Flashcards in BPH Deck (17)
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1
BPH symptoms
Irritative --> frequency, urgency, nocturia
Obstructive --> hesitancy, dribbling, fullness
Complications --> CKD, hematuria, UTI, etc
2
Anatomy
Transitional zone
Epithelial = grows by androgens
Stromal = smooth muscle contracts with alpha receptors
3
Physiology
Test/Androstenedione --> DHT via 5 alpha reductase
5alpha reductase II --> increased prostate growth
Normal stromal:epithelial 2:1. BPH 5:1
4
Static vs Dynamic
Static = 5AR, Androgens, Epithelial growth
Dynamic = A1, SM contraction, Urine obstruction
5
Medications causing BPH
Anticholinergics
TCA
Phenothiazines
6
Static medication & MOA
Finasteride --> 5 alpha reductase inhibitor
7
Finasteride ADE
ED, libido, ejaculatory dysfxn, gynecomastia
PSA decreases by 50%
8
Finasteride pro/con
Pro: good for enlarged >40g, delays progression
Con: takes 3-6 months
9
Dynamic medication & MOA
A1A blockers:
Doxazosin, Tansulosin, Alfuzosin, (Tadalafil)
10
A1A blocker ADE
1. Doxazosin: syncope, hypotension, dizzy
2. Tamsulosin: NO CV ADE
3. Alfuzosin: FEWER CV ADE
All: Floppy iris syndrome
11
A1A monitoring
BP & HR
12
A1A pros
Onset at 1-6 weeks
Decreases voiding symptoms
Good for interm measure
13
Symptomatic relief (Meds & MOA)
Oxybutynin & Mirabegron --> relax detrusor muscle
Oxybutynin: Anticholinergic
Mirabegron: B adrenergic agonist
14
Oxybutynin monitoring/ADE
1. Mental status
2. Bowel habits
3. Ability to urinate
ADE: Tachycardia & ED
15
Mirabegron monitoring/ADE
1. BP
2. Bowel habits
ADE: HTN, decreased cognition
16
Surgical indications
Severe, no response from meds, complications of BPH
17
