BPH

Question 1

Enlarged prostate gland leads to what kind of symptoms?

Answer 1

“Lower urinary tract symptoms (LUTS)” (urgency, weak stream/straining, nocturia, incomplete emptying, leaking/dribbling)
Causes direct bladder outlet obstruction (BOO) and increased smooth muscle tone and resistance
Causes more frequent urination because the bladder begins to contract even when it contains small amounts of urine
*NOTE: symptoms can be similar to prostate cancer

Question 2

Drugs that can worsen BPH

Answer 2

Anticholinergics (eg benztropine)
Antihistamines
Caffeine
Decongestants (sudafed)
Diuretics
SNRI's
TCA's, phenazothiazines, and other drugs w anticholinergic properties
Testosterone products

Question 3

What guides selection of treatment for BPH?

Answer 3

Severity of BPH treatment, based on questionnaires used to quantify symptoms

Question 4

Natural products sometimes used for BPH

Answer 4

Saw palmetto
Pygeum
Beta-sitosterol
Rye pollen

Question 5

Drug classes used for BPH

Answer 5

Alpha blockers (selective and non-selective) alone or in combination with 5-alpha reductase inhibitors

Can also use phosphodiesterase-5 (PDE-5) inhibitors such as tadalafil (Cialis) - works for pts with BPH and ED

Question 6

Caveat for using 5-alpha reductase inhibitors

Answer 6

Should only be used in patients with prostatic enlargement because they work by decreasing prostate size

Question 7

Terazosin class, dose

Answer 7

Non-selective alpha-1 blocker
TITRATE TERAZOSIN: 1 mg at bedtime, titrate slowly to effect (usually 10 mg HS)

*NOTE: “slowly” is underlined in the book

Question 8

Doxazosin class, brand, dose

Answer 8

Non-selective alpha-1 blocker
Cardura, Cardura XL
IR: TITRATE SLOWLY - 1 mg initially up to 4-8 mg daily, started at bedtime
XL: 4 mg daily up to 8 mg daily max

Question 9

Tamsulosin class, brand, dose

Answer 9

Selective alpha-1a blocker
Flomax
0.4 mg daily, 30 mins after same meal each day (up to 0.8 mg/day)

Question 10

Jalyn

Answer 10

Tamsulosin + dutasteride combo product

alpha-1a blocker + 5-alpha reductase blocker

Question 11

Warnings w alpha-1 blockers, side effects

Answer 11

Can cause orthostatic hypotension/syncope, especially the non-selective (terazosin, doxazosin) so give at bedtime

Side effects: dizziness, fatigue, headache, abnormal ejaculation (tamsulosin, silodosin)

Question 12

Effect expected with alpha-1 blockers

Answer 12

Work right away but may take 4-6 weeks for beneficial effect (exact wording from the book lol)
Do not shrink prostate size and do not change PSA levels

Question 13

Which drug has a ghost tablet?

Answer 13

Cardura XL

Question 14

Do not use which drug in patients w risk of QT prolongation

Answer 14

Alfuzosin

Question 15

Which drug causes retrograde ejaculation

Answer 15

Silodosin mostly

also tamsulosin

Question 16

Finasteride class, brand, dose

Answer 16

5 alpha reductase inhibitor
Proscar
5 mg daily

Question 17

Dutasteride class, brand, dose

Answer 17

5 alpha reductase inhibitor
Avodart
0.5 mg daily

Question 18

Contraindications for 5-alpha reductase inhibitors

Answer 18

Women of childearing potential, pregnancy, children

Question 19

Side effects of 5-alpha reductase inhibitors

Answer 19

Impotence
Decreased libido
Ejaculation disturbances
Breast enlargement or tenderness

Question 20

Notes for 5-alpha reductase inhibitor

Answer 20

Pregnant women should not handle or take

Can be absorbed through the skin

Question 21

Expected effect of 5-alpha reductase inhibitors

Answer 21

Shrink prostate

Decrease PSA levels

Question 22

Tadalafil class, brand, dose, warnings, side effects

Answer 22

Cialis (for ED) or adcirca (for pulmonary arterial hypertension)
5 mg daily same time each day (10-20 mg for ED)
Decrease dose to 2.5 mg if CrCL between 30-50 or if using a strong CYP3A4 inhibitor

Do not use if CrCL < 30 mL/min

Warnings: impaired color discrimination, hearing loss, vision loss, hypotension, priapism, chest pain (seek immediate medical help)

Dont use w nitrates obvi

Side effects: headache, flushing, dizziness, dyspepsia