Benign Prostatic Hyperplasia Flashcards
What are lower urinary tract symptoms associated with benign prostatic hyperplasia?
Voiding
- weak/interrupted stream
- dribbling
- hesitancy
- straining
Storage
- nocturia
- frequency
- urgency
What laboratory test is often done for BPH? What does it indicate?
Prostate specific antigen (PSA)
A predictor of prostate volume. In combo with age, can be useful at detecting prostate cancer.
What is the testing guidelines for PSA? (age recommendation)
40-54= baseline
55-69= discuss with MD
70+= not recommended
If life expectancy less than 10-15 years= not recommended
What drug class can affect PSA levels?
5-alpha reductase inhibitors
Be aware when evaluating results
What high risk populations should have their PSA levels tested earlier?
Positive family history
Black African/Caribbean descent
What should patients with problematic nocturia avoid in their diet?
Caffeine-containing beverages and alcohol in the evening
What are the three classes of medication that are often used to treat BPH?
Alpha-1 adrenergic receptor antagonist
5-alph reductase inhibitors
Phosphodiesterase type 5 inhibitors
Which drugs are under the alpha-1 adrenergic receptor antagonist?
Alfuzosin
Doxazosin
Terazosin
Silodosin
Tamsulosin
Which drugs are under the 5-alpha reductase inhibitors?
Dutasteride
Finasteride
What are the two classes of alpha1- adrenergic receptor?
Non selective:
- alfuzosin
- doxazosin
- terazosin
Selective
- silodosin
- tamsulosin
What is the mechanism of action of alpha-1 adrenergic receptors?
Mediates/relaxes smooth muscle activity in the bladder neck, prostate, and prostatic capsule
Reduces the dynamic component
Which of the alpha 1 adrenergic receptor antagonists need to be dose titrated?
Why?
Doxazosin
Terazosin
Avoid first dose syncope
Which alpha 1 adrenergic receptor antagonists require no dose titration?
Alfuzosin
Silodosin
Tamsulosin
What are common side effects with alpha-1 adrenergic receptor antagonists?
Dizziness, headaches, asthenia, nasal congestion
Which alpha 1 adrenergic receptor antagonist has the highest risk of decrease ejaculate volume? Which drug has the lowest risk?
Silodosin (highest)
Tamsulosin (middle)
Alfuzosin (uncommon)
What’s a drug interaction we have to watch out for with alpha-1 adrenergic receptor antagonist?
Hypertension medications
-may potentiate the antihypertensive effects
Which alpha1 adrenergic receptor antagonist has fewer systemic side effects? Why?
Silodosin
Tamsulosin
More selective
Doxazosin and terazosin is non-selective and has higher risk of hypotension. What can you do to reduce adverse events rate?
Doxazosin and terazosin
Which alpha blocker is linked to intraoperative floppy iris syndrome?
What must be counsel on?
Tamsulosin
Notify ophthalmologist of this medication before undergoing cataract surgery
What drugs are 5-alpha reductase inhibitors?
Finasteride
Dutasteride
What is the mechanism of action of 5-alpha reductase inhibitors?
Blocks the metabolism of testosterone to dihydrotestosterone.
Reduces prostatic volume (static component)
What population does 5-alpha reductase inhibitors work best in?
Those with large prostates (≥40 mL)
How long does it take for serum PSA levels to decrease following initiation of 5-alpha reductase inhibitors?
6 months
New PSA baseline should be done after 6 months
Some suggest doubling SPA levels in order to provide accurate PSA number for prostate cancer screening
At what age, is there an increased risk of self-harm and depression in patients using 5-alpah reductase inhibitors?
≥66 years of age
Finasteride and dutasteride have been shown to ________ overall risk of prostate cancer.
However, those diagnosed with prostate cancer are at a _______ risk of high-grade cancer
Reduced
Higher
What phosphodiesterase type 5 inhibitors is indicated for BPH as well?
Tadalafil
What is the general approach for combo therapies?
Combo therapy is effective for patients with demonstrable prostatic enlargement.
Discontinue alpha blocker after 6-12 months. If symptoms recur, restart alpha blockers.
What’s the danger of starting an alpha blocker and PDE5 at the same time?
Hypotensive effect
Recommended to stabilize on alpha blocker before introducing PDE5 inhibitor
If patient has persistent bothersome overactive bladder, what can we use in combo with the alpha blocker instead?
Antimuscarinic
- fesoterodine
- oxybutynin
- solifenacin
- tolterodine
Beta-3 adrenoceptor agonist
- Mirabegron
What’s the risk with antimuscarinic and mirabegron?
Small risk of urinary retention (tends to occur in first month of treatment)
To avoid this risk, only use in patients with residual urine volume >200 mL
For patients with problematic nocturnal polyuria, what drug can we use?
Desmopressin
What natural health product is recommended for BPH?
None.
Saw palmetto used to be recommended, but no longer recommended.
Are BPH medications continued indefinitely?
Yes, symptoms recur when medications get stopped
Which BPH medication may have a cross-sensitivity reaction with sulfa?
Tamsulosin
How long does it take for 5-alpha reductase inhibitors to start working?
6 months
What are risk factors for BPH?
Age>40, family history, medication use (antihistamines or diuretics), African descent, obesity, comorbid diabetes or heart disease
