BPH Flashcards
What is BPH?
-nonmalignant enlargement of the prostate gland
Prevalence of BPH
- most common benign neoplasm in US men
- 80% of older men develop microscopic evidence of changes assoc w/ BPH
Pathophys of BPH
- testosterone is converted to DHT, which causes prostate enlargement and growth
- contraction of prostate around urethra
- bladder detrusor muscle instability
Complications of BPH
- acute, painful urinary retention –> ARF
- bladder diverticula, stones
- recurrent UTI d/t urinary stasis
- overflow urinary incontinence or unstable bladder
- CRF d/t long standing bladder outlet obstruction
- persistent gross hematuria when tissues exceeds blood supply
Drugs that May Aggravate BPH
- testosterone replacement
- anticholinergics (1st gen antihistamines, phenothiazines, TCAs): decreases detrusor contractility
- sympathomimetics (pseudoephedrine, oxymetazoline, phenylephedrine): excessive tone of prostate and bladder neck
S+S of Mild BPH
-asymptomatic
-increased BUN and creatinine
-peak urinary flow rate 25-50 mL
(score < 7)
S+S of Moderate BPH
- increased BUN and creatinine
- low peak urinary flow rate
- postvoid residual volume >25-50 mL
- obstructive voiding sxs
- irritative voiding sxs
S+S of Severe BPH
-same as moderate BPH PLUS one or more complications of BPH
Treatment Goals of BPH
- reduce sxs
- slow dz progression
- prevent complications (post-renal/chronic renal failure, infx, hematuria, bladder stones)
Tx for Patients with Mild BPH
-watchful waiting
Tx for Patients with Moderate BPH
-pharmacologic treatment
Tx for Patients with Severe BPH
-surgery
MOA of Alpha 1 and Alpha 1A Blockers
-relax smooth muscle in bladder neck and prostate
When given a drug name, how do you know if it is alpha 1 or alpha 1A?
- alpha: end in Zosin
- alpha 1: osin
What is the onset of action for alpha 1 blockers?
-onset 2-4 weeks
What is an advantage of alpha 1A blockers?
uroselective so may cause less HoTN
Disadvantages of Alpha 1 and Alpha 1A Blockers?
- orthostatic HoTN (initiate at lowest dose and titrate at 2-7 day intervals)
- in alpha 1A: floppy iris syndrome during cataract surgery
What is the place in therapy of alpha 1 and 1A blockers?
-alpha 1 blockers 1st line treatment for moderate BPH
What is recommended when patients can’t tolerate the alpha 1 blockers?
-alpha 1A tamsulosin
What is the problem with silodosin?
most likely to cause abnormal ejaculation
MOA of 5 Alpha Reductase Inhibitors
-decrease conversion of testosterone to DHT
Advantages of 5 Alpha Reductase Inhibitors
decreased risk of orthostatic HoTN
Disadvantages of 5 Alpha Reductase Inhibitors
- onset of action 6 months
- may cause decreased libido, ED
What is the place in therapy for 5 alpha reductase inhibitors?
- most effective for patients with increased prostate size (> 30 g)
- used for pts unable to take alpha 1 or 1A blockers
Which PDE5 inhibitor can be given for BPH?
tadalafil (Cialis)
Advantages of PDE5 for BPH
onset of action 2-4 weeks
Disadvantages of PDE5 for BPH
- modest improvement
- not recommended with alpha blockers
When should tadalafil/PDE5 inhibitors be considered?
for concomitant ED and mild BPH sxs
Which herbals have been used for BPH?
- beta sitosterol
- pygeum
- saw palmetto
Is monotherapy sufficient for BPH treatment?
yes, but combination therapy has a greater effect
What must be monitored in pts taking 5 alpha reductase inhibitors?
-need to check baseline and yearly PSA b/c these drugs can decrease PSA up to 50%
Of alpha 1 blockers and 5 alpha reductase inhibitors, which decreases prostate size?
5 alpha reductase inhibitors
Of alpha 1 blockers and 5 alpha reductase inhibitors, which slows disease progression?
5 alpha reductase inhibitors
