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BPH Flashcards

1
Q

normal size prostate gland

A

-<20g
-growth is common after age 40

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2
Q

Benign Prostatic Hypertrophy mech

A

-a-1 receptors
-NE stimulation results in contraction
=narrowing of urethra
-type-II 5-a reductase

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3
Q

type II 5-a reductase

A

-in prostate gland
-testosterone to DHT
=prostate growth

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4
Q

Obstructive BPH symptoms

A

-dec force of stream
-hesitancy to initiate pissing
-strain/push to pee
-terminal dribbling
-intermittency

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5
Q

Irritative BPH symptoms

A

-nocturia
-freq
-urgency
-dysuria
-incontinence
-QOL

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6
Q

Nocturia

A

-2 or more pisses/night
-redistribution of edma

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7
Q

BPH diagnosis

A

-symptoms + exam
-measure flow rate
-measure residual volume
-AUA symptom score

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8
Q

Complications of BPH

A

-chronic renal failure
-overflow urinary incontinence
-recurrent UTIs
-diminished QOL

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9
Q

Role of pharmacist in BPH

A

-advise on OTC
-encourage evaluation
-advice on use
-screen for potential ADRs from meds

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10
Q

Treatment of mild (AUA<7) BPH

A

-watchful waiting

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11
Q

Treatment of mod (AUA 8-19) BPH w ED

A

-a-antagonist
-PDE-5 inhibitor
-or both

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12
Q

Treatment of mod (AUA 8-19) BPH w small prostate and low PSA

A

-a-adrenergic antagonist

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13
Q

Treatment of mod (AUA 8-19) BPH w large prostate and inc PSA

A

-5a-reductase inhibitor +/- a-antagonist

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14
Q

Treatment of mod (AUA 8-19) BPH w predominant irritative voiding symptoms

A

-a-antagonist
-anticholinergic agent

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15
Q

Treatment of severe BPH (>20)

A

-minimally invasive surgery
-prostatectomy

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16
Q

Goals of BPH therapy

A

-control symptoms
-dec AUA by at least 3 pts
-prevent complications
-delay need for surgery

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17
Q

Non-pharma treatment of BPH

A

-avoid drugs w strong anti-cholinergic properties (=urinary retention)
-antihistamines, tricyclic antidepressants, cogentin, artane, scopolamine, anti muscarinics

18
Q

BPH non-drug therapy

A

-restrcit fluid, alcohol and caffeine intake in pm
-avoid diuretics and nasal decongestants if possible
-use kegel exercises

19
Q

BPH + OAB treatment

A

-a-antagonist + anti-muscarinic

20
Q

avoid anti-muscarinics in

A

BPH pts w residual > 200 ml or max flow rate of < 5mL/sec

21
Q

Mild drug therapy of BPH

A

-CAM therapy
-Saw Palmetto 160 mg bid (iffy efficacy but some anti-androgenic activity)

22
Q

moderate BPH therapy

A

-non-drug measures
-alpha blockers +/-
-hormone therapy
-PDE inhibtiors

23
Q

secere BPH therapy

A

-consider invasive treatment

24
Q

A-1a adrenergic blockade

A

-developed for HTN
-relax smooth muscle of prostate gland and bladder (improves flow)
-does NOT reduce size of prostate gland
-onset 1-6 weeks
-dec AUA score 30-40%

25
A-1a blocker drugs
-Terazosin 1 mg hs to 10-20 mg -Doxatosin 1 mg hs to 4-8mg -Tamsulosin* 0.4mg hs to 0.4-0.8mg -Alfuzosin* 10mg qd -Sildodosin* 4 mg qd to 4-8mg -equal efficacy -* more selective in urinary tract
26
a1-a blocker side effects
-dizziness -fatigue -headache -hypotension (first dose w Cardua and Hytrin) -retrograde ejactulation esp silodosin (rapaflow) -intra-operative floppy iris syndrome
27
Tamsulosin side effects
-dizziness -somnolence -headache -asthenia -blurred vision -abnormal ejaculation
28
intra-op floppy iris syndrome
-side effect seen in. cataract surgery in pts on a1a block
29
PDE-inhibitors in BPH
-treat mod BPH -indicated if pt also has ED -similar effectiveness to a1a -relax smooth muscle tone of prostate and bladder
30
-PDE-inhibitor dosing in BPH treatment
-tadalafil 5mg daily -2.5mg if CrCl 30-50ml/min -do NOT use if CrCl < 30 ml/min
31
Do not use PDE inhibitors in BPH if:
-CrCl < 30ml -lower dose to 2.5mg id 30-50
32
Hormonal treatment of BPH
-5-a reductase inhibitors
33
5-a reductase inhibitors mech
-decrease DHT -dec SIZE of gland -prostate > 40g benefit most -onset might be six months
34
Hormonal therapy drugs
-Finasteride -Dutasteride
35
Finasteride
-5-a reductase inhibitor -treat mod BPH -Proscar -5mg qd
36
Dutasteride
-5-a reductase inhibitor -treat mode BPH -0.5mg PO qd
37
side effects of hormonal therapy
-15% d/c during first year -impotence -dec libido -dec ejaculation -breast tenderness
38
Hormonal therapy effect on PSA
-dec by 50% in 6 months
39
Hormonal therapy should not be handled by
women -risk of abnormal genitalia in male fetus
40
Minimally invasive therapies for BPH
-TUMT -TUNA -prostatic stent -interstitial laser coagulation -bTUDP -ultrasound -botox -benefits may be short lived

Therapeutics (78 decks)

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