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P2 E1 SG > BPH 1 > Flashcards

BPH 1 Flashcards

1
Q

What area of the prostate represents 70% of prostatic volume and is where a majority of prostate cancers form?

A

Peripheral Zone (posterior)

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2
Q

Which area of the prostate is where BPH occurs?

A

Transitional Zone

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3
Q

What are the 3 types of tissue in the prostate gland?

A
  • Epithelial
  • Stromal
  • Capsule
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4
Q

Which prostate tissue?

  • “glandular tissue”
  • Produces prostatic secretions
  • Androgens stimulate this tissue growth
A

Epithelial

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5
Q

Which prostate tissue?

  • “smooth muscle”
  • embedded with alpha 1 adrenergic receptors
  • _____ causes smooth muscle contraction–> extrinsic compression of urethra, reduction of urethral lumen, & decreased urinary bladder emptying
A

Stromal

  • norepinephrine
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6
Q

Which prostate tissue?

  • “outer shell”
  • “fibrous connective tissue & smooth muscle”
  • embedded w/ alpha 1 adrenergic receptors
  • when stimulated w/ _____, this tissue contracts around the urethra
A

Capsule

  • norepinephrine
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7
Q

_____ is the principal testicular androgen

______ is the principal adrenal androgen

  • These 2 hormones are responsible for what 3 things?
A
  • testosterone
  • androstenedione
  1. penile & scrotal enlargement
  2. increased muscle mass
  3. maintenance of normal male libido
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8
Q

Testosterone and Androsenedione are the principal testicular and adrenal androgens which are converted by ______ in the ___ cells to —-> _____ (an active metabolite)

A
  • 5 alpha-reductase
  • target
  • dihydrotestosterone (DHT)
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9
Q

____ is considered a more potent androgen than testosterone in the prostate

A

DHT

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10
Q

In the prostate, ___ induces growth and enlargement of the gland

A

DHT

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11
Q

2 types of 5 alpha-reductase. Which one?

  • localized to sebaceous glands in the frontal scalp, liver, and skin
  • DHT produces at these target tissues causes _____ and _______
A

Type 1 enzyme

  • acne & increased body/facial hair
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12
Q

2 types of 5 alpha-reductase. Which one?

  • localized to prostate, genital tissue, & hair follicles of scalp
  • In the prostate, DHT induces growth and enlargement of gland
A

Type 2 enzyme

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13
Q
  • The normal prostate is composed of a higher amount of ___ tissue than _____ tissue (2:1)
  • This ratio is exaggerated in BPH (__:1)
A
  • stromal : epithelial
  • 5
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14
Q

Epithelial TIssue (glandular tissue)

  • DHT production involves _____
  • DHT is responsible for ______
  • ______ reduces an enlarged prostate gland, but only by __%
A
  • 5 alpha reducatse
  • growth & enlargement of prostate gland
  • 5 alpha reductase inhibitors / 25%
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15
Q
  • Epithelial tissue has a ____ process
  • Stromal tissue has a _____ process
A
  • static
  • dynamic
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16
Q

Stromal Tissue (smooth muscle)

  • _______ receptors, when stimulated cause smooth muscle contraction in the enlarged prostate and in the bladder base, obstructing urine flow.
  • Therefore, ______ are quickly effective in symptomatic management of urinary flow
A
  • alpha 1 adrenergic receptors
  • alpha 1 adrenergic ANTagonists
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17
Q

Adrenaline levels are never _____!

A

static

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18
Q

What aggravates BPH?

A

Stress bc/ it increases norepinephrine –> alters urination

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19
Q

Pathogenesis of BPH

  • ______ factors relate to anatomic enlargement of the prostate gland, which produces a physical block at the bladder neck and thereby obstructs urinary outflow.
  • Enlargement of the gland depends on ____ stimulation of ____ tissue and ____stimulation of ____ tissue in the prostate
A
  • Static
  • androgen / epithelial
  • estrogen / stromal
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20
Q

Pathogenesis of BPH

  • ______ factors relate to excessive alpha adrenergic tone of the stromal component of the prostate gland, bladder neck, and posterior urethra
  • Results in contraction of the prostate gland around the urethra and narrowing of the urethral lumen
A

Dynamic

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21
Q

Pathphys of BPH

  • Chronic prostatic inflammation
  • Advanced atherosclerosis of blood supply to pelvis
  • Decreased release of _____ (vasodilator)
  • Decreased production of _______ at the bladder neck and in the prostate
A
  • nitric oxide
  • cyclic guanosine monophosphate (cGMP)
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22
Q

2 types of sxs of BPH. Which one?

  • urinary hesitancy
  • urine dribbling
  • bladder fullness post voiding
A

obstructive

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23
Q

2 types of sxs of BPH. Which one?

  • result from long-standing obstruction at the bladder neck
  • urinary frequency
  • urinary urgency
  • nocturia
A

irritative

24
Q

PSA level of ____ has been used as a surrogate marker for an enlarged prostate gland and those at risk for developing complications of BPH disease

A

1.4 ng/mL

25
Q

Sxs of BPH are collectively referred to as ____.

A

LUTS

(lower urinary tract symptoms)

26
Q

3 goals of BPH tx

A
  • control sxs
  • prevent progression of complications
  • delay need for surgical intervention
27
Q

Tx for mild asymptomatic disease or mildly bothersome sxs and no complications of BPH disease

A

No specific tx indicated

  • watchful waiting
  • behavior modification
  • return visits at 12 month intervals for assessment of worsening sxs or signs of BPH
28
Q

Tx for moderate or severe level sxs (obstructive voiding sxs and irritative voiding sxs) = signs of detrusor instability

A

Drug therapy or surgery is indicated

29
Q

3 types of BPH drugs

(what does each do?)

A
  • Interfere w/ testosterone’s stimulatory effect on prostate gland enlargement (reducing static factor)
  • Relax prostatic smooth muscle (reducing dynamic factor)
  • Relax bladder detrusor muscle (improving the urine storage capacity of the bladder)
30
Q

What 3 BPH drugs reduce the dynamic factor?

A
  • Doxazosin (bloack alpha 1 adregnergic receptors in stromal tissue - nonselective) *initially used for HTN
  • Tamsulosin (blocks alpha 1A receptors - selective) $$$ expensive
  • Tadalafil - PDE5 (causes smooth muscle relaxation of prostate, bladder neck, & prostatic urethra)
31
Q

Slow titration for immediate release terazosin & doxazosin

  • Slow titration up to therapeutic maintenance dose is necessary to minimize _____ and ______
A
  • orthostatic hypotension
  • first dose syncope
32
Q

Which BPH drug reduces the static factor and blocks 5 alpha reductase enzyme?

A

Finasteride

33
Q

Which BPH drug relaxes detrusor muscle of bladder?

A

Oxybutynin

34
Q

An alpha 1 adrenergic antagonist is an “___” measure

  • relieves voiding sxs (not being able to void)
  • Patients w/ prostates of at least __ g, ________ delay sxs progression and reduce the incidence of BPH related complications
A

“interim”

  • 40
  • 5-alpha reductase inhibitors
35
Q
  • All ______ are equally effective in relieving BPH sxs
  • Older 2nd gen immediate release formulations ( ____ and ____) can cause adverse CV effect
    • ____
    • _____
    • ______
  • 3rd gen, pharmacologically uroselective agents (____ and ____) are good alternatives to the 2nd gen…
A
  • alpha 1 adrenergic antagonists
  • terazosin & doxazosin
    • 1st dose syncope
    • orthostatic hypotension
    • dizziness
  • tamsulosin & silodosin
36
Q

What is the “gold standard” drug w/o CV effects?

A

Tamsulosin (3rd gen)

37
Q

Which drug?

  • alpha 1 adrengergic antagonist
  • extended release 2nd gen
  • functionally uroselective
  • fewer CV effects than immediate release formulations of terazosin or doxazosin
  • Uncertain if this drug has the same CV safety as tamsulosin
A

Alfuzosin

38
Q

Which type of drug?

  • Useful primarily for pts w/ large prostates greater than 40g who wish to avoid surgery and can tolerate the SE of alpha adrenergic antagonists
  • SLOW onset of action
    • taking up to 6 months to exert maximal clinical effects
A

5 alpha reductase inhibitors

39
Q

3 ADEs of 5-ARI

A
  • Decreased libido
  • ED
  • Ejaculation disorders
40
Q

Which drug?

  • Floppy Iris Syndrome
  • Priapism
  • Monitor: BP and HR
    *
A

Alpha Adrenergic Antagonist

(Alfuzosin, Terazosin, Doxazosin 2nd gen)

(Tamsulosin, silodosin 3rd gen)

41
Q

Which drug?

  • Erectile dysfunction
  • Decreased libido
  • Ejaculatory dysfunction
  • Gynecomastia
  • Monitor: PSA
  • Pt’s PSA level should decrease by 50% if adherent to therapy
A

5 ARI

(Finasteride, Dutasteride)

42
Q

AAA or 5-ARI?

  • Relaxes prostatic smooth muscle
  • Peak onset 1-6 weeks
  • 1-2 doses / day
  • CV effects
A

AAA (alpha 1 adrenergic antagonist)

43
Q

AAA or 5-ARI?

  • Decreases prostate size
  • Halts disease progression
  • Peak onset 3-6 months
  • Dosing once / day
  • Decreases PSA
  • No CV effects
A

5-ARI

44
Q

PDE inhibitor or Anticholinergic Agent?

  • Relaxes prostatic smooth muscle
  • Peak onset 4 weeks
  • No sexual dysfunction adverse effects
  • ADE: mild hypotension
A

PDE Inhibitor

45
Q

PDE Inhibitor or Anticholinergic Agent?

  • Peak onset 1-2 weeks
  • Relieves irritative sxs
  • ADE: ED
  • causes tachycardia
A

Anticholinergic Agent

46
Q

PDE inhibitor or Anticholinergic?

  • Dizziness
  • Nasal congestion
  • Dyspepsia
  • Back pain
  • Myalgia
  • Hearing loss
A

PDE inhibitor

47
Q

PDE inhibitor or Anticholinergic?

  • Dry mouth
  • Constipation
  • Tachycardia
  • Blurry vision
  • Acute urinary retention
  • Drowsiness
  • Confusion
  • Angioedema*
  • Anaphylaxis*
  • ED
A

Anticholinergic

48
Q

3 things you should monitor when prescribing PDE inhibitor

A
  • BP
  • Pulse
  • Hearing loss
49
Q

3 things you should monitor when prescribing anticholingerics

A
  • Mental status
  • Bowel habits
  • Ability to urinate

(BAM)

50
Q

If the patient experiences hearing loss, discontinue _____.

A

Tadalafil (PDE-5 inhibitor)

51
Q

Which drug?

  • Peak onset 2 weeks (may take 8 w)
  • Not effective in relieving bladder outlet obstruction
  • Effective in relieving irritative sxs
  • Causes HTN
A

Beta 3 Adrenergic Agonists

(Mirabegron)

52
Q

Beta 3 Adrenergic Agonist (Mirabegron)

  • When stimulated, ____ is produced which relaxes the detrusor muscle
  • What other 3 things does this drug accomplish?
A
  • cAMP
  1. reduces irritative voiding sxs
  2. increases bladder capacity
  3. increases intervals between voidings
53
Q

2 things to monitor when prescribing Beta 3 Adrenergic Agonist (Mirabegron)

A
  • BP
  • Bowel habits
54
Q

3 SE of Beta 3 Adrenergic Agonist (Mirabegron)

A
  • HTN
  • Constipation/Diarrhea
  • Impaired cognition
55
Q
  • What are the 2 surgical options for BPH?
  • Which allows for biopsy?
A
  • TURP / Green Light
  • TURP = biopsy

(Surgeries indicated for mod-severe sxs)

(Pts who do not respond to/do not tolerate drugs/complications of BPH)

P2 E1 SG (11 decks)

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