BPH

Question 1

What is BPH?

Answer 1

-nonmalignant enlargement of the prostate gland

Question 2

Prevalence of BPH

Answer 2

• most common benign neoplasm in US men

- 80% of older men develop microscopic evidence of changes assoc w/ BPH

Question 3

Pathophys of BPH

Answer 3

• testosterone is converted to DHT, which causes prostate enlargement and growth
• contraction of prostate around urethra
• bladder detrusor muscle instability

Question 4

Complications of BPH

Answer 4

• 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

Question 5

Drugs that May Aggravate BPH

Answer 5

• testosterone replacement
• anticholinergics (1st gen antihistamines, phenothiazines, TCAs): decreases detrusor contractility
• sympathomimetics (pseudoephedrine, oxymetazoline, phenylephedrine): excessive tone of prostate and bladder neck

Question 6

S+S of Mild BPH

Answer 6

-asymptomatic
-increased BUN and creatinine
-peak urinary flow rate 25-50 mL
(score < 7)

Question 7

S+S of Moderate BPH

Answer 7

• increased BUN and creatinine
• low peak urinary flow rate
• postvoid residual volume >25-50 mL
• obstructive voiding sxs
• irritative voiding sxs

Question 8

S+S of Severe BPH

Answer 8

-same as moderate BPH PLUS one or more complications of BPH

Question 9

Treatment Goals of BPH

Answer 9

• reduce sxs
• slow dz progression
• prevent complications (post-renal/chronic renal failure, infx, hematuria, bladder stones)

Question 10

Tx for Patients with Mild BPH

Answer 10

-watchful waiting

Question 11

Tx for Patients with Moderate BPH

Answer 11

-pharmacologic treatment

Question 12

Tx for Patients with Severe BPH

Answer 12

-surgery

Question 13

MOA of Alpha 1 and Alpha 1A Blockers

Answer 13

-relax smooth muscle in bladder neck and prostate

Question 14

When given a drug name, how do you know if it is alpha 1 or alpha 1A?

Answer 14

• alpha: end in Zosin

- alpha 1: osin

Question 15

What is the onset of action for alpha 1 blockers?

Answer 15

-onset 2-4 weeks

Question 16

What is an advantage of alpha 1A blockers?

Answer 16

uroselective so may cause less HoTN

Question 17

Disadvantages of Alpha 1 and Alpha 1A Blockers?

Answer 17

• orthostatic HoTN (initiate at lowest dose and titrate at 2-7 day intervals)
• in alpha 1A: floppy iris syndrome during cataract surgery

Question 18

What is the place in therapy of alpha 1 and 1A blockers?

Answer 18

-alpha 1 blockers 1st line treatment for moderate BPH

Question 19

What is recommended when patients can’t tolerate the alpha 1 blockers?

Answer 19

-alpha 1A tamsulosin

Question 20

What is the problem with silodosin?

Answer 20

most likely to cause abnormal ejaculation

Question 21

MOA of 5 Alpha Reductase Inhibitors

Answer 21

-decrease conversion of testosterone to DHT

Question 22

Advantages of 5 Alpha Reductase Inhibitors

Answer 22

decreased risk of orthostatic HoTN

Question 23

Disadvantages of 5 Alpha Reductase Inhibitors

Answer 23

• onset of action 6 months

- may cause decreased libido, ED

Question 24

What is the place in therapy for 5 alpha reductase inhibitors?

Answer 24

• most effective for patients with increased prostate size (> 30 g)
• used for pts unable to take alpha 1 or 1A blockers

Question 25

Which PDE5 inhibitor can be given for BPH?

Answer 25

tadalafil (Cialis)

Question 26

Advantages of PDE5 for BPH

Answer 26

onset of action 2-4 weeks

Question 27

Disadvantages of PDE5 for BPH

Answer 27

• modest improvement

- not recommended with alpha blockers

Question 28

When should tadalafil/PDE5 inhibitors be considered?

Answer 28

for concomitant ED and mild BPH sxs

Question 29

Which herbals have been used for BPH?

Answer 29

• beta sitosterol
• pygeum
• saw palmetto

Question 30

Is monotherapy sufficient for BPH treatment?

Answer 30

yes, but combination therapy has a greater effect

Question 31

What must be monitored in pts taking 5 alpha reductase inhibitors?

Answer 31

-need to check baseline and yearly PSA b/c these drugs can decrease PSA up to 50%

Question 32

Of alpha 1 blockers and 5 alpha reductase inhibitors, which decreases prostate size?

Answer 32

5 alpha reductase inhibitors

Question 33

Of alpha 1 blockers and 5 alpha reductase inhibitors, which slows disease progression?

Answer 33

5 alpha reductase inhibitors