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Week 64: Prostate Cancer and BPH > Pharm Approach for LUTD > Flashcards

Flashcards in Pharm Approach for LUTD Deck (18)
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1

BPH

Increase in number of peri-urethral epithelial and stromal cells (transition or central zone)
Imbalance between proliferation and apoptosis
Growth dependent on DHT

2

Symptoms of BPH

Hesitancy
Intermittency
Post-void dribbling
Straining
Nocturia
Weak stream
Incomplete emptying

3

Alpha blockers

Used to treat BPH
Alpha adrenergic receptors at the bladder neck and in the prostatic fossa (smooth muscle)
Smooth muscle contracts in the presence of NE, increasing urethra resistance
Onset 1-2 weeks
Ex: tamsulosin, silodosin, alfuzosin

4

Side effects of alpha blockers

Dizziness
Weakness (asthenia)
Flushing
Rhinitis
Headache
Retrograde ejaculation
Syncope

5

Where are types
1
2
5a-reductase enzymes found in the body?

1. Skin, scalp
2. Prostate

6

What is the best combo of treatment for BPH?

Alpha blocker and 5a-reductase inhibitor

7

PDE5 inhibitors and BPH

NO has a role in the relaxation response
Results in smooth muscle relaxation and increased pelvic blood flow
Relaxes prostate, bladder neck, and urethra
Not standard treatment currently

8

Criteria for an overactive bladder

Urgency (sudden urge to void, difficult to defer)
Frequency (8+ voids per 24 h)
Nocturia (2+ voids a night)
Urge incontinence

9

Conservative managements of overactive bladder

Lifestyle modification (avoid caffeine, fluid reduction)
Bladder training
Biofeedback

10

2 types of pharmacologic treatment for overactive bladder

Oral (anti muscarinics, B3 adrenergic agonists)
Intravesical (botox)

11

Effect on bladder via
1. Cholinergic
2. B3
receptors

1. Contraction
2. Relaxation

12

What type of muscarinic receptor is
1. most common in bladder
2. most important for bladder contraction

1. M2
2. M3

13

Main anticholinergic side effects

Blurred vision*
Dry mouth*
Constipation*
Urinary retention
Altered mental status
Tachycardia
Skin rash/erythema

14

Contraindications to anticholinergics

Acute angle glaucoma
Myasthenia gravis
Tachyarrhythmia
Gastric outlet obstruction
Bowel obstruction

15

Main side effect of B3 agonists

Hypertension

16

Onabotulinumtoxin A (botox) for overactive bladder

Inhibits ACh release at pre-synaptic cholinergic nerve terminal
Inhibits striated and smooth muscle contraction
Decreases urgency, frequency, and incontinence

17

Contraindications to botox for overactive bladder

Pregnant or breastfeeding
ALS
Aminoglycoside use
MG

18

Absolute contraindication for PDE5 inhibitor

Nitrate use (profound hypotension