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1. Pharm II > BPH > Flashcards

BPH Flashcards

1
Q

What are the 3 types of tissue in the prostate gland?

A
  • epithelial
  • stromal
  • capsule
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2
Q

What stimulates epithelial growth?

A

Androgens

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3
Q

What is stromal tissue embedded w/?

A

Alpha1-adrenergic receptors

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4
Q

What is the capsule embedded w/? What does norepinephrine do?

A

Alpha1-adrenergic receptors

- When stimulated w/ norepinephrine, the capsule contracts around the urethra

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5
Q

Testosterone is the principal…

A

testicular androgen

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6
Q

Androstenedione is the principal…

A

adrenal androgen

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7
Q

Androgens are converted into what?

A

5α-reductase converts androgens to DHT, an active metabolite

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8
Q

What is considered a more potent androgen than testosterone?

A

DHT

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9
Q

What does DHT do?

A

Induces growth & enlargement of the prostate

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10
Q

What are the 2 types of 5α-reductase?

A
  • Type I enzyme: causes acne & increased hair

- Type II enzyme

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11
Q

What is a normal prostate composed of?

A
  • Higher amounts of stromal tissue than epithelial, Ratio = 2:1
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12
Q

What is the stromal-to-epithelial tissue ratio in BPH?

A

5:1

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13
Q

What is the MOA of 5α-reductase inhibitors in epithelial tissue?

A

Reduce an enlarged prostate by 25%

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14
Q

What is the MOA of alpha1-adrenergic receptors in stromal tissue?

A

SM contraction in enlarged prostate & bladder base obstructing urine flow

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15
Q

What med is quickly effective in sx management of urinary flow?

A

alpha1-adrenergic antagonists

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16
Q

What do static factors relate to?

A

Enlargement of prostate

- Depends on androgen stimulation of epithelial tissue & estrogen stimulation of stromal tissue

17
Q

What do dynamic factors relate to?

A

Excessive α-adrenergic tone of the stromal component –> contraction of prostate around urethra & narrowing of urethral lumen

18
Q

Which factors are responsible for obstructive voiding sx?

A

Dynamic!

19
Q

What 3 agents reduce the dynamic factor in BPH?

A
  • Doxazosin (Cardura)
  • Tamsulosin (Flomax)
  • Tadalafil (Cialis)
20
Q

Which agent reduces the static factor in BPH?

A

Finasteride (Proscar)

21
Q

What 2 agents relax the detruser muscle of the bladder?

A
  • Oxybutynin (Ditropan)

- Mirabegron (Myrbetrig)

22
Q

Older 2nd-generation immediate-release α1-Adrenergic Antagonists can cause…

A

Adverse CV effect

23
Q

5α-Reductase Inhibitors are useful primarily for patients with…

A

large prostates

24
Q

Which class of meds has a slow onset of action?

A

5α-Reductase Inhibitors

- Takes up to 6 months!

25
Q

What are 4 adverse effects of 5α-Reductase Inhibitors?

A
  • Decreased libido
  • ED
  • Ejaculation disorders
  • Gynecomastia
26
Q

What 2 vitals should you monitor w/ α-Adrenergic antagonists?

A

BP & HR

27
Q

How do you administer 1st dose of α-Adrenergic antagonists?

A

Start on lowest dose, take at bedtime

28
Q

What is a contraindication of α-Adrenergic antagonists?

A

Cataract surgery

29
Q

What is a complication of α-Adrenergic antagonists?

A

Painful erection lasting longer than 4 hrs

30
Q

What is an ADE of α-Adrenergic antagonists?

A

Floppy iris syndrome

31
Q

What lab should you monitor w/ 5α-Reductase Inhibitors?

A

PSA

- Should decrease by 50%

32
Q

What is the peak onset of α-Adrenergic antagonists?

A

1-6wks

33
Q

Phosphodiesterase inhibitors vs anticholinergic agents

A
  • PD inhibitors: Relax SM
  • Anticholinergic ADE: ED
  • Both have CV ADEs
34
Q

What is are ADEs of β3-adrenergic agonists (Mirabegron)?

A
  • HTN (CV ADE)

- Impaired cognition

35
Q

What 2 things should you monitor w/ β3-adrenergic agonists (Mirabegron) ?

A

BP & bowel habits

1. Pharm II (11 decks)

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