BPH - Quiz 3 Flashcards
How is testosterone metabolized?
Broken down to DHT by 5-alpha reductase
What is BPH?
Overgrowth of the stromal and epithlial cells of the prostate gland
What are the drugs that worsen BPH?
- Centrally-acting anticholinergics
- Drugs with anticholinergic effects (antihistamine, decongestants, phenothiazines, TCAs)
- Caffeine
- Diuretics
- SNRIs
- Testosterone products
How is BPH diagnosed?
- Digital rectal exam for size of prostate
- Prostate specific antigens and urinanalysis
S/s of BPH?
- Hesitancy, intermittent urine flow, straining, weak stream
- Urgency, leaking, and dribbling
- Frequency, nocturia
- Incomplete emptying
- Bladder obstruction
Natural products for BPH?
- Saw palmetto
Natural products for prostate cancer prevention?
Lycopene
Drug classes for BPH?
- alpha-blocker
- 5-alpha reductase inhibitor
What drug class is used to decrease prostate size?
5-alpha reductase but delayed
When can anticholinergics be used for BPH?
PVR <250-300 mL
PDE5I that is indicated for BPH?
Tadalafil (Cialis)
What is the pathophys of intraoperative floppy iris syndrome (IFIS)
If a patient is using an alpha blocker while having catarat surgery, the iris becomes floppy and pupil is unable to dilate properly
* blockers use should be delayed until after surgery
What is the firstline tx for moderate-severe BPH sx?
alpha 1 blockers
MOA of alpha 1 blockers?
Inhibit alpha-1 adrenergic receptors causing relaxation of smooth muscle
* Reduces bladder obstruction and improves urine flow
What non selective alpha blockers have more ADRs?
Terazosin
Doxazosin
What are your selective alpha-A1 blockers?
Tamsulosn
Alfuzosin
Silodosin
When are non selective alpha blockers dosed?
Before bed to avoid orthostasis and dizziness from first dose
* TItrate slowly
Doxazosin
Cardura, Cardura XL
Terazosin
Hytrin
Tamsulosin
Flomax
ADR of alpha blockers?
- DZ
- Fatigue
- HA
- Abnormal ejaculation
- Hypotension, syncope
How long does it take for alpha blockers to reach beneficial effects?
Works quickly on LUTs, 4-6 wks for beneficial effects
* However, doesn’t shrink prostate and change PSA levels
Describe the formulation of Cardura XL
OROS tablet w/ ghost tablet
What drug can cause retrograde ejaculation that is reversable upon discontinuation?
Silodosin
What drug is cautioned when co-administering with alpha blockers?
PDE5I due to hypotesion
* Tadalafil should not be combined with alpha blockers if it was for the treatment of BPH
What alpha blcokers are CYP3A4 substrates?
- Tamsulosin
- Alfuzosin
- Silodosin
What alpha blocker causes QTc prolongation?
Alfuzosin
MOA of 5-alpha reductase inhibitors?
Blocks the conversion of testosteron to DHT
* Improves sx
* Reduce size of prostate and PSA levels
* Decrease risk for uinary retention
* Decrease need for surgery
What surgeries are used for BPH?
TURP (Transurethral resection of the prostate)
Prostatectomy
Finasteride
Proscar
Propecia (alopecia)
Dutsteride
Avodart
Alfuzosin
Uroxatral
Silodosin
Rapaflo
CI of 5-alpha reductase inhibitors?
Women of child bearing potential
Pregnancy
* Pregnant women shouldn’t take or handle med
ADR of 5-alpha reductase inhibitors?
- Impotence
- Decreased libido
- Ejaculation disturbances
- Breast enlargement and tenderness
How long does it take for 5-alpha reductase inhibitors to reach maximal effect?
6 months
Can a patient be on both Proscar and Propecia?
NO
What is the difference between Cialis and Adcirca
Cialis is for BPH and ED
Adcirca is for PAH
CI for tadalafil?
Co-administration with nitrates
ADRs of PDE5 inhibtors?
- Color discrimination
- Hearing loss
- Vision loss from NAION
- Hypotension
- Chest pain
- Priapsim
- HA, flushing, DZ, dyspepsia, back pain
Starting dose of tadalafil for BPH?
5 mg PO QD
Dosing of Tamsulosin for BPH?
0.4 mg PO QD
