BPH and ED drugs 2-3 Flashcards
BPH Patho
-nonmalignant enlargement of prostate
-mechanical obstruction: due to overgrowth of epithelial in prostate
-dynamic obstruction: contraction of SM around prostate and urethra
-s/s: difficulty to start flow, stream changes
Finasteride (Proscar)
(PO with or without food)
-for mechanical obstruction of BPH
-MOA: reduces DHT (dihydrotestosterone) levels (5 alpha reductase inhibitor) –> regression epithelial tissue
-decrease prostate size
-takes 6-12 months for effect
-treatment is LIFELONG
-know pt has therapeutic effect:
+ PSA (prostate antigen): decreases
+ pt report normal urine, less needing to press down to pee
Finasteride adverse
-gynecomastica
-decreased ejaculate volume and libido
Finasteride considerations and contraindications
-teratogenic to male babies: stillborn, abnormalities –> NO pregnant woman should handle
-need gloves to give meds
-should NOT donate blood while taking or 6months AFTER stopping treatment: bc blood recipient could be a pregnant woman
Alpha1 Adrenergic Blockers
-for dynamic obstruction
-MOA: blocks a1 –>relax SM in prostate, prostatic urethra, bladder neck
(alpha 1 is in heart, vessels, prostate)
-all are POmeds
Types of A1 blockers
nonselective: also affect BP –> decreases BP
-Terazosin (Hytrin):
-Alfuzosin (Uroxatral, Xatral)
-Doxazosin (Cardura): also affect BP
selective: only for alpha 1 in prostate
-Silodosin (Rapaflo):
-Tamsulosin (Flomax): also helps dilate urethra –> help with kidney stones (worry abt abnormal ejaculation)
ERECTILE DYSFUNCTION
-associated with diatbetes, HTN, hyperlipid, obesity, test intolerance, prostate cancer txt
-associated with increased risk CAD, PAD
-erection subsides when CGMP is removed by PDE5 (no more blood flow = erection)
-NEED adequate circulation for meds to work
ED treatment
1st line
-lifestyle (more exercise, smoking cessation, PDE-5inhibitors, changing drug regimes, psychotherapy)
-Phosphodiesterase 5 inhibitors: -afils
2nd line:
-injections or vacuum device
3rd line:
-surgery
PDE5 Inhibitors: Sildenafil (Viagra)
-for ED
-for pulmonary artery HTN
-MOA: inhibits PDE5 –> preserve cGMP levels in penis –> ehance blood flow to area
(NEED sexual arousal to work)
-DO NOT take with vasodilators and nitrates: drop BP
-dont take with high fat meals: slow absorption
-1h to peak (last 4h)
Sildenafil adverse
-hypotension: bc blood go to penis, diverted away from heart and body
-priapism: erection lasting longer than 4h –> ice it to vasoconstrict and divert blood away
-optic neuropathy (rare)
-sudden hearing loss (rare)
-common: ha, flushing, heartburn
Sildenafil interactions
-nitrates (Nitroglycerin), vasodilators, alpha blockers: allow at least 24h between viagra and nitrate dose (worry abt fatal BP drop)
-increase toxicity of grapefruit juice, erythromycin, cimetidine
-alcohol can negate effects
Contraindications for PDE5i
-history of heart attack, dysryhthmias, HTN/hypotn, HF, unstable angina, pt using nitrates/vasodilators/alpha blockers
==> basically pt w/ ton cardiac meds and CVS history
