Geriatrics: BPH

Question 1

BPH symptoms

Answer 1

incomplete emptying
frequency
intermittency
urgency
weak stream
straining
nocturia

Question 2

Non-pharm BPH treatment

Answer 2

incontinent pads
TURP
Urethral dilation
Foley catheters

Question 3

Medication classes for treating BPH

Answer 3

• Alpha antagonists (alpha 1a specific agents preferred)
• 5A Reductase inhibitors
• Tadalafil (PDE5 inhibitor)

Question 4

Non-specific alpha 1 antagonists

Answer 4

Terazosin > Doxazosin > Prazosin
relax muscle tone
ADE: postural hypotension, dizziness, blurred vision, drowsiness, asthenia, “first dose” effect (added effect with other HTN meds)

Question 5

Alpha 1a specific antagonists

Answer 5

Silodosin > Alfuzosin ~ Tamsulosin
(silodosin not available generic -> $$$)
ADE: rarely hypotension, vertigo, drowsiness, floppy iris syndrome, ejaculatory dysfunction

Question 6

5A Reductase inhibitors

Answer 6

Finasteride (Proscar)
Dutasteride (Avodart)
Reduce cellularity

Question 7

Tadalafil

Answer 7

Mechanism not established
PDE 5 inhibitor
ADE: symptomatic hypotension when in combo with alpha blockers

Question 8

Is saw palmetto effective treatment for BPH?

Answer 8

NO

Question 9

Drugs to avoid in BPH

Answer 9

Reduce detrusor contractility:
- TCAs
- Diphenhydramine
- Disopyramide
- Anticholinergics

Increase muscle tone:
- Pseudoephedrine
- Ephedrine