BPH Flashcards
Enlarged prostate gland leads to what kind of symptoms?
“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
Drugs that can worsen BPH
Anticholinergics (eg benztropine) Antihistamines Caffeine Decongestants (sudafed) Diuretics SNRI's TCA's, phenazothiazines, and other drugs w anticholinergic properties Testosterone products
What guides selection of treatment for BPH?
Severity of BPH treatment, based on questionnaires used to quantify symptoms
Natural products sometimes used for BPH
Saw palmetto
Pygeum
Beta-sitosterol
Rye pollen
Drug classes used for BPH
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
Caveat for using 5-alpha reductase inhibitors
Should only be used in patients with prostatic enlargement because they work by decreasing prostate size
Terazosin class, dose
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
Doxazosin class, brand, dose
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
Tamsulosin class, brand, dose
Selective alpha-1a blocker
Flomax
0.4 mg daily, 30 mins after same meal each day (up to 0.8 mg/day)
Jalyn
Tamsulosin + dutasteride combo product
alpha-1a blocker + 5-alpha reductase blocker
Warnings w alpha-1 blockers, side effects
Can cause orthostatic hypotension/syncope, especially the non-selective (terazosin, doxazosin) so give at bedtime
Side effects: dizziness, fatigue, headache, abnormal ejaculation (tamsulosin, silodosin)
Effect expected with alpha-1 blockers
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
Which drug has a ghost tablet?
Cardura XL
Do not use which drug in patients w risk of QT prolongation
Alfuzosin
Which drug causes retrograde ejaculation
Silodosin mostly
also tamsulosin
Finasteride class, brand, dose
5 alpha reductase inhibitor
Proscar
5 mg daily
Dutasteride class, brand, dose
5 alpha reductase inhibitor
Avodart
0.5 mg daily
Contraindications for 5-alpha reductase inhibitors
Women of childearing potential, pregnancy, children
Side effects of 5-alpha reductase inhibitors
Impotence
Decreased libido
Ejaculation disturbances
Breast enlargement or tenderness
Notes for 5-alpha reductase inhibitor
Pregnant women should not handle or take
Can be absorbed through the skin
Expected effect of 5-alpha reductase inhibitors
Shrink prostate
Decrease PSA levels
Tadalafil class, brand, dose, warnings, side effects
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
