BPH Flashcards

(41 cards)

1
Q

What does epithelial/glandular tissue produce?

A

Prostatic secretions

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2
Q

Function of androgens in epithelial/glandular tissue?

A

Androgens stimulate epithelial tissue growth

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3
Q

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

A

Static sx’s

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4
Q

What does stromal/smooth muscle tissue contain?

A

alpha 1 adrenergic receptors

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5
Q

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

A

Smooth muscle contraction

Results in decreased urinary bladder emptying

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6
Q

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

A

Dynamic sx’s

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7
Q

What is the capsule of the prostate composed of?

A

Fibrous connective tissue + smooth muscle tissue

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8
Q

What does the capsule contain?

A

alpha 1 adrenergic receptors

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9
Q

When norepinephrine is stimulated, what happens to the capsule?

A

Contracts around the urethra

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10
Q

Define static

A
  • Anatomic enlargement of prostate gland

- Physical block at bladder neck

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11
Q

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

A
  1. Androgen stimulation of prostate gland

2. Estrogen stimulation of stromal tissue

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12
Q

What exacerbates static sx’s?

A
  1. Stress
  2. Pain
    * Increased alpha-adrenergic tone may precipitate excessive contraction of prostatic stromal tissue
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13
Q

Define Dynamic

A
  • Excessive alpha adrenergic tone of the stromal compartment of prostate
  • Contaction of prostate gland around urethra
  • BUT normal prostate gland size
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14
Q

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

A

Obstructive sx’s

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15
Q

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

A

DHT

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16
Q

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

A

Type II

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17
Q

What does DHT induce in the prostate?

A

Growth and Enlargement

18
Q

What alpha adrenergic receptor is most selective to the prostate?

A

subtype-selective α1A-receptor

19
Q

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

A

5α-reductase

20
Q

What medications can exacerbate BPH sx’s?

A
  1. Anticholinergics
  2. Antihistamines
  3. TCA’s
  4. Phenothiazines
21
Q

Management of mild BPH

A
  1. Watchful waiting
  2. Behavior modifications
  3. Return visits every 12-months for assessment of worsening si/sx’s
22
Q

Management of moderate/severe BPH

A

Drug therapy or Surgery

23
Q

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

A

Minimize CV effects:

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

Terazosin and Doxazosin?

24
Q

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

A

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

25
What second generation α1-adrenergic antagonists has fewer CV ADE's? Why?
Extended release Alfuzosin | Functionally uroselective
26
Aside from CV effects, what is another major ADE of α1-adrenergic antagonists? And what patient education should you provide to your patient?
Floppy Iris syndrome | If cataract surgery, instruct patient to inform their opthalmologist they are taking an alpha blocker
27
α1-adrenergic antagonists dosing instructions
1. Start on lowest dose and titrate over several weeks | 2. Take first dose at bedtime
28
What α1-adrenergic antagonist ADE is a urologic emergency? Patient education?
Priapism | Seek medical attention if painful erection >4 hrs
29
What do you want to monitor with α1-adrenergic antagonist?
1. Blood pressure | 2. HR
30
What patient are 5α-reductase inhibitors primarily used in?
- Large prostate: >40 g - Want to avoid surgery - Can't tolerate α1-adrenergic antagonists SE's
31
List the 5α-reductase inhibitors
1. Finasteride | 2. Duasteride
32
5α-reductase inhibitors ADE's
1. Decreased libido 2. ED 3. Ejaculation disorders 4. Gynecomastia
33
What do you want to monitor in 5α-reductase inhibitors?
Prostate-specific antigen (PSA): Decrease by 50% IF pt is adherent to therapy
34
PDE-1 Effect/MOA
Dynamic effects: | Smooth muscle relaxation of prostate, bladder neck, and prostatic urethra
35
What do you want to monitor in PDE-I ?
1. BP 2. Pulse 3. Hearing loss- Discontinue drug
36
Anticholinergic Effects on the bladder
Relaxes detrusor muscle of the bladder
37
List the β3-adrenergic agonist
Mirabegron
38
β3-adrenergic agonist (Mirabegron | 0 MOA
Increases cAMP | Relaxes detrusor muscle
39
Overall effects of β3-adrenergic agonist (Mirabegron)
1. Decreases irritative sx's 2. Increases urinary bladder capacity 3. Increases intervals between voiding
40
β3-adrenergic agonist ADE's
1. HTN, Increased HR 2. Diarrhea/constipation 3. Impaired cognition
41
What do you want to monitor in β3-adrenergic agonist?
1. BP | 2. Bowel habits