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Pharmacology II > Benign Prostatic Hyperplasia > Flashcards

Benign Prostatic Hyperplasia Flashcards

1
Q

Signs of obstructive BPH

A
  • Urinary hesitancy
  • Urine dribbling
  • Bladder fullness post voiding

(can be from static or dynamic factors)

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2
Q

Signs of irritative BPH

A
  • Urinary frequency
  • Urgency
  • Nocturia

(these are from long-standing obstruction at the bladder neck)

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3
Q

Describe the 3 types of tissue in the prostate

A
  1. Epithelial - glandular tissue. Androgens stimulate growth (Stromal to epithelial tissue 2:1, 5:1 in BPH)
  2. Stromal tissue - smooth muscle tissue, alpha 1 adrenergic receptors (norepinephrine causes smooth muscle constriction)
  3. Capsule - fibrous connective tissue and smooth muscle (also has alpha 1 adrenergic receptors)
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4
Q

What is the principle testicular androgen?

A

testosterone

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5
Q

What is the principle adrenal androgen?

A

androstenedione

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6
Q

What are androgens converted to by 5 alpha reductase in target cells?

A

dihydrotestosterone (DHT)

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7
Q

What effect does DHT have on the prostate?

A

growth and enlargement

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8
Q

What is Type I 5-alpha reductase responsible for and where is it located?

A

Effects: acne and increased body and facial hair

Location: sebaceous glands in scalp, liver, and skin

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9
Q

What is Type II 5-alpha reductase responsible for and where is it located?

A

Effects: prostate, genital tissue (and hair follicles of scalp)

Location: DHT induces growth and enlargement of gland*

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10
Q

What medication type would help most quickly?

A

alpha-1 adrenergic antagonists

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11
Q

BPH: Static factors

A
  • anatomic enlargement

- Androgen stimulation of epithelial tissue

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12
Q

BPH: Dynamic factors

A
  • excessive alpha-adrenergic tone of stroma

- Results in contraction of prostate gland around urethra and narrowed urethral lumen

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13
Q

Name some drugs that can worsen BPH (4)

A
  1. Anticholinergic agents
  2. Antihistamines
  3. Tricyclic antidepressants
  4. Phenothiazines
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14
Q

What drug would block alpha1 - adrenergic receptors (non-selective)

A

Doxazosin (Cardura)

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15
Q

What drug blocks alpha 1-receptors selectively and is overall the preferred agent?

A

Tamsulosin (Flomax)

-also most expensive

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16
Q

What drug is a good fit for someone with BPH and ED?

A

Tadalafil (Cialis)

17
Q

Which drugs need to be slowly titrated up to maintenance dose to minimize orthostatic hypotension and first-dose syncope?

A
  • Doxazosin

- Terazosin

18
Q

What drug would be best for reducing the static factor of BPH by blocking 5 alpha-reductase?

A

Finasteride (Proscar)

Dutasteride (Avodart)

19
Q

Which 2 drugs relax the detrusor muscle of the bladder?

A

Oxybutynin (Ditropan)

Mirabegron (Myrbetriq)

20
Q

Name two preventative benefits of using an alpha-1 adrenergic antagonist?

A
  1. Delay symptom progression

2. Reduce complications of BPH

21
Q

What are some of the main downsides to using 5 alpha-reductase inhibitors? (5)

A
  • SLOW onset (up to 6 months to see max benefit)
  • Decreased libido
  • Erectile dysfunction
  • Ejaculation disorders
  • Gynecomastia
22
Q

What is an ADE affecting the eye for alpha-adrenergic antagonists (ex. Doxazosin, Tamsulosin)?

A

Floppy iris syndrome

23
Q

What lab value is important to monitor with 5 alpha reductase inhibitors?

A

PSA, which should drop by 50% if adherent to therapy

24
Q

Which two medications relax prostatic smooth muscle?

A
  1. Alpha-1 adrenergic antagonists (ex. Doxazosin and Tamsulosin)
  2. Phosphodiesterase inhibitors (ex. Tadenafil)
25
Q

Which is the only medication that can decrease the prostate’s size?

A

5 alpha-reductase inhibitors (ex. Finasteride (Proscar), Dutasteride (Avodart))

26
Q

Which is the only medication that lowers PSA?

A

5 alpha-reductase inhibitors (ex. Finasteride (Proscar), Dutasteride (Avodart))

27
Q

Which 4 medications have potential for cardiovascular adverse effects?

A
  1. Alpha-1 adrenergic antagonists
  2. PDE inhibitors: mild hypotension
  3. Anticholinergic agents (tachycardia)
  4. Mirabegron (hypertension)
28
Q

Which medication relaxes the detrusor muscle?

A

Mirabegron (Beta-3 adrenergic agonist)

29
Q

What are the effects of Mirabegron (Beta 3 adrenergic agonist)

A
  1. reduces irritative voiding symptoms
  2. Increases bladder capacity
  3. Increases time between voidings
30
Q

What is the best treatment option for a patient with BPH and a large prostate and irritative voiding symptoms?

A

alpha-1 adrenergic antagonist + anticholinergic

or

alpha-1 adrenergic antagonist + mirabegron

31
Q

What is the best treatment for someone with BPH, without prostate enlargement and low PSA?

A

alpha-1 adrenergic antagonist

Pharmacology II (31 decks)

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