BPH2 Flashcards
what alpha-adrenergic agonist medications should be avoided in pt’s w/ BPH?
- pseudoephedrine
- ephedrine
- phenylephrine
what anticholinergic medications should be avoided in BPH?
- antihistamines
- phenothiazines
- tricyclic antidepressants
what are treatment options for mild BPH symptoms
- education and behavioral therapy (aka watchful waiting)
2. on going assessment
what are treatment options for moderate to severe BPH symptoms
- noninvasive therapy: watchful waiting and medications (if don’t want it fine)
- invasive therapy: surgery
where is the alpha-1a receptors located
prostate and bladder neck
where is the alpha-1b receptors located
vascular smooth muscle
where is the alpha-1d receptors located
prostate
what agents work faster: alpha blockers or 5-alpha-reductase inhibitors
alpha blockers
what is the MOA of alpha blockers
inhibit alpha1 receptors, wich relaxes smooth muscle and relieves LUTS
how long does it take for pt’s to have dynamic LUTS symptoms relieved with alpha blockers
2-4 weeks
which generation alpha blockers are the most specific
3rd generation; the later the gen the more specific
what alpha receptor subtypes are found on the prostate?
alpha 1a
alpha 1d
list 3 3rd gen alpha blockers
tamsulosin
siodosin
alfuzosin
list 3 2nd gen alpha blockers
doxazosin
terazosin
prazosin
list a 1st gen alpha blocker
phenoxybenzamine
what generation alpha blocker is prazosin?
what is it’s indication?
2nd gen alpha-1 blocker
hypertension (not indicated for BPH)
what second gen medication is not indicated for BPH
prazosin
what 2nd gen alpha blocker has the longest half life
doxazosin
2nd gen alpha blocker is not typically used for BPH?
prazosin
what drug is technically a 2nd gen alpha blocker, but clinically is 3rd gen, concentrating in prostate
alfuzosin
what receptors are effected by 1st gen alpha blockers
alpha1 and alpha2
what receptors are effected by 2nd gen alpha blockers
alpha1
what receptors are effected by 3rd gen alpha blockers
alpha1a
what 2nd gen alpha blocker has the fewest CB side effects
terazosin
what is the preferred 2nd gen alpha blocker? why?
terazosin
less CV effects
what generation drugs do not require titration?
3rd generation alpha blockers
prazosin has what ADE that makes it not preffered
orthostatic hypotension
order 2nd gen from most preferential to least preferential
terazosin > doxazosin > prazosin
what 3rd gen alpha blocker should be taken on an empty stomach?
Tamsulosin
what are some dose dependent ADE’s of Tamsulosin
tired, ejaculatory dysfunction, and flu like symptoms
what is floppy iris syndrome?
blocking alpha 1a receptors in the eye
what should be d/c’d before cataracts surgery?
why?
how long before surgery should it be d/c’d
Tamsulosin
floppy iris syndrome
1 week before surgery
silodosin is contraindicated with what?
strong 3A4 inhibitors
what drug may cause retrograde ejaculation?
silodosin (and tamsolosin too)
what drug has a very high affinity for alpha 1A receptors?
silodosin
list some adverse effects of alpha 1 blockers
syncope headache orthostatic hypotension fatigue abnormal ejaculation dizziness
how long for FULL therapeutic benefit for alpha-1 blockers?
what are they efficacious for?
2-3 months
efficacious for short term relief
what is usual reason to stop using alpha blockers and switch to something else
intolerable side effects
patients with what disorder should use with caution ?
erectile dysfunction
