BPH Flashcards
Signs and symptoms of BPH are considered to be either _____________ in nature
obstructive or irritative
Incomplete emptying is a what sx?
obstructive
Frequency or urination is a what sx?
can be from obstruction but also can be from irritation (stimulation of muscarinic receptors)
Intermittency is a what sx?
obstructive - trying to push urine through the urethra with an enlarged prostate
Urgency is a what sx?
- irritative sx
Weak urinary stream is a what sx?
- obstructive sx
Nocturia is a what sx?
- irritative
What symptoms of BPH would make us think it was a more urgent case?
- blood in urine
- pain upon urination
- under 45 years of age
- men with incontinence - backing up of bladder so badly that it forcibly pushes out urine through the prostate
- complete bladder obstruction (suprapubic pain), agitation – need to out in a catheter to get rid of all of the urine
What causes acute urinary retention?
- unmanaged BPH
What are some of the medications that people with BPH need to avoid?
- antihistamines (muscarinic receptors are taking away the signal to empty the bladder)
- decongestants
- TCAs
- antipsychotics
- anti-muscarinic agents
- some parkinsons meds
- diuretics (furosemide, metolazone)
- testosterone gel
If a person ever tells you that their _________ infection is getting worse on BPH meds, TAKE IT SERIOUSLY
lower respiratory tract infection
What is the pathophys of BPH?
- increased size of the prostate- prostate encircles like a donut
- increased prostate = increased urine block through the urethra
What is the purpose of the prostate?
- gland that moves the fluid to the ejaculate- helps with reproduction
What is one mechanism in which the prostate grows?
- testosterone
- usually makes it grow by 30-40 cc’s in size
What do PSAs help us with?
not much- not specific for cancer or BPH
- just doing a PSA level is not definitive to diagnosing prostate cancer
What do 5-alpha reductase inhibitors do?
- block the production of DHT and cause a reduction in the size of the prostate
- reduces the amount that the gland grows and can also actually shrink it by as much as 25%
- – makes sense because if someone wasn’t having their prostate shrunk, then they wouldn’t have had any relief from the medication
If someone has a small prostate and a lot of smooth muscle clenching down on the urethra, you can get away with just using a ________
alpha blocker
When __________ is contracting, then you have the prostate squeezing down on the bladder
stromal cells
What receptors are the most overactive when men have an irritative bladder?
muscarinic
What do untreated symptomatic males likely end up developing?
- acute urinary retention
What is the MAIN SE associated with terazosin?
- dizziness (usually people take this med at night)
Is there a difference in efficacy between terazosin, alfuzosin and tamsulosin?
- NO (only difference is that first gen causes more vasodilation or action on a lot of other parts of the body- dizziness and hypotension can still happen)
What is the efficacy of these alpha-1 inhibitors?
- decrease the ISS score by 3-4
What are the main SE associated with alpha-1 blockers?
- dizziness, decrease in BP, unsteadiness on feet
- also nasal congestion, ejaculatory changes (retrograde ejaculation), and cataracts
