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Advanced Pharma > BPH > Flashcards

BPH Flashcards

1
Q

BPH

A

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

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2
Q

LUTS abbr

A

lower urinary tract symptoms

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3
Q

diagnosis includes

A

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

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4
Q

AUA symptom index for BPH

A

-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

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5
Q

DRE abbr

A

digital rectal exam

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6
Q

PVR abbr

A

post residual void

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7
Q

AUASI <7

A

watchful waiting, recheck 3-6m

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8
Q

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

A

watchful waiting, recheck 3-6m

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9
Q

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

A

alpha blocker

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10
Q

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

A

-alpha blocker
-PDE5-i
or BOTH

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11
Q

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

A

-5aRI

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12
Q

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

A

-alpha blocker + 5aRi
-minimally invasive therapy

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13
Q

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

A

minimally invasive therapy
surgical therapy

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14
Q

AUASI >20 with complication

A

surgical therapy

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15
Q

lifestyle modification

A

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

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16
Q

alpha-blockers

A

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

17
Q

MOA: alpha-blockers

A

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

18
Q

which alpha-blocker agents preferred?

A

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

19
Q

older agents ____ & _______ ADRs

A

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

20
Q

5 alpha-reductase inhibitors (5AR-i)

A

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

21
Q

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

A

by 0.3ng/L

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

22
Q

5AR-i ADRs

A

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

23
Q

PDE5-i abbr

A

phosphodiesterase type 5
tadalafil

24
Q

PDE5-i

A

tx of the sxs of BPH +/- ED

relaxes smooth muscle of urethra, prostate and bladder neck

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

25
Q

tadalafil may be prescribed

A

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

26
Q

tadalafil ADRs

A

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

27
Q

myalgia

A

muscles aches and pain

28
Q

cyanopsia

A

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

29
Q

tadalafil precaution & contraindication

A

unstable angina, uncontrolled or high-risk arrhythmias, persistent hypotension, poorly controlled HTN

NOT to use w/ nitrates

30
Q

combination therapy

A

alpha-blocker offer immediate relief
5 alpha-RIs reduce prostate enlargement over time

recommended for enlarged prostate & elevated PSA >1.4ng/mL

31
Q

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

A

alpha-adrenergic antagonist w/ anticholinergic agent

32
Q

if pt cant tolerate anticholinergic, an alternative is

A

Mirabegron

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

33
Q

for men with moderate sxs of BPH and ED tx

A

tadalafil 5mg daily

or in combination w/
tamsulosin 0.4mg daily

addition of PDE-5Is to alpha blockers may improve LUTS

34
Q

PDE-5i and 5a-RIs

A

can offset ED

35
Q

herbal for LUTS secondary to BPH

A

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

36
Q

prior to initiation of anticholinergic therapy

A

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

37
Q

anticholinergic agents that inhibit M3 receptors are

A

Darifenacin or solifefenacin

38
Q

Mirabegron

A

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

39
Q

Mirabegron known for

A

reduces irritative voiding symptoms

Advanced Pharma (27 decks)

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