Benign Prostatic Hyperplasia

Question 1

What receptors predominate in the lower bladder, prostate, and urethra? What is in the upper bladder?

Answer 1

alpha1a- lower, prostate, urethra

alpha1d-upper

Question 2

Does data suggest using saw palmetto or beta stiosterols over anything medical?

Answer 2

no…

Question 3

What is the MOA of Alpha 1 blockers to tray BPH?

Answer 3

Block A1 receptors, reducing vasoresistance.

Relax the lining of the bladder, prostate, urethra.

Question 4

What are the advantages of alpha blockers? Disadvantages?

Answer 4

Advantages: no CV effects, low hypotension
Disadvantage: Abnormal ejaculation, blocks dopamine

Question 5

What is the best alpha blocker with least AEs?

Answer 5

Alfuzosin

Question 6

What is a AE of alpha blockers in the eye?

Answer 6

Floppy iris syndrome: during cataract surgery

Change surgical technique

Question 7

How long does alfuzosin work?

Answer 7

10 hours

Question 8

What is alfuzosin elimination?

Answer 8

Fecal and renal: 3:1

Question 9

What is an off label use of alfuzosin?

Answer 9

Erectile dysfunction

Question 10

How do PDE5 inhibitors work for BPH?

Answer 10

Prevent cGMP breakdown
decreased Ca+
smooth muscle relaxation

Question 11

What is MOA of tidalafil?

Answer 11

PDE5 inh

Question 12

What is AE, contraindications of tidalafil?

Answer 12

AE: 
   non arteric optic neuropathy
   retinal artery occlusion
   hearing loss
    HA
    flushing
    CV
    bleeding
CI: Nitrates!!!: worse with alcohol

Question 13

What are 5aReductase inhibitors used for in BPH?

Answer 13

Decrease DHT

AE: CatX, not carried in semen, ejaculatory dysfunction, decreased lbido, gynecomastia, prostate cancer risk, decreased PSA

Question 14

What can cause a false negative low PSA in prostate cancer monitoring?

Answer 14

5a Reductase inhibitors:
finasteride
dutasteride