BPH

Question 1

What are the 3 types of tissue in the prostate gland?

Answer 1

• epithelial
• stromal
• capsule

Question 2

What stimulates epithelial growth?

Answer 2

Androgens

Question 3

What is stromal tissue embedded w/?

Answer 3

Alpha1-adrenergic receptors

Question 4

What is the capsule embedded w/? What does norepinephrine do?

Answer 4

Alpha1-adrenergic receptors

- When stimulated w/ norepinephrine, the capsule contracts around the urethra

Question 5

Testosterone is the principal…

Answer 5

testicular androgen

Question 6

Androstenedione is the principal…

Answer 6

adrenal androgen

Question 7

Androgens are converted into what?

Answer 7

5α-reductase converts androgens to DHT, an active metabolite

Question 8

What is considered a more potent androgen than testosterone?

Answer 8

DHT

Question 9

What does DHT do?

Answer 9

Induces growth & enlargement of the prostate

Question 10

What are the 2 types of 5α-reductase?

Answer 10

• Type I enzyme: causes acne & increased hair

- Type II enzyme

Question 11

What is a normal prostate composed of?

Answer 11

• Higher amounts of stromal tissue than epithelial, Ratio = 2:1

Question 12

What is the stromal-to-epithelial tissue ratio in BPH?

Answer 12

5:1

Question 13

What is the MOA of 5α-reductase inhibitors in epithelial tissue?

Answer 13

Reduce an enlarged prostate by 25%

Question 14

What is the MOA of alpha1-adrenergic receptors in stromal tissue?

Answer 14

SM contraction in enlarged prostate & bladder base obstructing urine flow

Question 15

What med is quickly effective in sx management of urinary flow?

Answer 15

alpha1-adrenergic antagonists

Question 16

What do static factors relate to?

Answer 16

Enlargement of prostate

- Depends on androgen stimulation of epithelial tissue & estrogen stimulation of stromal tissue

Question 17

What do dynamic factors relate to?

Answer 17

Excessive α-adrenergic tone of the stromal component –> contraction of prostate around urethra & narrowing of urethral lumen

Question 18

Which factors are responsible for obstructive voiding sx?

Answer 18

Dynamic!

Question 19

What 3 agents reduce the dynamic factor in BPH?

Answer 19

• Doxazosin (Cardura)
• Tamsulosin (Flomax)
• Tadalafil (Cialis)

Question 20

Which agent reduces the static factor in BPH?

Answer 20

Finasteride (Proscar)

Question 21

What 2 agents relax the detruser muscle of the bladder?

Answer 21

• Oxybutynin (Ditropan)

- Mirabegron (Myrbetrig)

Question 22

Older 2nd-generation immediate-release α1-Adrenergic Antagonists can cause…

Answer 22

Adverse CV effect

Question 23

5α-Reductase Inhibitors are useful primarily for patients with…

Answer 23

large prostates

Question 24

Which class of meds has a slow onset of action?

Answer 24

5α-Reductase Inhibitors

- Takes up to 6 months!

Question 25

What are 4 adverse effects of 5α-Reductase Inhibitors?

Answer 25

- Decreased libido - ED - Ejaculation disorders - Gynecomastia

Question 26

What 2 vitals should you monitor w/ α-Adrenergic antagonists?

Answer 26

BP & HR

Question 27

How do you administer 1st dose of α-Adrenergic antagonists?

Answer 27

Start on lowest dose, take at bedtime

Question 28

What is a contraindication of α-Adrenergic antagonists?

Answer 28

Cataract surgery

Question 29

What is a complication of α-Adrenergic antagonists?

Answer 29

Painful erection lasting longer than 4 hrs

Question 30

What is an ADE of α-Adrenergic antagonists?

Answer 30

Floppy iris syndrome

Question 31

What lab should you monitor w/ 5α-Reductase Inhibitors?

Answer 31

PSA | - Should decrease by 50%

Question 32

What is the peak onset of α-Adrenergic antagonists?

Answer 32

1-6wks

Question 33

Phosphodiesterase inhibitors vs anticholinergic agents

Answer 33

- PD inhibitors: Relax SM - Anticholinergic ADE: ED - Both have CV ADEs

Question 34

What is are ADEs of β3-adrenergic agonists (Mirabegron)?

Answer 34

- HTN (CV ADE) | - Impaired cognition

Question 35

What 2 things should you monitor w/ β3-adrenergic agonists (Mirabegron) ?

Answer 35

BP & bowel habits