Benign Prostatic Hyperplasia (BPH) Flashcards
What’s the role of dihydrotestosterone (DHT)?
DHT is responsible for normal and hyperplastic growth (increase in number of cells)
What’s testosterone metabolized to?
Dihydrotestosterone (DHT)
How does BPH occur?
BPH results from overgrowth of stromal and epithelial cells of the prostate gland
What’s the effect of enlarged gland in prostate?
The enlarge gland contributes to lower urinary tract sx (LUTS) via direct bladder outlet obstruction (BOO) and increased smooth muscle tone and resistance
Is there a direct linear correlation between protease size and sx?
No
Does enlarged prostate increase the risk of prostate cancer?
No
What mainly causes the s/sx of BPH?
LUTS (Lower Urinary Tract Sx)
LUTS (lower urinary tract sx) may include the ff
Hesitancy, intermittency, straining or weak stream of urine
Urinary urgency and leaking or dribbling
Incomplete emptying of the bladder (bladder always feels full)
Urinary frequency, especially nocturia (urination at night)
Bladder outlet obstruction (BOO)
List drugs that may worsen BPH?
Decongestants e.g. Pseudoephrine
Anticholinergics e.g. Benztropine
Antihistamines e.g. Diphenhydramine, Chlorpheniramine
TCAs, phenothiazines and other drugs with anticholinergic properties
Caffeine (can worsen sx)
Diuretics (increase urination-be sure to take early in the day to limit nocturia)
SNRIs (affect urethral resistance)
Testosterone pdts
What guides selection of tx modality in a pt?
The patient’s perception of the severity of BPH sx guides selection of tx
List tx options of BPH
Watchful waiting (mild dx; pt returns for yearly reassessment)
Pharmacologic therapy
Surgical intervention
When are 5-alpha reductase inhibitors used in BPH?
LUTS secondary to BPH + Prostatic enlargement
T/4 don’t use if no prostatic enlargement
Why should 5 alpha-reductase inhibitors not be used if no prostatic enlargement?
5 alpha-reductase inhibitors work by decreasing prostate size
What’s a reasonable option for men w/o an elevated post void residual (PRV) urine and when LUTS are predominately irritative?
Peripheral-acting anticholinergic agent used for over active bladder e.g. Tolterodine
What’s the value of PVR for anticholinergic to be used?
< 250-300mL
What’s an option for men with both BPH and erectile dysfunction?
Tadalafil
What’s the standard BPH tx?
Alpha blockers e.g. Terazosin, Doxazosin
When is a 5 alpha-reductase inhibitor combined with alpha blockers?
Moderate sx of BPH
What’s the most popular alpha-blocker? With SE is it recently associated with?
Tamsulosin
Floppy iris syndrome
Effect of tamsulosin’s floppy iris syndrome on cataract?
Increases the risk of cataract
AND
Makes cataract surgery itself difficult (important to tell ophthalmologist that pt has ever used alpa-blocker)
List natural pdts used in BPH
Saw palmetto (prostate cancer MUST be ruled out first b4 use)
Pygeum
Beta-sitosterol
Rye grass pollen
Should pharmacists recommend natural pdts for BPH?
No.
MOA of alpha-blockers
Inhibit alpha-1 adrenergic receptors and relax the smooth muscle of the bladder neck reducing bladder outlet obstruction and improving urinary flow
List non-selective alpha-1 blockers
Terazosin (Hytrin)
Doxazosin (Cardura, Cardura XL)
Prazosin
Whats the brand name of Terazosin? (Non-selective alpha-1 blockers)
Hytrin
Whats the brand name of Doxazosin? (Non-selective alpha-1 blockers)
Cardura
Cardura XL
How are terazosin, Doxazosin, and prazosin titrated?
Slowly
What’s the associated warning with non-selective alpha-1 blockers?
Orthostatic hypotension/ Syncope (typically with 1st dose). T/4 dose QHS, especially during initiation
Floppy iris syndrome (can occur during cataract surgery)