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NAPLEX 2024 > 51. BPH > Flashcards

51. BPH Flashcards

1
Q

Testosterone is metabolized to ____ by ____

A

dihydrotestosterone (DHT) by 5 alpha-reductase

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2
Q

Benign prostatic hyperplasia (BPH) results from overgrowth of the ___ and ___ of the prostate gland

A

Stromal and epithelial cells

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3
Q

What are some drugs that can worsen BPH?

A

Centrally-acting anticholinergics (e.g. benztropine)
Drugs with anticholinergic effects
- antihistamines (e.g. diphenhydramine)
- Decongestants (e.g. pseudoephedrine)
- Phenothiazines (e.g. prochlorperazine)
- TCAs (e.g. amitriptyline)
Caffeine
Diuretics
SNRIs
Testosterone products

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4
Q

Diagnosis of BPH includes ___

A

digital rectal exam (DRE) to determine size of prostate and identify any lumps or nodules
Urinalysis and serum prostate-specific antigen (PSA) to rule out other conditions

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5
Q

S/sx of BPH are mainly lower urinary tract symptoms. What are some examples

A

Hesitancy, intermittent urine flow, straining or weak stream
Urgency, leaking or dribbling
Frequency, especially nocturia
Incomplete emptying of the bladder
Bladder outlet obstruction

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6
Q

BPH rarely causes more severe symptoms but if blockage is severe, urine could back up into the kidneys and result in ___

A

acute renal failure

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7
Q

Treatment for mild BPH disease vs Moderate/severe BPH disease

A

Mild = watchful waiting and monitoring
Moderate/severe = meds or surgery (transurethral resection of the prostate (TURP))

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8
Q

What natural product is used for BPH (although unlikely to be effective)?

A

Saw palmetto

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9
Q

What natural products is used for prostate cancer prevention

A

Lycopene

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10
Q

5 alpha-reductase inhibitors work by ___ but they have delayed onset

A

decreasing prostate size

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11
Q

When should 5 alpha-reductase inhibitors NOT be used?

A

Men who have bladder outlet obstruction symptoms w/o prostate nelargement

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12
Q

What med regimen would be fitting for patients with BPH and erectile dysfunction?

A

PDE-5i tadalafil ± finasteride

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13
Q

MOA Alpha-1 blocker

A

Inhibit alpha-1 adrenergic receptors&raquo_space; relaxation of smooth muscle in prostate and bladder neck&raquo_space; reduces bladder outlet obstruction and improves urinary flow

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14
Q

What type of alpha-1 receptor is primarily found in the prostate?

A

Alpha-1A

Note: Alpha-1B and Alpha-1D are primarily found in the heart and arteries

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15
Q

What are examples of selective alpha-1A blockers?

A

Tamsulosin, alfuzosin, sildosin

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16
Q

What are examples of non-selective alpha-1 blockers?

A

Terazosin, doxazosin

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17
Q

Which type of alpha-1 blockers have more side effects: selective or non-selective?

A

Non-selective (terazosin, doxazosin)

18
Q

Patients using alpha-blockers are at risk of developing ___ during cataract surgery. If cataract surgery is planned, can alpha-blockers still be used?

A

Intraoperative floppy iris syndrome (IFIS)
Alpha-blocker treatment should be delayed until surgery has been completed

Note: alpha-1 receptors are present on the iris dilator muscle in the eye

19
Q

What alpha blockers used in BPH are recommended to be given at bedtime and titrated slowly

A

Non-selective alpha-1 blockers: Doxazosin (Cardura, Cardura XL) and terazosin

20
Q

Warnings for alpha blockers used in BPH

A

Orthostatic hypotension/syncope (if dosage is increased too rapidly, another antiHTN med, or PDE-5i used)
IFIS in cataract surgery
Priapism (prolonged erection, seek med attention if >4 hrs)
Angina (d/c if angina begin or worsens)

21
Q

Starting dose for tamsulosin (Flomax)

A

0.4mg daily

22
Q

Side effects for alpha-1 blockers

A

Dizziness, fatigue, HA, abnormal ejaculation (esp with tamsulosin and silodosin), fluid retention, rhinitis (tamsulosin)

23
Q

Why are non-selective alpha-1 blockers recommended to be given at bed time?

A

To minimize initial “first-dose” effect of orthostasis/dizziness

24
Q

Alpha-blockers work quickly on LUTS but may take ____ to assess whether beneficial effects have been achieved

A

4-6 weeks

25
Q

Alpha blockers work quickly but do not ___

A

shrink the prostate or change PSA levels

26
Q

Which alpha-1 blocker can cause retrograde ejaculation in ~30% patients (reversible upon d/c)

A

Silodosin

27
Q

Pt is on tadalafil for BPH but may require additional BPH med. Which BPH meds should be avoided?

A

Alpha-1 blockers (risk of orthostatic hypotension/syncope)

28
Q

Which alpha-1 blocker can cause QT prolongation?

A

Alfuzosin (Uroxatral)

29
Q

MOA 5 alpha-reductase inhibitors

A

Inhibit 5 alpha-reductase enzyme, which blocks conversion of testosterone to dihydrotestosterone (DHT)

30
Q

___ is selective for the 5 alpha-reductase type II enzyme (more prevalent within prostate) while ___ inhibits both type I and II

A

Finasteride
Dutasteride

31
Q

What is the rationale to use alpha-blockers + 5 alpha-reductase inhibitors?

A

Improve symptoms
Decrease risk of acute urinary retention
Decrease need for surgery

Alpha-blockers = LUTS
5 alpha-reductase inhibitors = shrink prostate and decrease PSA levels

32
Q

Indication for 5 alpha-reductase inhibitors

A

Treatment for symptomatic BPH in men with enlarged prostate

33
Q

Contraindications for 5 alpha-reductase inhibitors

A

Women of child bearing potential, pregnancy, children

34
Q

Side effects of 5 alpha-reductase inhibitors

A

Impotence, decreased libido, ejaculation disturbances, breast enlargement and tenderness, rash

Note: sexual side effects decrease with time and return to baseline at 1 year of use in some men

35
Q

Which BPH meds should pregnant women NOT take or handle

A

5 alpha-reductase inhibitors

36
Q

5 alpha-reductase inhibitors take ___ for maximal efficacy

A

6 months or longer

37
Q

5 alpha-reductase inhibitors affect on BPH

A

shrink prostate and decrease PSA levels

38
Q

Which brand name of finasteride is for alopecia

A

Propecia
Note: do not use Proscar if using Propecia for hair loss

39
Q

____ is the only PDE-5i that is FDA-approved for treatment of BPH with or w/o ED

A

Tadalafil

40
Q

Contraindications for tadalafil (Cialis)

A

Do NOT use with nitrates or riociguat

41
Q

Warnings for tadalafil (Cialis)

A

Impaired color discrimination (dose-related, higher risk with retinitis pigmentosa)
Hearingl oss
Vision loss (can be d/t nonarteritic anterior ischemic optic neuropath NAION)
Hypotension
CVD (seek immediate med help for chest pain)
Priapism (seek emergency med care if erection > 4hr)

42
Q

Side effects for tadalafil (Cialis)

A

HA, flushing, dizziness, dyspepsia, muscle/back pain, myalgia, blurred vision, increased sensitivity to light, epistaxis, diarrhea

NAPLEX 2024 (74 decks)

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