BPH treatment

Question 1

What is used to assess BPH

Answer 1

AUA symptom index: 0-35
0-7: mild
8-19: moderate
20-35: severe

Question 2

What are the goals of BPH management

Answer 2

Reduce symptoms
Delay progression

Question 3

What are some behavioral modifications for BPH management

Answer 3

Fluid restrictions at bedtime
Avoid caffeine and alcohol

Question 4

What drugs exacerbate BPH symptoms

Answer 4

Testosterone replacement
Adrenergic agonists (decongestants)
Anticholinergic drugs (antihistamines, TCA, antispasmodics)
Diuretics
Caffeine
Alcohol

Question 5

How should BPH with mild symptoms be treated?

Answer 5

Yearly reassessment of symptoms
Behavioral modifications

Question 6

What should be done if there are moderate to severe BPH symptoms (AUA >= 8)

Answer 6

Consider:
Alpha 1 Antagonists
5-Alpha-Reductase Inhibitors
A combination of these meds
Surgery

Question 7

What are the Alpha 1 antagonists

Answer 7

Terazosin
Doxazosin
Tamsulosin
Silodosin
Alfuzosin

Question 8

What are the 5-Alpha-Reductase Inhibitors

Answer 8

Finasteride
Dutasteride

Question 9

What are the first line meds for patients with moderate to severe symptoms without complications

Answer 9

Alpha 1 Antagonists

Question 10

How do Alpha 1 antagonists work

Answer 10

improve urinary flow and symptoms

Question 11

What is the mechanism of action of Alpha 1 Antagonists

Answer 11

Inhibition of alpha-adrenergic receptors reduces smooth muscle contraction in the prostate

Question 12

What is the onset of action of Alpha 1 Antagonists

Answer 12

within days to weeks

Question 13

What is the efficacy of Alpha 1 Antagonists

Answer 13

Reduce AUA symptom score by 30-40%
Similar efficacy among all agents in class

Question 14

What is the main drug interaction with Alpha 1 Antagonists

Answer 14

Cytochrome P450 Metabolism
-CYP3A4
-PDE-5

Question 15

What are the adverse effects of Alpha 1 Antagonists

Answer 15

Dizziness
Hypotension
Syncope
*more common with nonselective agents

Question 16

What is an example of a nonselective vs a uroselective agent

Answer 16

Nonselective: Terazosin (weeks)
Uroselective: Tamsulosin (days)

Question 17

How should nonselective Alpha 1 Antagonists be prescribed

Answer 17

Titrate slowly to prevent hypotension and syncope (4-7 weeks)

Initial starting doses do not provide any BPH symptom relief - higher doses terazosin 10mg and Doxazosin 8mg provide relief

Question 18

How should uroselective Alpha 1 Antagonists be prescribed

Answer 18

tamsulosin
0.4-0.8mg daily
administer 30 minutes after a meal
DO NOT crush or chew
Start at dose that provides symptomatic relief
Do not cause hypotension and syncope

Question 19

What is the first line treatment for patients with BPH with moderate to severe symptoms

Answer 19

5-Alpha-Reductase Inhibitors (finasteride)

Question 20

What type of patients are 5-Alpha-Reductase Inhibitors most effective for?

Answer 20

Patients with larger prostate

Question 21

What is the onset of action and efficacy of 5-Alpha-Reductase Inhibitors

Answer 21

3-6 months
Reduce prostate size

Question 22

In what cases are 5-Alpha-Reductase Inhibitors contraindicated?

Answer 22

1. women who are pregnant/planning to become pregnant should not handle the tablets
2. Pregnant women should not come into contact with semen from men taking the med
3. Men should not donate blood for at least 6 months after last dose

Question 23

What are the benefits and cons of combination therapy

Answer 23

more effective than monotherapy
increased risk of adverse effects

Question 24

What is a pharm alternative therapy for BPH treatment

Answer 24

phosphodiesterase type-5 (PDE-5) inhibitors

Question 25

Describe PDE-5 inhibitors

Answer 25

Tadalafil (Cialis) recommended not to use in combination with other meds due to hypotension as adverse effect

Question 26

What is the use of Saw Palmetto in BPH

Answer 26

An alternative supplement, but has no efficacy data and is not recommended by the current AUA guidelines