BPH Flashcards
What does epithelial/glandular tissue produce?
Prostatic secretions
Function of androgens in epithelial/glandular tissue?
Androgens stimulate epithelial tissue growth
What kind of sx’s does epithelial/glandular tissue produce?
Static sx’s
What does stromal/smooth muscle tissue contain?
alpha 1 adrenergic receptors
What does norepinephrine cause in stromal/smooth muscle tissue? result?
Smooth muscle contraction
Results in decreased urinary bladder emptying
What kind of sx’s does stromal/smooth muscle tissue produce?
Dynamic sx’s
What is the capsule of the prostate composed of?
Fibrous connective tissue + smooth muscle tissue
What does the capsule contain?
alpha 1 adrenergic receptors
When norepinephrine is stimulated, what happens to the capsule?
Contracts around the urethra
Define static
- Anatomic enlargement of prostate gland
- Physical block at bladder neck
What is the enlargement due to in static sx’s?
- Androgen stimulation of prostate gland
2. Estrogen stimulation of stromal tissue
What exacerbates static sx’s?
- Stress
- Pain
* Increased alpha-adrenergic tone may precipitate excessive contraction of prostatic stromal tissue
Define Dynamic
- Excessive alpha adrenergic tone of the stromal compartment of prostate
- Contaction of prostate gland around urethra
- BUT normal prostate gland size
What type of sx’s do we see in dynamic sx’s?
Obstructive sx’s
What is considered a more potent androgen than testosterone in the prostate?
DHT
Is type I or type II enzyme localized to the prostate?
Type II
What does DHT induce in the prostate?
Growth and Enlargement
What alpha adrenergic receptor is most selective to the prostate?
subtype-selective α1A-receptor
What enzyme converts testosterone and androstenedione to the active metabolite DHT?
5α-reductase
What medications can exacerbate BPH sx’s?
- Anticholinergics
- Antihistamines
- TCA’s
- Phenothiazines
Management of mild BPH
- Watchful waiting
- Behavior modifications
- Return visits every 12-months for assessment of worsening si/sx’s
Management of moderate/severe BPH
Drug therapy or Surgery
Why do you want to titrate older, immediate-release, second generation α1-adrenergic antagonists?List the name of these drugs
Minimize CV effects:
- Orthostatic hypotension
- First dose syncope
- Dizziness
Terazosin and Doxazosin?
What is unique about 3rd generation α1-adrenergic antagonists? List the name
Tamsulosin:
Pharmacologically uroselective
Good alternative when experiencing ADE’s with 2nd generation
What second generation α1-adrenergic antagonists has fewer CV ADE’s? Why?
Extended release Alfuzosin
Functionally uroselective
Aside from CV effects, what is another major ADE of α1-adrenergic antagonists? And what patient education should you provide to your patient?
Floppy Iris syndrome
If cataract surgery, instruct patient to inform their opthalmologist they are taking an alpha blocker
α1-adrenergic antagonists dosing instructions
- Start on lowest dose and titrate over several weeks
2. Take first dose at bedtime
What α1-adrenergic antagonist ADE is a urologic emergency? Patient education?
Priapism
Seek medical attention if painful erection >4 hrs
What do you want to monitor with α1-adrenergic antagonist?
- Blood pressure
2. HR
What patient are 5α-reductase inhibitors primarily used in?
- Large prostate: >40 g
- Want to avoid surgery
- Can’t tolerate α1-adrenergic antagonists SE’s
List the 5α-reductase inhibitors
- Finasteride
2. Duasteride
5α-reductase inhibitors ADE’s
- Decreased libido
- ED
- Ejaculation disorders
- Gynecomastia
What do you want to monitor in 5α-reductase inhibitors?
Prostate-specific antigen (PSA): Decrease by 50% IF pt is adherent to therapy
PDE-1 Effect/MOA
Dynamic effects:
Smooth muscle relaxation of prostate, bladder neck, and prostatic urethra
What do you want to monitor in PDE-I ?
- BP
- Pulse
- Hearing loss- Discontinue drug
Anticholinergic Effects on the bladder
Relaxes detrusor muscle of the bladder
List the β3-adrenergic agonist
Mirabegron
β3-adrenergic agonist (Mirabegron
0 MOA
Increases cAMP
Relaxes detrusor muscle
Overall effects of β3-adrenergic agonist (Mirabegron)
- Decreases irritative sx’s
- Increases urinary bladder capacity
- Increases intervals between voiding
β3-adrenergic agonist ADE’s
- HTN, Increased HR
- Diarrhea/constipation
- Impaired cognition
What do you want to monitor in β3-adrenergic agonist?
- BP
2. Bowel habits
