BPH

Question 1

BPH

Answer 1

increases urethral resistance, resulting in compensatory changes in the bladder
-smooth muscle hypertrophy+age=urinary freq., urgency, & nocturia (bothersome complaints)

Question 2

LUTS abbr

Answer 2

lower urinary tract symptoms

Question 3

diagnosis includes

Answer 3

-symptom assessment (AUA score)
-PE
-PSA (correlates w/ prostate size; used as a prognostic marker)

Question 4

AUA symptom index for BPH

Answer 4

-mild (<7) enlarged prostate on DRE, peak urinary flow less than 10mL/s
-moderate (8-19) all of the above, PVR >50mL, irritative symptoms
-severe (>20) all of the above plus 1+ complications of BPH

Question 5

DRE abbr

Answer 5

digital rectal exam

Question 6

PVR abbr

Answer 6

post residual void

Question 7

AUASI <7

Answer 7

watchful waiting, recheck 3-6m

Question 8

AUASI >8, less than 30mL prostate size, no sxs

Answer 8

watchful waiting, recheck 3-6m

Question 9

AUASI >8, less than 30mL prostate size w/ sxs

Answer 9

alpha blocker

Question 10

AUASI >8, less than 30mL prostate size w/ sxs & ED

Answer 10

-alpha blocker
-PDE5-i
or BOTH

Question 11

AUASI >8, greater than 30mL prostate size w/ no sxs

Answer 11

-5aRI

Question 12

AUASI >8, greater than 30mL prostate size w/ sxs, no complications

Answer 12

-alpha blocker + 5aRi
-minimally invasive therapy

Question 13

AUASI >8, greater than 30mL prostate size w/ sxs and complications

Answer 13

minimally invasive therapy
surgical therapy

Question 14

AUASI >20 with complication

Answer 14

surgical therapy

Question 15

lifestyle modification

Answer 15

limit EToH, caffeine, avoid certain meds (decongestants [constrict blood vessels], androgens [pre-receptor & post receptor center on the binding of testosterone]

Question 16

alpha-blockers

Answer 16

tamsulosin (Flomax)
terazosin
doxazosin (Cardura)
alfuzosin (Uroxatral)

onset: 2-4 wk w/ rapid symptom resolution, durable effect (years) with AUA symptom index improving 30-45%

no effect on prostate size (PSA) or disease progression

Question 17

MOA: alpha-blockers

Answer 17

vasodilate by blocking the alpha 1 & 2 receptors (inhibit catecholamines that cause vasoconstriction)

Question 18

which alpha-blocker agents preferred?

Answer 18

alfuzosin (2nd generation) & tamsulosin & silodosin) bc of uroselectivity (no need for dose titration & limited orthostasis)

Question 19

older agents ____ & _______ ADRs

Answer 19

terazosin & doxazosin

for HTN & CV ADRs (orthostasis, reflex tachycardia, etc). they were NOT selective and impacted alpha receptors in vasculature

req titration

individual management of BPH and HTN* however, treat each separately; alpha-blocker may provide benefits of additional BP lowering

Question 20

5 alpha-reductase inhibitors (5AR-i)

Answer 20

dutasteride, finasteride

-management of moderate-to-severe BPH in pts w/ enlarged prostate glands

cant tolerate alpha-1-adrenergic antagonists and do NOT have predominately irritant symptoms or convomitant ED

reduces prostate size and PSA = outlet obstruction

Question 21

if PSA failed to decline by 50% after 6-12 months on finasteride or Dutasteride, titrate

Answer 21

by 0.3ng/L

eval for prostate cancer
may indicate condition worsening or non-compliance w/ 5AR-i

Question 22

5AR-i ADRs

Answer 22

androgen insufficiency = decreased libido, impotence, ejaculatory disorder, breast tenderness & enlargement

Question 23

PDE5-i abbr

Answer 23

phosphodiesterase type 5
tadalafil

Question 24

PDE5-i

Answer 24

tx of the sxs of BPH +/- ED

relaxes smooth muscle of urethra, prostate and bladder neck

long plasma half-life
peak onset 1-4wk
$$$

Question 25

tadalafil may be prescribed

Answer 25

alone or w/ alpha1-adrenergic antagonist and/or 5AR-i

Question 26

tadalafil ADRs

Answer 26

w/ alpha-blockers, antihypertensives or substantial amounts of alcohol = hypotension, headache, dizziness, flushing, back pain, myalgia, and cyanopsia

Question 27

myalgia

Answer 27

muscles aches and pain

Question 28

cyanopsia

Answer 28

seeing everything tinted with blue -often occurs for a few days, weeks, or months after removal of a cataract from the eye. -s/e: of sildenafil, tadalafil, or vardenafil

Question 29

tadalafil precaution & contraindication

Answer 29

unstable angina, uncontrolled or high-risk arrhythmias, persistent hypotension, poorly controlled HTN NOT to use w/ nitrates

Question 30

combination therapy

Answer 30

alpha-blocker offer immediate relief 5 alpha-RIs reduce prostate enlargement over time recommended for enlarged prostate & elevated PSA >1.4ng/mL

Question 31

for men with low post-void residual urine volumes and irritative sxs (freq, urgency) that persist during treatment, try

Answer 31

alpha-adrenergic antagonist w/ anticholinergic agent

Question 32

if pt cant tolerate anticholinergic, an alternative is

Answer 32

Mirabegron s/e: increased urine volume, decreased maximal urinary flow rate, or acute urinary retention is low

Question 33

for men with moderate sxs of BPH and ED tx

Answer 33

tadalafil 5mg daily or in combination w/ tamsulosin 0.4mg daily addition of PDE-5Is to alpha blockers may improve LUTS

Question 34

PDE-5i and 5a-RIs

Answer 34

can offset ED

Question 35

herbal for LUTS secondary to BPH

Answer 35

no dietary supplementation, combination phytotherapeutic (plants/herbs) agent or other nonconventional therapy

Question 36

prior to initiation of anticholinergic therapy

Answer 36

baseline PBR urine should be assessed use in caution in pts w/ PVR greater than 250 to 300mL to avoid anticholinergic agent-induced acute urinary retention idea pt for combination has a urinary flow rate of at least 10mL/s and a PVR less than 50

Question 37

anticholinergic agents that inhibit M3 receptors are

Answer 37

Darifenacin or solifefenacin

Question 38

Mirabegron

Answer 38

used alone or in combination with solifenancin to treat overactive bladder agonist of the b3 adrenergic receptor by relaxing the detrusor (muscle forming bladder wall) during the storage phase of the urinary bladder fill-void cycle

Question 39

Mirabegron known for

Answer 39

reduces irritative voiding symptoms