5 Inhibs:
- Which is the ONLY FDA approved pde5 inhibitor for BPH???
- WHy shouldnt it be used in combo with an alpha blocker for the tx of BPH?
- Brand name for ED and BPH?
- brand name for Pulm HTN?
- Contraindications?
- Warnings of:
Impaired ____
H___
V____
H____
P___ –> Seek emergency medical care if an erection lasts > 4 hrs - Wats a warning/ae that pt’s should seek immediate medical help for?
- Side effects of: H, F, D, D, B
A
- Tadalafil
- risks of hypotension
- Cialis
- adcirca
- dont use with nitrates or riociguat
- color discrimination
-hearing loss
-vision loss (can be due to nonarteritic anterior ischemic optic neuropathy or NAION)
-hypotension
-priapism - chest pain
- headache
flushing
dizziness
dyspepsia
back pain
