BPH Flashcards
what subjective tool is used to classify degree of BPH
american urological association symptom score (AUASS)
mc herbal therapy used for bph that is not recommended
saw palmetto
others: beta-sitosterol, cermilton, pygeum africanum
what 4 procedures are used for bph
TURP (transurethral resection of prostate)
transurethral ablation
simple prostatectomy
prostatic arterial embolization
when is sx recommended for bph
when COBMO therapy is persistent after 12-24 months of tx
what 4 med classes are used for bph
-a-adrenergic antagonists (a-blockers): tamsulosin, doxazosin
-5 alpha reductase inhibitors: finasteride, dutaseride
-anticholinergics: tolterodine, oxybutynin, fesoterodine
-pde5 inhibitors: tadalafil, sildenafil
first line med for bph w. ed
pde5 inhibitors: sildenafil, tadalafil
first line med for bph w. urge incontinence
beta-3 adrenergic agonists: mirabegron, vibegron
what med prevents progression of bph
5 alpha reductase inhibitors
moa of alpha blockers
antagonize alpha adrenergic receptors -> relaxation of bladder neck, prostatic urethra, and prostate smooth muscle
what do you tell your pt who says alpha blockers are not working after 1 week of treatment
it takes days to weeks to become effective
who are alpha blockers recommended for
first line tx for pt’s with normal prostate size AND psa
mc dose limiting s.e of alpha blockers
hypotn
syncope
mc w. terazosin and doxazosin (immediate-release)
when combined w. antihypertensives and pde5 inhibitors, alpha blockers can cause
hypotn
less w. tamsulosin
alpha blockers should be titrated up q
2 weeks
when should pt take alpha blocker
bedtime
alpha blockers are not recommended as monotherapy for patients with bph and
htn
what 2 alpha blocker require dose titration
doxazosin
terazosin
older and cheaper
moa for 5 alpha reductase inhibitors
inhibit 5 alpha reductase -> inhibits conversion of testosterone to dihydrotestosterone -> inhibits prostate tissue growth -> shrinks enlarged prostate
5 alpha reductase inhibitors result in shrinkage of prostate __% x __ months
and can decrease psa by __%
20-25%
6 months
50%
how long do 5 alpha reductase inhibitors take to work
minimum of 6 mo
benefits of alpha reductase inhibitors over alpha blockers
5 alpha reductase inhibitors:
prevent bph-related complications
prevent disease progression
5 alpha reductase inhibitors are first line tx for patients with
enlarged prostate AND/OR elevated psa
s.e of 5 alpha reductase inhibitors (5)
decreased libido
ed
ejaculation d.o
gynecomastia
breast tenderness
orthostatic hypotn (not as severe as alpha blockers)
what 3 s.e of 5 alpha reductase inhibitors may persist after drug is stopped
decreased libido
ed
ejaculation d.o
when would combo therapy of alpha blockers and 5 alpha reductase inhibitors be considered (2)
-symptomatic pt who have not responded to monotherapy
-high risk of bph complications
t/f: alpha blockers are contraindicated in pt w. htn
f!
how would you adjust dosing for pt on alpha blocker plus htn meds
take antihypertensives in the AM
take alpha blocker in the PM
management of bph w. mild sx
watchful waiting
when would you start a pt on a 5 alpha reductase inhibitor
mod-severe sx w.o bph complications AND prostate >/= 30 g
if prostate < 30 g -> watchful waiting
how would you manage a pt w. severe bph sx and compications
surgery
what 2 bph drugs relax prostatic smooth muscle
alpha blockers
pde 5 inhibitors
what bph drug reduces the size of the prostate
5 alpha reductase inhibitors
what bph drug is most useful for relieving voiding sx and improving flow rate
alpha blockers
when are anticholinergics used for bph
overactive bladder
5 chronic conditions associated w. ed
htn
DM
BPH
CAD
CKD
4 lifestyle factors associated w. ed
smoking
etoh
obesity
reduced PA
first line tx for bph
manage comorbidities
lifestyle factors
4 meds commonly associated w. ED
bb
TCAs
5 alpha reductase inhibitors
HCTZ
8 classes of drugs associated w. ED
antihypertensives
CNS depressants
lipid meds
antidepressants/antipsychotics
anticonvulsants
GI agents
antiandrogens and hormones
recreational drugs
what must you do before initiating drugs for ED
-medical, social, med hx w. emphasis on cardiac conditions
-assess ability to have sex
-assess ddi
-address reversible/modifiable factors first
what bph drug inhibits cGMP degradation, which causes smooth muscle relaxation
pde-5 inhibitors
what needs to be present in order for pde 5 inhibitors to work
sexual stimulation
s.e of pde 5 inhibitors
hypotn
ha
facial flushing
nasal congestion
dyspepsia
myalgia
back pain
priaprism (rare)
most concerning s.e of pde5 inhibitors
priaprism
medical attention needed if erection > 4-6 hr
what pde5 inhibitor can be used concurrently for symptomatic tx of bph
tadalafil (cialis)
absolute contraindication for pde5 inhibitors
nitrates
drugs to be cautious w. when taking pde 5 inhibitors
alpha 1 blockers
erythromycin
antifungals
what pde5 inhibitor interacts w. antiarrhythmics
levitra
up to __ of patients will not respond to pde5 inhibitors,
but __ attempts may be needed for success
1/3
6-8
alternative medication to pde5 inhibitors for ed
alprostadil
moa for alprostadil
prostaglandin E1 analog
stimulates adenyl cyclase -> increased cAMP, smooth muscle relaxation, increased penile rigidity
dosing for cialis if used as adjunctive sx tx for bph
must be daily
