BPH - Quiz 3

Question 1

How is testosterone metabolized?

Answer 1

Broken down to DHT by 5-alpha reductase

Question 2

What is BPH?

Answer 2

Overgrowth of the stromal and epithlial cells of the prostate gland

Question 3

What are the drugs that worsen BPH?

Answer 3

1. Centrally-acting anticholinergics
2. Drugs with anticholinergic effects (antihistamine, decongestants, phenothiazines, TCAs)
3. Caffeine
4. Diuretics
5. SNRIs
6. Testosterone products

Question 4

How is BPH diagnosed?

Answer 4

1. Digital rectal exam for size of prostate
2. Prostate specific antigens and urinanalysis

Question 5

S/s of BPH?

Answer 5

1. Hesitancy, intermittent urine flow, straining, weak stream
2. Urgency, leaking, and dribbling
3. Frequency, nocturia
4. Incomplete emptying
5. Bladder obstruction

Question 6

Natural products for BPH?

Answer 6

1. Saw palmetto

Question 7

Natural products for prostate cancer prevention?

Answer 7

Lycopene

Question 8

Drug classes for BPH?

Answer 8

1. alpha-blocker
2. 5-alpha reductase inhibitor

Question 9

What drug class is used to decrease prostate size?

Answer 9

5-alpha reductase but delayed

Question 10

When can anticholinergics be used for BPH?

Answer 10

PVR <250-300 mL

Question 11

PDE5I that is indicated for BPH?

Answer 11

Tadalafil (Cialis)

Question 12

What is the pathophys of intraoperative floppy iris syndrome (IFIS)

Answer 12

If a patient is using an alpha blocker while having catarat surgery, the iris becomes floppy and pupil is unable to dilate properly
* blockers use should be delayed until after surgery

Question 13

What is the firstline tx for moderate-severe BPH sx?

Answer 13

alpha 1 blockers

Question 14

MOA of alpha 1 blockers?

Answer 14

Inhibit alpha-1 adrenergic receptors causing relaxation of smooth muscle
* Reduces bladder obstruction and improves urine flow

Question 15

What non selective alpha blockers have more ADRs?

Answer 15

Terazosin
Doxazosin

Question 16

What are your selective alpha-A1 blockers?

Answer 16

Tamsulosn
Alfuzosin
Silodosin

Question 17

When are non selective alpha blockers dosed?

Answer 17

Before bed to avoid orthostasis and dizziness from first dose
* TItrate slowly

Question 18

Doxazosin

Answer 18

Cardura, Cardura XL

Question 19

Terazosin

Answer 19

Hytrin

Question 20

Tamsulosin

Answer 20

Flomax

Question 21

ADR of alpha blockers?

Answer 21

1. DZ
2. Fatigue
3. HA
4. Abnormal ejaculation
5. Hypotension, syncope

Question 22

How long does it take for alpha blockers to reach beneficial effects?

Answer 22

Works quickly on LUTs, 4-6 wks for beneficial effects
* However, doesn’t shrink prostate and change PSA levels

Question 23

Describe the formulation of Cardura XL

Answer 23

OROS tablet w/ ghost tablet

Question 24

What drug can cause retrograde ejaculation that is reversable upon discontinuation?

Answer 24

Silodosin

Question 25

What drug is cautioned when co-administering with alpha blockers?

Answer 25

PDE5I due to hypotesion * Tadalafil should not be combined with alpha blockers if it was for the treatment of BPH

Question 26

What alpha blcokers are CYP3A4 substrates?

Answer 26

1. Tamsulosin 2. Alfuzosin 3. Silodosin

Question 27

What alpha blocker causes QTc prolongation?

Answer 27

Alfuzosin

Question 28

MOA of 5-alpha reductase inhibitors?

Answer 28

Blocks the conversion of testosteron to DHT * Improves sx * Reduce size of prostate and PSA levels * Decrease risk for uinary retention * Decrease need for surgery

Question 29

What surgeries are used for BPH?

Answer 29

TURP (Transurethral resection of the prostate) Prostatectomy

Question 30

Finasteride

Answer 30

Proscar Propecia (alopecia)

Question 31

Dutsteride

Answer 31

Avodart

Question 32

Alfuzosin

Answer 32

Uroxatral

Question 33

Silodosin

Answer 33

Rapaflo

Question 34

CI of 5-alpha reductase inhibitors?

Answer 34

Women of child bearing potential Pregnancy * Pregnant women shouldn't take or handle med

Question 35

ADR of 5-alpha reductase inhibitors?

Answer 35

1. Impotence 2. Decreased libido 3. Ejaculation disturbances 4. Breast enlargement and tenderness

Question 36

How long does it take for 5-alpha reductase inhibitors to reach maximal effect?

Answer 36

6 months

Question 37

Can a patient be on both Proscar and Propecia?

Answer 37

NO

Question 38

What is the difference between Cialis and Adcirca

Answer 38

Cialis is for BPH and ED Adcirca is for PAH

Question 39

CI for tadalafil?

Answer 39

Co-administration with nitrates

Question 40

ADRs of PDE5 inhibtors?

Answer 40

1. Color discrimination 2. Hearing loss 3. Vision loss from NAION 4. Hypotension 5. Chest pain 6. Priapsim 7. HA, flushing, DZ, dyspepsia, back pain

Question 41

Starting dose of tadalafil for BPH?

Answer 41

5 mg PO QD

Question 42

Dosing of Tamsulosin for BPH?

Answer 42

0.4 mg PO QD