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NAPLEX: Evan > Benign Prostatic Hyperplasia (BPH) > Flashcards

Benign Prostatic Hyperplasia (BPH) Flashcards

1
Q

How does BPH occur?

A

BPH results from overgrowth of stromal and epithelial cells of the prostate gland

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2
Q

What’s the effect of enlarged gland in prostate?

A

lower urinary tract sx (LUTS) via direct bladder outlet obstruction (BOO)
increased smooth muscle tone and resistance

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3
Q

Is there a direct linear correlation between protease size and sx?

A

No

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4
Q

Does enlarged prostate increase the risk of prostate cancer?

A

No

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5
Q

What are the s/sx of BPH?

A

LUTS (Lower Urinary Tract Sx)

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6
Q

LUTS (lower urinary tract sx) may include the ff

A

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)

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7
Q

List drugs that may worsen BPH?

A

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

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8
Q

What guides selection of tx modality in a pt?

A

The patient’s perception of the severity

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9
Q

List tx options of BPH

A

Watchful waiting

Pharmacologic therapy

Surgery

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10
Q

When are 5-alpha reductase inhibitors used in BPH?

A

ONLY if prostatic enlargement

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11
Q

Why should 5 alpha-reductase inhibitors not be used if no prostatic enlargement?

A

5 alpha-reductase inhibitors work by decreasing prostate size

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12
Q

What’s a reasonable option for men w/o an elevated post void residual (PRV) urine and when LUTS are predominately irritative?

A

Peripheral-acting anticholinergic agent used for over active bladder
e.g. Tolterodine

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13
Q

What’s the value of PVR for anticholinergic to be used?

A

< 250-300mL

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14
Q

What’s an option for men with both BPH and erectile dysfunction?

A

Tadalafil

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15
Q

What’s the standard BPH tx?

A

Alpha blockers

e.g. tamsulosin, terazosin, doxazosin

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16
Q

When is a 5 alpha-reductase inhibitor combined with alpha blockers?

A

Moderate sx of BPH

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17
Q

What’s the most popular alpha-blocker? With SE is it recently associated with?

A

tamsulosin

Floppy iris syndrome

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18
Q

Effect of tamsulosin’s floppy iris syndrome?

A

Increases the risk of cataract

AND

Makes cataract surgery itself difficult (important to tell ophthalmologist that pt has ever used alpa-blocker)

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19
Q

List natural pdts used in BPH

A

Saw palmetto (prostate cancer MUST be ruled out first b4 use)

Pygeum

Beta-sitosterol

Rye grass pollen

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20
Q

Should pharmacists recommend natural pdts for BPH?

A

No.

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21
Q

MOA of alpha-blockers

A

Inhibit alpha-1 adrenergic receptors and relax the smooth muscle of the bladder neck reducing bladder outlet obstruction and improving urinary flow

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22
Q

List non-selective alpha-1 blockers

A

Terazosin (Hytrin)

Doxazosin (Cardura, Cardura XL)

Prazosin

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23
Q

Whats the brand name of Terazosin? (Non-selective alpha-1 blockers)

A

Hytrin

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24
Q

Whats the brand name of Doxazosin? (Non-selective alpha-1 blockers)

A

Cardura

Cardura XL

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25
Q

How are terazosin, doxazosin, and prazosin titrated?

A

Slowly

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26
Q

What’s the associated warning with non-selective alpha-1 blockers?

A

Orthostatic hypotension/ Syncope (typically with 1st dose). T/4 dose QHS, especially during initiation

Floppy iris syndrome (can occur during cataract surgery)

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27
Q

SE of a non-selective alpha-1 blockers (terazosin, Doxazosin, prazosin)

A

Dizziness

Fatigue

Orthodtatic hypotension

Headache

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28
Q

How are non-selective alpha-1 blockers taken? Why? Exception?

A

All taken at QHS

To help minimize the initial orthostasis/ dizziness

Except Cardura XL, which is taken with breakfast

29
Q

List types of alpha receptors

A

1A receptors primarily found in prostate

1B and 1D

30
Q

Effect of alpha-blockers on prostate size and PSA levels?

A

Alpha blockers have NO effect on prostate size (they don’t shrink) and NO changes to PSA levels

31
Q

List selective alpha1a blockers

A

Tamsulosin (Flomax)

Tamsulosin + Dutasteride (Jalyn)

Alfuzosin (Uroxatral)

Silososin (Rapaflo)

32
Q

What’s the brand name of Tamsulosin? (Selective Alpha1a blocker)?

A

Flomax

33
Q

What’s the dose of Tamsulosin (Flomax)? (Selective alpha 1a blocker)?

A

0.4mg daily, 30mins after the same meal each day; max 0.8mg daily

34
Q

What’s the warning associated with selective alpha-1a blockers?

A

Floppy iris syndrome

They have lower risk of orthostatic hypotension than non-selective

35
Q

What’s the cut-off CrCl for selective alpha-1a blockers use?

A

CrCl < 30mL/min

36
Q

SE of selective alpha-1a blockers?

A

Dizziness

Fatigue

Hypotension

Headache

Abnormal ejaculation (esp with Tamsulosin and Silodosin)

37
Q

Which selective alpha-1a blockers have a higher risk of abnormal ejaculation?

A

Tamsulosin (Flomax)

Silodosin (Rapaflo)

38
Q

In what group of pt is Alfuzosin contra-indicated?

A

Don’t use in pts at risk for QT prolongation - prolongs QT-interval

39
Q

What’s the off-label use of alpha-blockers in women?

A

Bladder outlet obstruction

40
Q

What’s the concern with using PDE-5 inhibitors (Viagra/Revatio, Cialis/Adcirca, Levitra/Staxyn, Stendra) co-admin with alpha blockers?

A

Both are vasodilators with BP lowering effects

41
Q

T/F? The selective alpha-1a blocker are all major CYP 3A4 substrates?

A

True

42
Q

What should be avoided with Tamsulosin, Alfuzosin, Silodosin because they are CYP 3A4 substrate?

A

Strong 3A4 inhibitors

Ritonavir

Itraconazole

Ketoconazole

Clarithromycin

Others

43
Q

What should Silodosin not be used with aside from 3A4 inhibitors?

A

Strong P-GP inhibitors e.g. Cyclosporine

44
Q

T/F? Alfuzosin can cause QT prolongation?

A

True

45
Q

Which alpha-blocker may result in QT prolongation?

A

Alfuzosin (Uroxatral)

46
Q

MOA of 5 alpha-reductase inhibitors?

A

Inhibits 5 alpha-reductase enzyme which blocks the conversion of testosterone to dihydrotestosterone (DHT)

47
Q

What’s the indication for 5 alpha-reductase inhibitors use?

A

Tx of symptomatic BPH in men with ENLARGE PROSTATE

48
Q

List 5 alpha-reductase inhibitors agents?

A

Finasteride (Proscar)

Dutasteride (Avodart)

Dutasteride + Tamsulosin (Jalyn)

49
Q

What’s the brand name of Finasteride? (5 alpha-reductase inhibitors)

A

Proscar

50
Q

What’s the brand name of Dutasteride? (5 alpha-reductase inhibitors)

A

Avodart

51
Q

What’s the dose of Finasteride (Proscar) used for BPH?

A

5mg daily

1mg is for hair loss

52
Q

Whats the contra-indication to 5 alpha-reductase inhibitors use?

A

Women of child-bearing potential, pregnancy, children

53
Q

SE of 5 alpha-reductase inhibitors (Finasteride - Proscar; Dutasteride - Avodart)?

A

Impotence

Reduce libido

Ejaculation disturbances

Breast enlargement and tenderness

54
Q

What’s the pregnancy category of 5 alpha-reductase inhibitors (Finasteride - Proscar; Dutasteride - Avodart)?

A

X

55
Q

Effects of 5 alpha-reductase inhibitors (Finasteride - Proscar; Dutasteride - Avodart) on prostate size and PSA levels

A

They shrink prostate size and reduce PSA levels

56
Q

List Phosphodiesterase-5 (PDE-5) inhibitor agent used in BPH?

A

Tadalafil (Cialis)

57
Q

What’s the brand name of Tadalafil?

A

Cialis

58
Q

SE of Phosphodiesterase-5 (PDE-5) inhibitor agent (Tadalafil - Cialis)?

A

Headache

Flushing

Dyspepsia

Color vision changes

Blurred vision

Increased sensitivity to light

Epistaxis

Erythemia

59
Q

Effect of cold and allergy meds (e.g. Decongestants) and antihistamines on BPH sx?

A

They may worsen BPH sx

60
Q

Can alpa blockers result in a painful erection?

A

Yes. But, this erection can’t be relieved with sex

61
Q

How should Tamsulosin (Flomax) be used?

A

Appox half an hr following the same meal each day

62
Q

How should Alfuzosin be taken?

A

Don’t crush, chew or break Alfuzosin tab. Swallow whole

Take at the same time each day with food

63
Q

Why is Alfuzosin encouraged to be taken with food?

A

Food increases absorption

64
Q

What’s the most common SE ass with Silodosin?

A

An orgasm with reduced or no semen (dry orgasm)

65
Q

Why does 5 alpha-reductase inhibitors take a long time to work?

A

Bcuz they shrink the prostate slowly

66
Q

Why are 5 alpha-reductase inh preg cat x?

A

They cause birth defects to a developing male fetus

NOTE: Semens of males using 5 alpha-reductase may also be harmful

67
Q

Why are PSA levels measured with 5 alpha-reductase inhibitors (Finasteride - Proscar; Dutasteride - Avodart) and NOT alpha-blockers?

A

5 alpha-reductase inhibitors (Finasteride - Proscar; Dutasteride - Avodart) actually reduce PSA levels (and shrink prostate size too)

Alpha-blockers have no such effect

68
Q

List the worrisome SE of 5 alpha-reductase inhibitors (Finasteride - Proscar; Dutasteride - Avodart)

A

Decreased sex drive

Decreased vol of ejaculate

Impotence

Breast tenderness/ enlargement

69
Q

What’s testosterone metabolized to?

A

Dihydrotestosterone (DHT)

NAPLEX: Evan (7 decks)

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