Benign Prostatic Hyperplasia Flashcards
What are key regulators of the prostate gland?
Androgens
What hormone plays a role in the development of BPH?
Androgens
Any drug that is capable of doing what may help improve flow of urine?
Relaxing contractile smooth muscle
What are the two subclasses of BPH drugs?
Alpha blockers
5-alpha-reductase inhibitors
Why do alpha blockers work for BPH?
They act as adrenergic antagonists
What is the common suffix for alpha blockers for BPH?
-osin
What is one of the more popular alpha blockers for BPH?
Tamsulosin [Flomax]
What is the MOA of Tamsulosin?
Selective competitive antagonism of lower urinary tract alpha-1a adrenergic receptors, relaxing smooth muscle of the bladder neck andprostate
What are the indications for Tamsulosin?
BPH
Nephrolithiasis (kidney stones)
What are the common adverse effects of Tamsulosin?
Dizziness Sinusitis Pharyngitis Cough Infection
What are the serious adverse side effects of Tamsulosin?
Orthostatic hypotension
Syncope
What are the ocular adverse side effects of Tamsulosin?
Floppy iris syndrome
Why does Tamsulosin have Dizziness as a side effect, as well?
While it is selective for the urinary tract, it also works a bit to relax blood vessels, decreasing BP
If a patient is on a drug ending in -osin, and they may need lens or retinal surgery, what should your first step be?
Contact PCP to get them off of it so that they don’t have floppy iris syndrome
What is the effect of chloroquine interacting with Tamsulosin?
Reduces the hepatic metabolism of Tamsulosin, increasing the likelihood of side effects
Macrolides, azole antifungals, and fluorouinolones do what when they interact with Tamsulosin?
Enhance hepatic metabolism of Tamsulosin
What are the contraindications for Tamsulosin?
Cataract surgery
Glaucoma surgery
Sulfonamide allergy
What is the suffix for the BPH drugs classified as 5-alpha-reductase inhibitors (5-ARIs)?
-eride
What are the two 5-alpha-reductase inhibitors?
Finasteride
Dutasteride
What is the MOA of 5-ARIs?
Inhibits type II 5-alpha-reductase, interfering with conversion of testosterone to 5-alpha-dihydrotestosterone
What are the indications for Finasteride?
BPH
Androgen-dependent hair loss
What are the common adverse effects of Finasteride?
Orthostatic hypotension
What are the serious adverse effects of finasteride?
Prostate cancer
Breast cancer
Why is it that finasteride can cause cancer?
It messes with the hormones that play in cell cycling
What happens if a patient is on Finasteride as wells as a CYP3A4 substrate, like nafcillin (penicillin)?
It enhances the matbolism of Finasteride, to the point where there may be no benefit of Finasteride
What are the contraindications to Finasteride?
Hypersensitivity
Hepatic disease
Why is finasteride prone to cause hepatic disease?
Changes hormone regulation and the liver is key in metabolism
