BPH Notes

Question 1

What is benign prostatic hyperplasia?

Answer 1

a nonmalignant enlargement of the prostate gland that occurs with aging.

Question 2

What changes occur due to BPH?

Answer 2

1. urethral obstruction
2. detrusor overactivity (urge incontinence) and underactivity (overflow incontinence)
3. 5 alpha reductase enzyme converts testosterone to dihydrotestosterone- a potent androgen that stimulates prostate growth.
4. alpha adrenergic receptors are stimulated in the prostate and bladder neck which increases smoother muscle tone there contributing to urethral resistance.

Question 3

What medication group help to address the stimulation of 5 alpha reductase enzyme with BPH and how do they work?

Answer 3

5 Alpha Reductase Inhibitors work by blocking the conversion of testosterone to dihydrotestosterone, reducing DHT levels, and consequently shrinking the prostate.

Question 4

What medication group helps to address the stimulation of alpha-adrenergic receptors in a patient with BPH and how do they work?

Answer 4

Alpha blockers are medications that relax these smooth muscles in the prostate and bladder neck by blocking alpha adrenergic receptors, thereby decreasing urethral resistance and improving urine flow.

Question 5

What are signs and symptoms of a patient with BPH?

Answer 5

1. urinary obstruction
2. postvoid dribbling
3. sensation of incomplete emptying of bladder (overflow incontinence)
4. increased urinary frequency during day and night (nocturia)
5. urgency (urge incontinence)

Question 6

What is the difference between selective and nonselective alpha blockers?

Answer 6

nonselective alpha blockers may be more suitable for patients who also require blood pressure management by blocking both alpha 1A and alpha 1B receptors. selective alpha blockers are more appropriate for patients who have history of hypotension and are sensitive to BP changes by only blocking alpha 1A receptors.

Question 7

What enzymes are alpha blockers metabolized by?

Answer 7

CYP450 enzymes

Question 8

Who is contraindicated for taking Silodosin (Rapaflo)?

Answer 8

Silodosin [Rapaflo] may be contraindicated in patients with severe chronic kidney disease (CKD).

Question 9

what are adverse effects of alpha blockers?

Answer 9

drowsiness, nasal congestion, HA, orthostatic hypotension

Question 10

What is an important note to consider when prescribing a patient Alfuzosin (Uroxatral)?

Answer 10

Alfuzosin [Uroxatral] may prolong the QT interval, requiring caution when use in patients who are taking other medications that can also prolong QT interval.

Question 11

What is the MOA of adrenergic antagonists (alpha blockers)?

Answer 11

Block Alpha1A and/or Alpha1B adrenergic receptors in the prostate and bladder neck causing smooth muscle relaxation and decreased urinary obstruction.

Question 12

What is the MOA of 5-Alpha Reductase Inhibitors?

Answer 12

Inhibit the enzyme 5-alpha reductase, which converts testosterone into dihydrotestosterone (DHT) reducing the size of the prostate over time which improves urine flow.

Question 13

When is onset of action for adrenergic antagonists (alpha blockers)?

Answer 13

Quick onset, with symptomatic relief typically observed within 7-10 days.

Question 14

What is the primary benefit of taking adrenergic antagonists (alpha blockers)?

Answer 14

Rapid improvement in urinary symptoms

Question 15

What is the onset of action when taking 5-alpha reductase inhibitors?

Answer 15

Slow acting; takes 9-12 months to achieve maximum therapeutic effect.

Question 16

What is the primary benefit of taking 5-alpha reductase inhibitors?

Answer 16

Significant reduction in prostate size and sustained improvement in urinary symptoms over the long term.

Question 17

what are common side effects of 5-alpha reductase inhibitors?

Answer 17

sexual dysfunction such as ED, decreased libido, and gynecomastia.

Question 18

Who should be careful with 5-alpha reductase inhibitors?

Answer 18

These drugs are teratogenic; women who are pregnant or may become pregnant should not handle crushed or broken tablets as they can cause birth defects in male fetuses.

Question 19

What drug interactions of adrenergic antagonists (alpha blockers) should be carefully watched?

Answer 19

1. drugs that inhibit metabolism of CYP450 enzymes (Verapamil, Diltiazem) can increase plasma levels of alpha blockers.
2. drugs that induce CYP450 (Tegretol, St John’s Wort) may decrease effectiveness of alpha blockers.

Question 20

What are indications for taking single therapy alpha blockers vs 5-alpha reductase inhibitors?

Answer 20

alpha blockers are indicated for patients experiencing lower urinary tract symptoms (LUTS) such as urinary frequency, urgency, and weak stream and need rapid symptom relief.

5-alpha reductase inhibitors are indicated for patients with enlarged prostates who require long-term reduction in prostate size and symptom improvement.

Question 21

What lab tests need to be initiated when starting a patient on these medications?

Answer 21

Obtain baseline PSA (Prostate-Specific Antigen) levels because these drugs decrease PSA by 50% potentially masking prostate cancer, serum creatinine for renal function, and liver function tests (LFTs) if indicated.