IC19 BPH

Question 1

Assessment of BPH

Answer 1

• Digital rectal exam
• Qmax: maximum urinary flow rate
• Postvoid residual: < 100ml is normal, > 200ml is inadequate emptying
• Prostate specific antigen: may be elevated but is not specific to BPH

Question 2

Medications which may worsen BPH

Answer 2

Anticholinergics
Decongestants
Opioids
Diuretics
Testosterone

Question 3

Goals of therapy

Answer 3

Relieve LUTS
Increase QOL
Prevent progression of BPH and its complications

Question 4

Non pharm management

Answer 4

• Watchful waiting: mild symptoms, or not bothered by symptoms
• Scheduled voiding
• Limit fluid intake in evening
• Limit caffeine and alcohol

Question 5

Indications for alpha adrenergic antagonist

Answer 5

• Small prostate size
• For voiding symptoms: dribbling, hesitancy, incomplete emptying
• Does not reduce prostate size
• Does not prevent progression
• Fast onset

Question 6

Non selective alpha adrenergic antagonist examples

Answer 6

• Terazosin
• Doxazosin
• Prazosin

Question 7

MOA of non selective alpha adrenergic antagonist

Answer 7

• Vascular and Urinary receptors
• BP lowering effect

Question 8

ADR of non selective alpha adrenergic receptors

Answer 8

• Hypotension
• Syncope
• Dizziness

Question 9

MOA of selective alpha adrenergic receptors

Answer 9

• Selective for urinary receptors
• Does not lower BP as much

Question 10

Selective alpha adrenergic receptors examples

Answer 10

• Alfuzosin
• Tamsulosin
• Silodosin

Question 11

ADR of selective alpha adrenergic antagonists

Answer 11

Ejaculatory disturbances retrograde ejaculation

Question 12

Caution when using alpha adrenergic antagonists

Answer 12

Intraoperative floppy iris syndrome: cataract surgery, hold drug at least 14 days before surgery, can initiate after surgery

Question 13

5 alpha reductase inhibitors examples

Answer 13

Finasteride
Dutasteride

Question 14

Indication of 5 alpha reductase inhibitors

Answer 14

• Reduce prostate size
• Slows progression of disease
• Decrease PSA levels: if levels > 1.5ng/ml
• Slow onset of 6-12 months

Question 15

ADR of 5 alpha reductase inhibitors

Answer 15

• Ejaculatory disturbances
• ED
• Decrease libido

Question 16

Contraindication of 5 alpha reductase inhibitors

Answer 16

Pregnancy or child bearing age females

Question 17

Indication for PDE5 inhibitors

Answer 17

• Add on
• For voiding symptoms
• Does not decrease prostate size

Question 18

DDI of PDE5I

Answer 18

Nitrates due to fatal hypotension