BPH Flashcards
Signs and symptoms of BPH are considered to be either _____________ in nature
obstructive or irritative
Incomplete emptying is a what sx?
obstructive
Frequency or urination is a what sx?
can be from obstruction but also can be from irritation (stimulation of muscarinic receptors)
Intermittency is a what sx?
obstructive - trying to push urine through the urethra with an enlarged prostate
Urgency is a what sx?
- irritative sx
Weak urinary stream is a what sx?
- obstructive sx
Nocturia is a what sx?
- irritative
What symptoms of BPH would make us think it was a more urgent case?
- blood in urine
- pain upon urination
- under 45 years of age
- men with incontinence - backing up of bladder so badly that it forcibly pushes out urine through the prostate
- complete bladder obstruction (suprapubic pain), agitation – need to out in a catheter to get rid of all of the urine
What causes acute urinary retention?
- unmanaged BPH
What are some of the medications that people with BPH need to avoid?
- antihistamines (muscarinic receptors are taking away the signal to empty the bladder)
- decongestants
- TCAs
- antipsychotics
- anti-muscarinic agents
- some parkinsons meds
- diuretics (furosemide, metolazone)
- testosterone gel
If a person ever tells you that their _________ infection is getting worse on BPH meds, TAKE IT SERIOUSLY
lower respiratory tract infection
What is the pathophys of BPH?
- increased size of the prostate- prostate encircles like a donut
- increased prostate = increased urine block through the urethra
What is the purpose of the prostate?
- gland that moves the fluid to the ejaculate- helps with reproduction
What is one mechanism in which the prostate grows?
- testosterone
- usually makes it grow by 30-40 cc’s in size
What do PSAs help us with?
not much- not specific for cancer or BPH
- just doing a PSA level is not definitive to diagnosing prostate cancer
What do 5-alpha reductase inhibitors do?
- block the production of DHT and cause a reduction in the size of the prostate
- reduces the amount that the gland grows and can also actually shrink it by as much as 25%
- – makes sense because if someone wasn’t having their prostate shrunk, then they wouldn’t have had any relief from the medication
If someone has a small prostate and a lot of smooth muscle clenching down on the urethra, you can get away with just using a ________
alpha blocker
When __________ is contracting, then you have the prostate squeezing down on the bladder
stromal cells
What receptors are the most overactive when men have an irritative bladder?
muscarinic
What do untreated symptomatic males likely end up developing?
- acute urinary retention
What is the MAIN SE associated with terazosin?
- dizziness (usually people take this med at night)
Is there a difference in efficacy between terazosin, alfuzosin and tamsulosin?
- NO (only difference is that first gen causes more vasodilation or action on a lot of other parts of the body- dizziness and hypotension can still happen)
What is the efficacy of these alpha-1 inhibitors?
- decrease the ISS score by 3-4
What are the main SE associated with alpha-1 blockers?
- dizziness, decrease in BP, unsteadiness on feet
- also nasal congestion, ejaculatory changes (retrograde ejaculation), and cataracts
What is the benefit of using tamsulosin instead of other medications?
- less dizziness and cardiovascular signs and symptoms- BUT NOT NONE
____ changes are still a concern with tamsulosin and _____ syndrome
ejaculatory
floppy iris
What is the main thing finasteride is used for
enlarged prostate and more severe symptoms
- only way to stop prostate growth is to add a 5-a blocker
What finasteride, we can decrease the IPSS score by ______ units
6-9 units
What are the main SE of finasteride?
- sexual dysfunction (erectile dysfunction, ejaculatory issues, decreased libido)
Does finasteride increase the risk of developing prostate cancer?
- no it doesn’t- it does increase the probability that the cancer a patient will get will be higher grade though and more severe (need to have this conversation with patients)
Notice from health canada about using finasteride and ______ cancer in men
breast
When is cialis usually used for bph?
- when used with a combo of ED and BPH
How much does cialis decrease IPSS scores?
by 2-3 units
What are the main SE associated with cialis?
flushing, back pain, priapism (erection that lasts longer than 4 hours)
What is the most significant DI associated with cialis?
- nitrates
What is the main effect of saw palmetto?
- some effect, but some of the guidelines say not enough evidence
- will see people using this
What anticholinergics will you see people using for BPH?
- oxybutinin
- tolteridone
What do anticholinergic drugs help with?
- trying to help with the irritative effect of the bladder
ask the patient if they were getting up every hour, if they had to pee all the time, etc
What are the endpoints associated with BPH?
- decrease in signs and symptoms pretty instantly, by 3-4 units within 1 week
- finasteride takes 3-6 months to start working and will decrease the IPSS score in about 6 months
- decreased risk of AUR
- decreased risk of prostate surgery by 3% in 5-10 years
When do side effect stay present for?
- 1-2 weeks
PSA levels will go down by 50% in first _____ months
6
If you see a person’s PSA levels go up while on finasteride or dutasteride, what are you concerned about?
- concerned about cancer
