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PHA 551 > BPH > Flashcards

BPH Flashcards

1
Q

What are the 4 zones of the prostate?

A

peripheral
central
transitional
anterior

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2
Q

What is the MC zone to develop prostate cancer?

A

peripheral zone

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3
Q

What is the MC zone to develop BPH?

A

transitional zone

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4
Q

What is the MC zone to develop prostatitis?

A

central zone

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5
Q

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

A

epithelial tissue
stromal tissue
capsule

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6
Q

What is the main function of the epithelial tissue?

What stimulates the epithelial tissue?

A

produce prostatic secretions

androgens

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7
Q

What is the primary receptor in the stromal tissue?

What stimulates the stromal tissue?

A

alpha 1 adrenergic receptors
(also seen in the capsule)

norepinephrine
(NE –> smooth muscle contraction –> extrinsic compression of the urethra –> dec bladder emptying)

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8
Q

What is the normal ratio of stromal to epithelial tissue?

A

2:1 (stromal:epithelial)

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9
Q

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

A

5:1 (stromal:epithelial)

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10
Q

Where is type 1 5alpha reductase located?

What does DHT cause in these locations?

A

sebaceous glands in the frontal scalp, liver, skin

causes acne, inc body/facial hair

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11
Q

Where is type 2 5alpha reductase located?

What does DHT cause in these locations?

A

prostate, genital tissue, hair follicles of scalp

induces growth and enlargement of the gland

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12
Q

In the pathogenesis of BPH, what do STATIC factors relate to?

A

enlargement of the prostate gland

depends on:

  • androgens stimulating the epithelial tissue
  • estrogens stimulating the stromal tissue
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13
Q

In the pathogenesis of BPH, what do DYNAMIC factors relate to?

A

excessive alpha adrenergic tone on the stromal tissue

results in contraction of the gland around the urethra

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14
Q

What are other factors implicated in the pathophysiology of BPH?

A

chronic prostatic inflammation
advanced atherosclerosis
dec release of nitric oxide
dec production of cGMP

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15
Q

What are other factors implicated in the pathophysiology of BPH?

A

chronic prostatic inflammation
advanced atherosclerosis
dec release of nitric oxide
dec production of cGMP

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16
Q

What are signs and symptoms of OBSTRUCTIVE vs IRRITATIVE BPH?

A

OBSTRUCTIVE:

  • urinary hesitancy
  • urine dribbling
  • bladder fullness post voiding

IRRITATIVE:

  • urinary frequency
  • urinary urgency
  • nocturia
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17
Q

What PSA level indicates an enlarged prostate?

A

1.4 ng/mL

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18
Q

How is mild asymptomatic/mildly bothersome BPH w/ no complications managed?

A

watchful waiting
behavior modification
12 month return visits

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19
Q

How is BPH w/ moderate or severe symptoms managed?

A

drug therapy or surgery

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20
Q

What are the 3 types of agents used in BPH drug therapy?

A
  • agents that interfere w/ testosterone’s stimulatory effect on prostate gland enlargement
  • agents that relax prostatic smooth muscle
  • agents that relax bladder detrusor muscle
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21
Q

What are the non selective alpha 1 adrenergic antagonists?

Which factor do they target?

A

Doxazosin (immediate release)
Terazosin (immediate release)
Alfuzosin (extended release – less CV ADEs)
Prazosin

dynamic

22
Q

What are the selective alpha 1 adrenergic antagonists?

Which factor do they target?

A

Tamsulosin
Silodosin

dynamic

23
Q

Tadalafil

  • MOA
  • class
  • which factor does it target?
A

causes smooth muscle relaxation (prostate, bladder neck, prostatic urethra)

PDE 5

dynamic

24
Q

What precautions need to be considered with immediate release terazosin and doxazosin?

A

slow titration to minimize orthostatic hypotension and first dose syncope

solution: long acting formulation of doxazosin

25
Q

Finasteride:

  • MOA
  • which factor does it target?
A

blocks 5alpha reductase enzyme

static

26
Q

Bicalutamide, Flutamide:

  • MOA
  • which factor does it target?
A

blocks DHT at intracellular receptor

static

**not FDA approved for BPH – used for prostate cancer

27
Q

Leuprolide, Goserelin:

  • MOA
  • which factor does it target?
A

blocks pituitary release of LH

static

**not FDA approved for BPH – used for prostate cancer

28
Q

Megestrol Acetate:

  • MOA
  • which factor does it target?
A

blocks pituitary release of LH and blocks androgen receptor

static

**not FDA approved for BPH – used for prostate cancer

29
Q

Oxybutynin, Mirabegron: MOA

A

relax detrusor muscle of bladder

30
Q

What is the role of alpha1 adrenergic antagonist in BPH drug therapy?

A

interim measure

relieves voiding symptoms

31
Q

At what size of the prostate are 5 alpha reductase inhibitors indicated?

What is their role in BPH drug therapy?

A

at least 40g

  • delay symptom progression
  • reduce complications
  • dec gland size by ~25%
32
Q

Among all alpha 1 adrenergic antagonists, what are their similarities and differences?

A

equally effective

differ in cardiovascular effects

33
Q

What are the ADE’s associated with Terazosin and Doxazosin?

A

first dose syncope
orthostatic hypotension
dizziness

34
Q

Which of the alpha 1 adrenergic antagonists is the gold standard? Why?

A

Tamsulosin

selectivity, less CV effects
**NOT more effective **

35
Q

What is a major disadvantage of 5 alpha reductase inhibitors?

A

slow onset of action (takes up to 6 months to exert maximal effects)

36
Q

5 Alpha Reductase Inhibitors: ADEs

A

GYNECOMASTIA
dec libido
erectile dysfunction
ejaculation disorders

37
Q

Alpha Adrenergic Antagonists: ADEs

A 
FLOPPY IRIS SYNDROME
syncope
lightheadedness
orthostatic hypotension
tachycardia
nasal congestion
ejaculatory dysfunction
priapism
38
Q

Alpha Adrenergic Antagonists: monitoring parameters

A

BP

HR

39
Q

Alpha Adrenergic Antagonists: patient education

A

start at lowest dose - slow titration up

first dose at bedtime

caution w/ cataract surgery

seek medical attention if painful erection lasting longer than 4 hrs

40
Q

5 Alpha Reductase Inhibitors: monitoring parameter

A

PSA (should dec by 50%)

41
Q

Which agents relax prostatic smooth muscle?

A

alpha 1 adrenergic antagonists

phosphodiesterase inhibitors

42
Q

Which agent decreases prostate size?

A

5 alpha reductase inhibitors

43
Q

Which agent decreases PSA?

A

5 alpha reductase inhibitors

44
Q

Which agent has NO cardiovascular effects?

A

5 alpha reductase inhibitors

45
Q

Which agents exclusively treats irritative symptoms?

A

anticholinergic agents
mirabegron

(no efficacy in relieving bladder outlet obstruction)

46
Q

Which agent has no sexual dysfunction ADEs?

A

phosphodiesterase inhibitors

47
Q

Mirabegron: MOA

A

beta 3 adrenergic receptors inc production of cAMP –> relaxed detrusor muscle –> reduced irritative/voiding symptoms, inc bladder capacity, inc interval bt voidings

48
Q

Mirabegron: monitoring parameters

A

BP

bowel habits

49
Q

Mirabegron: class

A

beta 3 adrenergic agonist

50
Q

Mirabegron: ADEs

A

dose related, reversible

HYPERTENSION
IMPAIRED COGNITION
tachycardia
dry mouth
nausea
constipation
diarrhea
headache
nasopharyngitis
51
Q

What are the surgical options for BPH?

What are their indications?

A 
TURP (biopsy possible)
green light (no biopsy possible)

INDICATIONS:

  • moderate-severe symptoms
  • no response/don’t tolerate drug therapy
  • BPH w/ complications

PHA 551 (9 decks)

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