BPH3

Question 1

how long should you wait to use a PD-5 inhibitor after taking alpha inhibitors?
what is one exception that is okay

Answer 1

4 hours before or after

tamsolozin with tadalafil

Question 2

what is the MOA of 5-alpha-reducase inhibitors

Answer 2

inhibits 5-alpha reductase, decreasing conversion of testosterone to dihydrotestosterone

Question 3

which class of drugs may actually reduce size of prostate?

Answer 3

5-alpha reductase inhibitors (not alpha inhibitors)

Question 4

what substances concentration in the prostate does not decrease with age

Answer 4

dihydrotestosterone

Question 5

what is decreased by 5-alpha reductase inhibitors?

Answer 5

1. prostate size
2. PSA levels
3. static factors

Question 6

what are the 2 5-alpha reductase inhibitors

Answer 6

finasteride (proscar)

dutasteride (Avodart)

Question 7

both 5-alpha reductase inhibitors inhibit what specific type of receptors

Answer 7

type II 5-alpha reductase

Question 8

what 5-alpha reductase inhibitor has longest half life

Answer 8

finasteride

Question 9

what 5-alpha reductase inhibitor has the quickest onset?

Answer 9

dutasteride

Question 10

what 5-alpha reductase inhibitor is preferred

Answer 10

no preference both have equal treatment effects

Question 11

what 5-alpha reductase inhibitor inhibits both type 1 and 2 receptors

Answer 11

dutasteride

Question 12

list some adverse effects of 5-alpha reductase inhibitors

Answer 12

1. sexual dysfunction (reversible)
2. decreased libido (reversible)
3. gynecomastia
4. nausea
5. abdominal pain
6. dizziness

Question 13

who should not handle the 5-alpha reductase inhibitors?

Answer 13

females (category X for pregnancy)

can absorb thru the skin

Question 14

what can you not do when taking 5-alpha reductase inhibitors?

Answer 14

blood donation

Question 15

what is a positive and a negative characteristic of 5-alpha reductase inhibitors?

Answer 15

positive: reduce prostate cancer
negative: long time for symptom improvement

Question 16

list 3 benefits of alpha blockers over 5-alpha reductase inhibitors

Answer 16

alpha blockers:

1. improve symptoms better
2. faster onset
3. considered 1st line

Question 17

when should 5-alpha reductase inhibitors be used for BPH?

Answer 17

1. if pt. is intolerant to alpha blockers

2. if prostate is larger than 40 grams

Question 18

when is combination therapy preferred for BPH

Answer 18

severe symptoms:

1. prostate larger than 40 grams
2. PSA of at least 1.4
3. AUASI score greater than 20

Question 19

what drugs were used in combination therapy studies?

Answer 19

finasteride and doxazosin

Question 20

what drugs are combined in Jalyn?

Answer 20

dutasteride and tamsulosin

Question 21

what is the gold standard of BPH surgical intervention?

how is this done?

Answer 21

transurethral resection of the prostate (TURP)

endoscopic insertion to remove core of prostate often reduces pressure on urethra

Question 22

what are 3 minimally invasive procedures?

PROBLY NOT ON TEST

Answer 22

1. Transurethral needle ablation (TUNA)
2. Transurethral microwave thermotherapy (TUMT)
3. Interstitial laser thermoblation

Question 23

what is the main phytotherapeutic used for BPH?

why should it not be used

Answer 23

saw palmetto

not studied by FDA, could be ineffective, side effects, drug interactions

Question 24

what are 4 tx options of BPH

Answer 24

1. alpha blocker
2. 5-alpha reductase inhibitors
3. Combination therapy
4. surgery

Question 25

what are the staging classifications of BPH and treatment for each?

Answer 25

1. mild = watchful waiting

2. moderate to severe = medication

Question 26

what AUASI scores indicate what staging?

Answer 26

mild = 0-7
moderate = 8-19
severe = 20-35

Question 27

mild staged BPH is treated how?

Answer 27

watchful waiting is first line
education
behavioral therapy