Sweatman BPH Drugs

Question 1

three drug classes used in BPH treatment

Answer 1

Alpha antagonist
PDE5 inhibitors
5 alpha reductase inhibitors

Question 2

dynamic bladder-outles obstruction due to

Answer 2

signalling via Alpha 1a,b,d receptors

Question 3

static bladder-outlet obstruction

Answer 3

5 alpha reductase-testosterone-enlargment of the prostate (hyperplasia)

Question 4

bladder muscle is under what control

Answer 4

Muscarcinic (Acetylcholine) M3 selective and M2 non-selective

Question 5

only alpha families that matter

Answer 5

alpha 1a

alpha 1d

Question 6

detrussor muscle is under what receptor control

Answer 6

alpha-1d

Question 7

Lower GI tract”–>Trigone, prostatic urethra, prostate gland penile urethra of bladder is under what receptor control

Answer 7

alpha 1a

blockade causes relaxation of all these entities and allows for easier urination

Question 8

alpha blocker with great variation from patient to patient

Answer 8

prazosin

Question 9

dose titration necessary

Answer 9

prazosin

Question 10

all alpha blockers end in

Answer 10

• Zosin
• losin
• dozin

Question 11

advantage of selective alpha 1a agents

Answer 11

no need for dose titration, less CV effects

Question 12

disadvantages of alpha 1a agents

Answer 12

• retrograde ejactulation (tamsulosin, silodosin)

- blockade of dopa receptors in CNS

Question 13

superior Alpha antagonist at the momen

Answer 13

Alfuzosin–> no CNS or ejaculatory effects

Question 14

alpha 1 blockers in eye surgery

Answer 14

floppy iris syndrome

Question 15

events in erection

Answer 15

(PNS S2-S4) via the cavernous nerve-ACH-NOS-NO-SOLUBLE GC–>cGMP–>active PKG–>efflux of calcium (dec intraceullualr concentration)–> vasodilation

Question 16

MOA for PDE5i

Answer 16

inhibits PDE5 which allows cGMP to linger—>prolongs natural vasodilatory action of the endogenous molecule

Question 17

name the PDE5i

Answer 17

tadalafil (cialis)

Question 18

ADE’s for tadalafil

Answer 18

Nasopahrygitis, URTI, NON-arteric ischemic optic neuropathy, retinal artery occluson, hearling loss

Question 19

contraindicated in tadalafil usage

Answer 19

nitrate-profoudn hypotension

worse with ETOH consumption

Question 20

which androgen activate gene expression more efficiently

Answer 20

DHT»testosterone–> binds with higher affinity

Question 21

distribution of type I/II 5 alpha reductase

Answer 21

type I: non genital skin, liver, bone

2–> urogenital tissue and genital skin in men and women

Question 22

MOA for 5 alpha reductase inhibitors

Answer 22

reduce DHT driven proliferation of the prostate-providing relief for urinary evacuation

Question 23

inhibits type I and 2

Answer 23

dutasteride

Question 24

inhibits type 2 only

Answer 24

finasteride

Question 25

pregnancy category for 5 alpha reductase inhibitors

Answer 25

category X

Question 26

side effects of 5 alpah reductase inhibtors

Answer 26

ejaculatory dysfuntion, dec libido, gynecomastia

Question 27

effect on PSA for 5 alpha reductase inhibitors

Answer 27

reduces PSA levels-therfore problem if PSA being monitored for Prostate CA

Question 28

beta sitosterols

Answer 28

relieve symptoms, improved flow, without shrinking the prostate

Question 29

Saw palmeto and BPH

Answer 29

no benefit on symptoms and does not reduce PSA levels

Question 30

Erectile Dysfunction drug that mimics PGE1

Answer 30

alprostadil

Question 31

MOA for alprostadil

Answer 31

activates adenylate cyclase--> makes cAMP from ATP-->PKA-->calcium efflux, vasodilation

Question 32

delivery for alprostadil and systemic effects

Answer 32

``` urethral suppository direct injection into corpus cavernosum *these routes show very litle systematization no drug dugr interxns *Cv events rare ```

Question 33

adverse effects of oral ED tablets

Answer 33

CV issues angina and MI (and worsening of pre-exisiting CV issues) Sudden loss of hearing and Optic Neuropathy (vision loss) headache

Question 34

why is tadalafil used for both BPH and ED

Answer 34

long duration of action

Question 35

Drug Drug interaction with oral ED pills

Answer 35

YES | --all hepatically metabolised by 3A4

Question 36

absolute contraindications for ED pills

Answer 36

Nitrates

Question 37

potential contraindictions for ED pills

Answer 37

alpha blockers | drugs acting on cyps

Question 38

ED pill with QT prolonging propensity

Answer 38

Vardenafil | interaction with > 70 drugs

Question 39

testosterone therapy (HRT) and its effect on ED

Answer 39

may improve sensitivty to PDE5i's-->High levels of T not necessary to maintain erection,

Question 40

this drug inihibits Alpha 2-AR's by NE, as well as antagonized NANC (presynaptic inhibition)-->increases release of NO

Answer 40

Yohimbe

Question 41

Yohimbe contrainidacted in

Answer 41

renal failure/dysfunction