BPH

Question 1

What does epithelial/glandular tissue produce?

Answer 1

Prostatic secretions

Question 2

Function of androgens in epithelial/glandular tissue?

Answer 2

Androgens stimulate epithelial tissue growth

Question 3

What kind of sx’s does epithelial/glandular tissue produce?

Answer 3

Static sx’s

Question 4

What does stromal/smooth muscle tissue contain?

Answer 4

alpha 1 adrenergic receptors

Question 5

What does norepinephrine cause in stromal/smooth muscle tissue? result?

Answer 5

Smooth muscle contraction

Results in decreased urinary bladder emptying

Question 6

What kind of sx’s does stromal/smooth muscle tissue produce?

Answer 6

Dynamic sx’s

Question 7

What is the capsule of the prostate composed of?

Answer 7

Fibrous connective tissue + smooth muscle tissue

Question 8

What does the capsule contain?

Answer 8

alpha 1 adrenergic receptors

Question 9

When norepinephrine is stimulated, what happens to the capsule?

Answer 9

Contracts around the urethra

Question 10

Define static

Answer 10

• Anatomic enlargement of prostate gland

- Physical block at bladder neck

Question 11

What is the enlargement due to in static sx’s?

Answer 11

1. Androgen stimulation of prostate gland

2. Estrogen stimulation of stromal tissue

Question 12

What exacerbates static sx’s?

Answer 12

1. Stress
2. Pain
   * Increased alpha-adrenergic tone may precipitate excessive contraction of prostatic stromal tissue

Question 13

Define Dynamic

Answer 13

• Excessive alpha adrenergic tone of the stromal compartment of prostate
• Contaction of prostate gland around urethra
• BUT normal prostate gland size

Question 14

What type of sx’s do we see in dynamic sx’s?

Answer 14

Obstructive sx’s

Question 15

What is considered a more potent androgen than testosterone in the prostate?

Answer 15

DHT

Question 16

Is type I or type II enzyme localized to the prostate?

Answer 16

Type II

Question 17

What does DHT induce in the prostate?

Answer 17

Growth and Enlargement

Question 18

What alpha adrenergic receptor is most selective to the prostate?

Answer 18

subtype-selective α1A-receptor

Question 19

What enzyme converts testosterone and androstenedione to the active metabolite DHT?

Answer 19

5α-reductase

Question 20

What medications can exacerbate BPH sx’s?

Answer 20

1. Anticholinergics
2. Antihistamines
3. TCA’s
4. Phenothiazines

Question 21

Management of mild BPH

Answer 21

1. Watchful waiting
2. Behavior modifications
3. Return visits every 12-months for assessment of worsening si/sx’s

Question 22

Management of moderate/severe BPH

Answer 22

Drug therapy or Surgery

Question 23

Why do you want to titrate older, immediate-release, second generation α1-adrenergic antagonists?List the name of these drugs

Answer 23

Minimize CV effects:

1. Orthostatic hypotension
2. First dose syncope
3. Dizziness

Terazosin and Doxazosin?

Question 24

What is unique about 3rd generation α1-adrenergic antagonists? List the name

Answer 24

Tamsulosin:
Pharmacologically uroselective
Good alternative when experiencing ADE’s with 2nd generation

Question 25

What second generation α1-adrenergic antagonists has fewer CV ADE's? Why?

Answer 25

Extended release Alfuzosin | Functionally uroselective

Question 26

Aside from CV effects, what is another major ADE of α1-adrenergic antagonists? And what patient education should you provide to your patient?

Answer 26

Floppy Iris syndrome | If cataract surgery, instruct patient to inform their opthalmologist they are taking an alpha blocker

Question 27

α1-adrenergic antagonists dosing instructions

Answer 27

1. Start on lowest dose and titrate over several weeks | 2. Take first dose at bedtime

Question 28

What α1-adrenergic antagonist ADE is a urologic emergency? Patient education?

Answer 28

Priapism | Seek medical attention if painful erection >4 hrs

Question 29

What do you want to monitor with α1-adrenergic antagonist?

Answer 29

1. Blood pressure | 2. HR

Question 30

What patient are 5α-reductase inhibitors primarily used in?

Answer 30

- Large prostate: >40 g - Want to avoid surgery - Can't tolerate α1-adrenergic antagonists SE's

Question 31

List the 5α-reductase inhibitors

Answer 31

1. Finasteride | 2. Duasteride

Question 32

5α-reductase inhibitors ADE's

Answer 32

1. Decreased libido 2. ED 3. Ejaculation disorders 4. Gynecomastia

Question 33

What do you want to monitor in 5α-reductase inhibitors?

Answer 33

Prostate-specific antigen (PSA): Decrease by 50% IF pt is adherent to therapy

Question 34

PDE-1 Effect/MOA

Answer 34

Dynamic effects: | Smooth muscle relaxation of prostate, bladder neck, and prostatic urethra

Question 35

What do you want to monitor in PDE-I ?

Answer 35

1. BP 2. Pulse 3. Hearing loss- Discontinue drug

Question 36

Anticholinergic Effects on the bladder

Answer 36

Relaxes detrusor muscle of the bladder

Question 37

List the β3-adrenergic agonist

Answer 37

Mirabegron

Question 38

β3-adrenergic agonist (Mirabegron | 0 MOA

Answer 38

Increases cAMP | Relaxes detrusor muscle

Question 39

Overall effects of β3-adrenergic agonist (Mirabegron)

Answer 39

1. Decreases irritative sx's 2. Increases urinary bladder capacity 3. Increases intervals between voiding

Question 40

β3-adrenergic agonist ADE's

Answer 40

1. HTN, Increased HR 2. Diarrhea/constipation 3. Impaired cognition

Question 41

What do you want to monitor in β3-adrenergic agonist?

Answer 41

1. BP | 2. Bowel habits