BPH Pharmacotherapy Exam 3 Flashcards
Physical Exam for BPH
- Digital rectal exam (DRE)
- Urine flow study
- Intravenous pyelogram (IVP)
- Cystoscopy
- Prostate specific antigen (PSA) blood test
- Urinalysis
Digital rectal exam (DRE)
- Usually the first test done to assess prostate
- Prostate is palpated through rectal wall
Urine flow study
- Reduced flow suggests BPH; best non-invasive study to detect lower urinary tract obstruction
- Normal is at least 10 mL/s
Intravenous pyelogram (IVP)
X-ray of the urinary tract that is used to identify obstructions or blockages
Cystoscopy
Allows for visualization of the prostate gland and a determination of the size and degree of obstruction
Prostate specific antigen (PSA) blood test
- To rule out prostate cancer
- Normal 0-4.0 ng/mL
Urinalysis
To determine if there is an underlying urinary tract infection or other problem such as stones causing obstructions
American Urologic Association/International Prostate Symptom Score
- 0-7 points: mild
- 8-19 points: moderate
- 20-35 points: severe
If a patient has mild BPH symptoms, what is the next step?
- Watchful Waiting
- Counsel on lifestyle measures
- Reassess in 6 or 12 month intervals
If a patient has moderate BPH symptoms, what is the next step?
- With ED: Alpha-1 blocker ± PDE5i
- Small Prostate and Low PSA: Alpha-1 blocker
- Large prostate (>30g) and increased PSA: Alpha-1 blocker + 5-alpha reductase inhibitor
- Predominant Irritative Voiding Symptoms: Alpha1 blocker + [Anticholinergic OR B3 agonist]
If a patient has severe BPH symptoms, what is the next step?
Surgery
What are the drug classes that can be used to treat BPH?
- Alpha-1 blocker
- 5-alpha reductase inhibitors
- PDE5i
- anticholinergics
- Beta-3 agonist
What are the Alpha-1 blocker drugs?
- Terazosin (Hytrin)
- Doxazosin (Cardura, XL)
- Alfuzosin (Uroxatral)
- Tamsulosin (Flomax) (3rd)
- Silodosin (Rapaflo) (3rd)
What are the 5-alpha reductase inhibitors drugs?
- Finasteride (Proscar)
- Dutasteride (Avodart)
What are the PDE5i drugs?
Tadalafil (Cialis®)
What are the anticholinergics drugs?
- Oxybutynin (Ditropan)
- Tolterodine (Detrol)
- Solifenacin (Vesicare)
- Trospium (Sanctura)
- Darifenacin (Enablex)
- Fesoterodine (Toviaz)
What are the Beta-3 agonist drugs?
Mirabegron (Myrbetriq)
Terazosin (Hytrin) pearls
- take at bedtime
- titrate 4-6 wks
- No renal or hepatic dosing
- food slows absorption
- NOT uroselective
Doxazosin (Cardura, XL) pearls
- QHS or QAM (doses are different); QH titrate wkly; QAM titrate 3-4 wks
- No renal dosing
- avoid in severe hepatic disease
- NOT uroselective
Alfuzosin (Uroxatral) pearls
- 100% uroselective
- after the same meal QD
- Avoid in severe renal disease
- C/I in severe hepatic disease
- food slows absorption
Tamsulosin (Flomax)
- 30 min after same meal QD; titrate 2-4 wks
- No renal or hepatic dosing
- food slows absorption
Silodosin (Rapaflo)
- once daily after meal
- renal dosing
- C/I in severe hepatic disease
- food slows absorption