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*Pharmacotherapy 4271 > BPH (Final) > Flashcards

BPH (Final) Flashcards

1
Q

this receptor is stimulated by NE which causes the prostate to contract and a lot of pressure is at the bladder neck which means urine wont be passed to the urethra as easily therefore the patient has trouble voiding

A

alpha-adrenergic recpetors

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2
Q

this part of the prostate is also known as the glandular tissue. it produces prostatic secertion delievered to the urethra duing ejaculation. growth of this is stimulated by testosterone

A

epithelial tissue

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3
Q

this part of the prostate is also known as the smooth muscle. it is embedded with alpha1-adrenergic receptors = contraction/compression. too much of this contraction/compression leads to decreased bladder emptying

A

stromal tissue

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4
Q

this is the part that contracts the prostate. it is comprised of fibrous connective tissue and smooth muscle with embedded alpha1-adrenergic receptors

A

capsule

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5
Q

this type of 5alpha-redctase enzyme is located at the site of the prostate

A

type II

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6
Q

this induces growth and enlargement of the prostate

A

DHT

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7
Q

true or false: with age there is decreased testosterone production therefore there is less DHT

A

false - DHT levels remain normal in the prostate.

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8
Q

true or false: in BPH, anatomical enlargement of the prostate gland occurs which causes a physical block at the bladder neck obstructing urine outflow

A

true

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9
Q

this is one of the two factors that cause BPH; it is an increase in size of prostate due to testosterone stimulation of the epithelial tissue

A

static factor

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10
Q

this is one of the two factors that cause BPH; it is from excessive alpha1-adrenergic tone

A

dynamic factors

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11
Q

describe the clinical presentation of BPH

A
  • urine stream diminished
  • bladder feels full even after voiding
  • urinary frequency
  • bedwetting/nocturia
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12
Q

what are some red flags for BPH

A
  • sus Digital Rectal Exam
  • refractory retention (trouble voiding despite tx)
  • hematuria
  • bladder stones
  • renal insufficiency
  • recurrent UTI
  • elevated PSA (could be prostate cancer)
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13
Q

what are some medications that can lead to similar sxs to BPH or even cause BPH

A
  • anticholinergics (cause urinary retention)
  • alpha1-agoinst (e.g. decongestant such as psedofed)
  • testosterone supplements (can cause enlargement of prostate)
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14
Q

what are some non-pharm measurements used to treat BPH

A
  • fluid restriction before bed
  • avoidance of caffeine, alcohol, spicy foods
  • timed voiding (bladder training)
  • weight loss & exercise (can decrease intra-abdominal pressure which can decrease pressure on bladder)
  • avoid causative meds
  • manage constipation
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15
Q

when would single agent drug therapy be used for BPH

A

if the patients prostate is not enlarged therefore just experiencing dynamic factors

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16
Q

when would dual agent drug therapy be used for BPH

A

if the patients prostate is enlarged (static factors)

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17
Q

this class of medications is 1st line for individuals with BPH due to dynamic factors, therefore these agents have no effect on prostate size

A

alpha-adrenergic antagonists

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18
Q

true or false: all alpha-adrenergic antagonists have the same effectiveness at reducing lower urinary tract symptoms

A

true

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19
Q

how long does it take for alpha-adrenergic antagonists to work

A

1-3 weeks

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20
Q

these 3 alpha-adrenergic antagonsits target alpha1 adrenergic receptors. they decrease post-void residual (PVR) volume and increase urinary flow.

A

terazosin, doxazosin and alfuzosin

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21
Q

out of terazosin, doxazosin and alfuzosin, which ones have a hypotensive effect therefore need to start low & go slow? + if several days of medication is missed need to re-titreate

A

terazosin and doxazosin

22
Q

true or false: prazosin is an alpha-adrenergic antagonists used in BPH

A

false - has a marked hypotensive effect therefore not recommended

23
Q

these 2 alpha-adrenergic antagonists target alpha1A- andrenergic receptors. they decrease post-void residual (PVR) volume and increase urinary flow. they have a decreased hyptensive effect

A

tamsulosin and silodosin

24
Q

what are some a/e associated with alpha1-adrenergic antagonists (non-selective agents: terazosin, doxazosin and alfuzosin)

A
  • dizziness
  • syncope
  • orthostatic hypotensoin
  • h/a
    rare: intraoperative floppy iris syndrome (IFIS) which is blockage of the alpha1-adrenergic receptors in the iris dilator muscles and during cataract surgery causes constriction of the pupil and billowing out of iris (need to tell eye dr they are on these meds)
25
Q

what are some a/e associated with alpha1A-adrenergic antagonists (selective agents: tamsulosin and silodosin)

A
  • droswiness
  • nasal congestion
  • retrograde ejactulation and reduced ejaculate volume
  • IFIS
26
Q

this selective alpha1A-adrenergic antagonist contains a sulfa moetiy

A

tamsulosin

27
Q

alpha-adrenergic antagonists are etabolized by these enzyme, therefore need to watch out for inducers (carbamazepine) and inhibitors (clarithromycin, ketoconzole)

A

CYP 3A4

28
Q

this alpha-adrenergic antagonist is a substrate of p-gp therefore caution needs to be taken when taken with p-gp inhibitors

A

silodosin

29
Q

are non-selective or selective alpha-adrenergic antagonists more likely to cause severe hypotension when combined with a PDE5 inhibitors

A

selective

30
Q

the patients BP should be stable on an alpha-adrenergic antagonist before being started on this class of medication

A

PDE5 inhibitor

31
Q

if a patient is on both an alpha-adrenergic antagonist and PDE5 inhibitor, can they be taken together or should they be separated

A

separate by 4 hours

32
Q

how should doxazosin and terazosin be titrated

A

1-2mg weekly

33
Q

true or false: terazosin and doxazosin are best taken in the morning

A

false - HS dosing allow for most hypotensive effects to occur during sleep

34
Q

true or false: alfuzosin should be taken with food

A

true

35
Q

true or false: tamsulosin CR should be swallowed whole

A

true

36
Q

true or false: tamsulosin SR can be chewed or crushed

A

false - swalloe whole

37
Q

true or false: tamsulosin CR should be taken with food

A

false

38
Q

true or false: tamsulosin SR should be taken with food

A

true - 1/2 hr after same meal each day

39
Q

true or false: silodosin should be taken with food

A

true

40
Q

this class of medication is 1st line for patients with BPH due to static factors (size). they inhibit 5alpha-reductase thereby decrease conversion of testosterone to DHT. effective at decreasing PVR and increasing urinary flow.

A

5alpha-reeductase inhibitors

41
Q

what is the onset of action for 5alpha-reductase inhibitors

A

6-12 months

42
Q

this is a competitive inhibitor of type II 5alpha-reductase. it is a tablet. and crushed tablets should not be handled by those planning conception or are pregnancy

A

finasteride

43
Q

this is a competitive inhibitor of type I AND type II 5alpha-reductase. it is a capsule that should be swallowed whole. it may work more quickly than finasteride

A

dutasteride

44
Q

what are some a/e associated with 5alpha-reductase inhibitors

A
  • decreased libido
  • ED and other ejactulatory disorders

rare: muscle weakness

45
Q

this is an antigen produced by the prostate and small amount are produced into the bloodstream. an increase in these levels may be an indicator of BPH and/or prostate cancer,

A

PSA

46
Q

5alpha-reducatse inhibitors decrease PSA. baseline PSA should be obtained in those starting treatment. when should a repeat PSA be performed after starting tx

A

6 months (think onset of action is 6-12 months)

47
Q

this is indicated for patients with symptomatic LUTS with prostate enlargement (> 30 cc). with this, there is more risk of adverese effects especially ejactulatory disorders

A

combination tx (e.g. Jalyn - dutasteride/tamsulosin)

48
Q

this class of medications has been shown to improve LUTS in men with BPH. may be recommended as monotherapy for men with LUTS/BPH and, in particular, men with both LUTS and ED

A

PDE inhibitors
e.g. Tadalafil 5mg once a day regimen

49
Q

this class of medication may be useful for indivuduals with BPH and storage symptoms as they are commonly used in patients with overactive bladders.

A

antimuscarinic agents (fesoterodine, tolterodine, oxybutynin, solifenacin)

beta-3 agonist - myrbetriq

50
Q

this medication may be considered for men with BPH whose predominant symptoms is noctuira, who do not respond to other treatments; it is a supplement for endogenous ADH + sodium monitoring is important with this medication!

A

desmopressin

*Pharmacotherapy 4271 (29 decks)

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