BPH (Final)

Question 1

this receptor is stimulated by NE which causes the prostate to contract and a lot of pressure is at the bladder neck which means urine wont be passed to the urethra as easily therefore the patient has trouble voiding

Answer 1

alpha-adrenergic recpetors

Question 2

this part of the prostate is also known as the glandular tissue. it produces prostatic secertion delievered to the urethra duing ejaculation. growth of this is stimulated by testosterone

Answer 2

epithelial tissue

Question 3

this part of the prostate is also known as the smooth muscle. it is embedded with alpha1-adrenergic receptors = contraction/compression. too much of this contraction/compression leads to decreased bladder emptying

Answer 3

stromal tissue

Question 4

this is the part that contracts the prostate. it is comprised of fibrous connective tissue and smooth muscle with embedded alpha1-adrenergic receptors

Answer 4

capsule

Question 5

this type of 5alpha-redctase enzyme is located at the site of the prostate

Answer 5

type II

Question 6

this induces growth and enlargement of the prostate

Answer 6

DHT

Question 7

true or false: with age there is decreased testosterone production therefore there is less DHT

Answer 7

false - DHT levels remain normal in the prostate.

Question 8

true or false: in BPH, anatomical enlargement of the prostate gland occurs which causes a physical block at the bladder neck obstructing urine outflow

Answer 8

true

Question 9

this is one of the two factors that cause BPH; it is an increase in size of prostate due to testosterone stimulation of the epithelial tissue

Answer 9

static factor

Question 10

this is one of the two factors that cause BPH; it is from excessive alpha1-adrenergic tone

Answer 10

dynamic factors

Question 11

describe the clinical presentation of BPH

Answer 11

• urine stream diminished
• bladder feels full even after voiding
• urinary frequency
• bedwetting/nocturia

Question 12

what are some red flags for BPH

Answer 12

• sus Digital Rectal Exam
• refractory retention (trouble voiding despite tx)
• hematuria
• bladder stones
• renal insufficiency
• recurrent UTI
• elevated PSA (could be prostate cancer)

Question 13

what are some medications that can lead to similar sxs to BPH or even cause BPH

Answer 13

• anticholinergics (cause urinary retention)
• alpha1-agoinst (e.g. decongestant such as psedofed)
• testosterone supplements (can cause enlargement of prostate)

Question 14

what are some non-pharm measurements used to treat BPH

Answer 14

• fluid restriction before bed
• avoidance of caffeine, alcohol, spicy foods
• timed voiding (bladder training)
• weight loss & exercise (can decrease intra-abdominal pressure which can decrease pressure on bladder)
• avoid causative meds
• manage constipation

Question 15

when would single agent drug therapy be used for BPH

Answer 15

if the patients prostate is not enlarged therefore just experiencing dynamic factors

Question 16

when would dual agent drug therapy be used for BPH

Answer 16

if the patients prostate is enlarged (static factors)

Question 17

this class of medications is 1st line for individuals with BPH due to dynamic factors, therefore these agents have no effect on prostate size

Answer 17

alpha-adrenergic antagonists

Question 18

true or false: all alpha-adrenergic antagonists have the same effectiveness at reducing lower urinary tract symptoms

Answer 18

true

Question 19

how long does it take for alpha-adrenergic antagonists to work

Answer 19

1-3 weeks

Question 20

these 3 alpha-adrenergic antagonsits target alpha1 adrenergic receptors. they decrease post-void residual (PVR) volume and increase urinary flow.

Answer 20

terazosin, doxazosin and alfuzosin

Question 21

out of terazosin, doxazosin and alfuzosin, which ones have a hypotensive effect therefore need to start low & go slow? + if several days of medication is missed need to re-titreate

Answer 21

terazosin and doxazosin

Question 22

true or false: prazosin is an alpha-adrenergic antagonists used in BPH

Answer 22

false - has a marked hypotensive effect therefore not recommended

Question 23

these 2 alpha-adrenergic antagonists target alpha1A- andrenergic receptors. they decrease post-void residual (PVR) volume and increase urinary flow. they have a decreased hyptensive effect

Answer 23

tamsulosin and silodosin

Question 24

what are some a/e associated with alpha1-adrenergic antagonists (non-selective agents: terazosin, doxazosin and alfuzosin)

Answer 24

• dizziness
• syncope
• orthostatic hypotensoin
• h/a
  rare: intraoperative floppy iris syndrome (IFIS) which is blockage of the alpha1-adrenergic receptors in the iris dilator muscles and during cataract surgery causes constriction of the pupil and billowing out of iris (need to tell eye dr they are on these meds)

Question 25

what are some a/e associated with alpha1A-adrenergic antagonists (selective agents: tamsulosin and silodosin)

Answer 25

- droswiness - nasal congestion - retrograde ejactulation and reduced ejaculate volume - IFIS

Question 26

this selective alpha1A-adrenergic antagonist contains a sulfa moetiy

Answer 26

tamsulosin

Question 27

alpha-adrenergic antagonists are etabolized by these enzyme, therefore need to watch out for inducers (carbamazepine) and inhibitors (clarithromycin, ketoconzole)

Answer 27

CYP 3A4

Question 28

this alpha-adrenergic antagonist is a substrate of p-gp therefore caution needs to be taken when taken with p-gp inhibitors

Answer 28

silodosin

Question 29

are non-selective or selective alpha-adrenergic antagonists more likely to cause severe hypotension when combined with a PDE5 inhibitors

Answer 29

selective

Question 30

the patients BP should be stable on an alpha-adrenergic antagonist before being started on this class of medication

Answer 30

PDE5 inhibitor

Question 31

if a patient is on both an alpha-adrenergic antagonist and PDE5 inhibitor, can they be taken together or should they be separated

Answer 31

separate by 4 hours

Question 32

how should doxazosin and terazosin be titrated

Answer 32

1-2mg weekly

Question 33

true or false: terazosin and doxazosin are best taken in the morning

Answer 33

false - HS dosing allow for most hypotensive effects to occur during sleep

Question 34

true or false: alfuzosin should be taken with food

Answer 34

true

Question 35

true or false: tamsulosin CR should be swallowed whole

Answer 35

true

Question 36

true or false: tamsulosin SR can be chewed or crushed

Answer 36

false - swalloe whole

Question 37

true or false: tamsulosin CR should be taken with food

Answer 37

false

Question 38

true or false: tamsulosin SR should be taken with food

Answer 38

true - 1/2 hr after same meal each day

Question 39

true or false: silodosin should be taken with food

Answer 39

true

Question 40

this class of medication is 1st line for patients with BPH due to static factors (size). they inhibit 5alpha-reductase thereby decrease conversion of testosterone to DHT. effective at decreasing PVR and increasing urinary flow.

Answer 40

5alpha-reeductase inhibitors

Question 41

what is the onset of action for 5alpha-reductase inhibitors

Answer 41

6-12 months

Question 42

this is a competitive inhibitor of type II 5alpha-reductase. it is a tablet. and crushed tablets should not be handled by those planning conception or are pregnancy

Answer 42

finasteride

Question 43

this is a competitive inhibitor of type I AND type II 5alpha-reductase. it is a capsule that should be swallowed whole. it may work more quickly than finasteride

Answer 43

dutasteride

Question 44

what are some a/e associated with 5alpha-reductase inhibitors

Answer 44

- decreased libido - ED and other ejactulatory disorders rare: muscle weakness

Question 45

this is an antigen produced by the prostate and small amount are produced into the bloodstream. an increase in these levels may be an indicator of BPH and/or prostate cancer,

Answer 45

PSA

Question 46

5alpha-reducatse inhibitors decrease PSA. baseline PSA should be obtained in those starting treatment. when should a repeat PSA be performed after starting tx

Answer 46

6 months (think onset of action is 6-12 months)

Question 47

this is indicated for patients with symptomatic LUTS with prostate enlargement (> 30 cc). with this, there is more risk of adverese effects especially ejactulatory disorders

Answer 47

combination tx (e.g. Jalyn - dutasteride/tamsulosin)

Question 48

this class of medications has been shown to improve LUTS in men with BPH. may be recommended as monotherapy for men with LUTS/BPH and, in particular, men with both LUTS and ED

Answer 48

PDE inhibitors e.g. Tadalafil 5mg once a day regimen

Question 49

this class of medication may be useful for indivuduals with BPH and storage symptoms as they are commonly used in patients with overactive bladders.

Answer 49

antimuscarinic agents (fesoterodine, tolterodine, oxybutynin, solifenacin) beta-3 agonist - myrbetriq

Question 50

this medication may be considered for men with BPH whose predominant symptoms is noctuira, who do not respond to other treatments; it is a supplement for endogenous ADH + sodium monitoring is important with this medication!

Answer 50

desmopressin