Chapter 51: Benign Prostatic Hyperplasia (BPH) Flashcards
(28 cards)
What is testosterone metabolized to?
DiHydroTestosteron by 5-alpha reductase
What are drugs that can worsen BPH?
- Centrally-acting anticholinergics (e.g., benztropine)
- antihistamines,
- decongestants,
- phenothiazines,
- TCAs,
- caffeine,
- diuretics,
- SNRIs,
- testosterone products
What tests are used to diagnose BPH?
Digital rectal exam and PSA
What are the symptoms of BPH?
- Hesitancy, intermittent urine flow, straining or a weak stream of urine;
- urinary urgency & leaking or dribbling;
- urinary frequency, especially nocturia.
How is mild BPH treated?
Watchful waiting
Which natural products can be used for BPH?
Saw palmetto
Lycopene (prostate cancer prevention)
What are the drug treatments for BPH?
Alpha-blockers +/- 5-Alpa Reductase Inhibitor
Or tadalafil +/- finasteride
What is the mechanism of action (MOA) of 5-ARIs?
Decrease prostate size by blocking 5-alpha reductase enzyme which blocks conversion of testosterone to DHT
In which cases should 5-ARIs NOT be used?
Men who have bladder outlet obstruction symptoms without prostate enlargement
What is the first-line treatment for mod-severe BPH?
Alpha blockers
What is the mechanism of action (MOA) of alpha-blockers?
Inhibit alpha-1 adrenergic receptors, causing relaxation of smooth muscle in the prostate bladder neck, reducing bladder outlet obstruction and improving urinary flow
Which alpha receptor is primarily found in the prostate?
Alpha-1A
What are the non-selective alpha-1 blockers?
terazosin and doxazosin
Have more side effects
What is the brand name of Doxazosin?
Cardura
What time of day are non-selective alpha-blockers taken?
At bedtime (to minimize initial first-dose effect of orthostasis/dizziness)
What is the brand name of Tamsulosin?
Flomax
What are the warnings associated with alpha-blockers?
Orthostatic hypotension/syncope
Intraoperative floppy iris syndrome can occur in cataract surgery
What are the side effects of alpha-blockers?
Dizziness, fatigue, headache, abnormal ejaculation
How many weeks may alpha-blockers need to assess beneficial effects?
4-6 weeks
True or False: Alpha-blockers do not shrink the prostate or change PSA levels.
True
What is a counseling point for Cardura XL?
OROS formulation - leaves a ghost tablet
What side effect can Silodosin cause?
Retrograde ejaculation
What is the dosing for Tamsulosin?
0.4 mg daily
What is the brand name of Finasteride?
Proscar
