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Pharmacotherapeutics - Final > BPH > Flashcards

BPH Flashcards

1
Q

what subjective tool is used to classify degree of BPH

A

american urological association symptom score (AUASS)

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2
Q

mc herbal therapy used for bph that is not recommended

A

saw palmetto

others: beta-sitosterol, cermilton, pygeum africanum

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3
Q

what 4 procedures are used for bph

A

TURP (transurethral resection of prostate)
transurethral ablation
simple prostatectomy
prostatic arterial embolization

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4
Q

when is sx recommended for bph

A

when COBMO therapy is persistent after 12-24 months of tx

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5
Q

what 4 med classes are used for bph

A

-a-adrenergic antagonists (a-blockers): tamsulosin, doxazosin
-5 alpha reductase inhibitors: finasteride, dutaseride
-anticholinergics: tolterodine, oxybutynin, fesoterodine
-pde5 inhibitors: tadalafil, sildenafil

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6
Q

first line med for bph w. ed

A

pde5 inhibitors: sildenafil, tadalafil

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7
Q

first line med for bph w. urge incontinence

A

beta-3 adrenergic agonists: mirabegron, vibegron

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8
Q

what med prevents progression of bph

A

5 alpha reductase inhibitors

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9
Q

moa of alpha blockers

A

antagonize alpha adrenergic receptors -> relaxation of bladder neck, prostatic urethra, and prostate smooth muscle

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10
Q

what do you tell your pt who says alpha blockers are not working after 1 week of treatment

A

it takes days to weeks to become effective

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11
Q

who are alpha blockers recommended for

A

first line tx for pt’s with normal prostate size AND psa

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12
Q

mc dose limiting s.e of alpha blockers

A

hypotn
syncope

mc w. terazosin and doxazosin (immediate-release)

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13
Q

when combined w. antihypertensives and pde5 inhibitors, alpha blockers can cause

A

hypotn

less w. tamsulosin

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14
Q

alpha blockers should be titrated up q

A

2 weeks

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15
Q

when should pt take alpha blocker

A

bedtime

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16
Q

alpha blockers are not recommended as monotherapy for patients with bph and

A

htn

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17
Q

what 2 alpha blocker require dose titration

A

doxazosin
terazosin

older and cheaper

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18
Q

moa for 5 alpha reductase inhibitors

A

inhibit 5 alpha reductase -> inhibits conversion of testosterone to dihydrotestosterone -> inhibits prostate tissue growth -> shrinks enlarged prostate

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19
Q

5 alpha reductase inhibitors result in shrinkage of prostate __% x __ months

and can decrease psa by __%

A

20-25%
6 months
50%

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20
Q

how long do 5 alpha reductase inhibitors take to work

A

minimum of 6 mo

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21
Q

benefits of alpha reductase inhibitors over alpha blockers

A

5 alpha reductase inhibitors:
prevent bph-related complications
prevent disease progression

22
Q

5 alpha reductase inhibitors are first line tx for patients with

A

enlarged prostate AND/OR elevated psa

23
Q

s.e of 5 alpha reductase inhibitors (5)

A

decreased libido
ed
ejaculation d.o
gynecomastia
breast tenderness
orthostatic hypotn (not as severe as alpha blockers)

24
Q

what 3 s.e of 5 alpha reductase inhibitors may persist after drug is stopped

A

decreased libido
ed
ejaculation d.o

25
Q

when would combo therapy of alpha blockers and 5 alpha reductase inhibitors be considered (2)

A

-symptomatic pt who have not responded to monotherapy
-high risk of bph complications

26
Q

t/f: alpha blockers are contraindicated in pt w. htn

A

f!

27
Q

how would you adjust dosing for pt on alpha blocker plus htn meds

A

take antihypertensives in the AM
take alpha blocker in the PM

28
Q

management of bph w. mild sx

A

watchful waiting

29
Q

when would you start a pt on a 5 alpha reductase inhibitor

A

mod-severe sx w.o bph complications AND prostate >/= 30 g

if prostate < 30 g -> watchful waiting

30
Q

how would you manage a pt w. severe bph sx and compications

A

surgery

31
Q

what 2 bph drugs relax prostatic smooth muscle

A

alpha blockers
pde 5 inhibitors

32
Q

what bph drug reduces the size of the prostate

A

5 alpha reductase inhibitors

33
Q

what bph drug is most useful for relieving voiding sx and improving flow rate

A

alpha blockers

34
Q

when are anticholinergics used for bph

A

overactive bladder

35
Q

5 chronic conditions associated w. ed

A

htn
DM
BPH
CAD
CKD

36
Q

4 lifestyle factors associated w. ed

A

smoking
etoh
obesity
reduced PA

37
Q

first line tx for bph

A

manage comorbidities
lifestyle factors

38
Q

4 meds commonly associated w. ED

A

bb
TCAs
5 alpha reductase inhibitors
HCTZ

39
Q

8 classes of drugs associated w. ED

A

antihypertensives
CNS depressants
lipid meds
antidepressants/antipsychotics
anticonvulsants
GI agents
antiandrogens and hormones
recreational drugs

40
Q

what must you do before initiating drugs for ED

A

-medical, social, med hx w. emphasis on cardiac conditions
-assess ability to have sex
-assess ddi
-address reversible/modifiable factors first

41
Q

what bph drug inhibits cGMP degradation, which causes smooth muscle relaxation

A

pde-5 inhibitors

42
Q

what needs to be present in order for pde 5 inhibitors to work

A

sexual stimulation

43
Q

s.e of pde 5 inhibitors

A

hypotn
ha
facial flushing
nasal congestion
dyspepsia
myalgia
back pain
priaprism (rare)

44
Q

most concerning s.e of pde5 inhibitors

A

priaprism

medical attention needed if erection > 4-6 hr

45
Q

what pde5 inhibitor can be used concurrently for symptomatic tx of bph

A

tadalafil (cialis)

46
Q

absolute contraindication for pde5 inhibitors

A

nitrates

47
Q

drugs to be cautious w. when taking pde 5 inhibitors

A

alpha 1 blockers
erythromycin
antifungals

48
Q

what pde5 inhibitor interacts w. antiarrhythmics

A

levitra

49
Q

up to __ of patients will not respond to pde5 inhibitors,
but __ attempts may be needed for success

A

1/3
6-8

50
Q

alternative medication to pde5 inhibitors for ed

A

alprostadil

51
Q

moa for alprostadil

A

prostaglandin E1 analog
stimulates adenyl cyclase -> increased cAMP, smooth muscle relaxation, increased penile rigidity

52
Q

dosing for cialis if used as adjunctive sx tx for bph

A

must be daily

Pharmacotherapeutics - Final (6 decks)

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