BPHFC Flashcards
Benign Prostatic Hyperplasia (BPH) pathophys
Prostate is dependant on androgens (testosterone) for development and maintenance of size
As the Prostate enlarges, the gland presses agaisnt the urethra like a clamp
the bladder will become thicker and irritated
the bladder will begin to contract even when it contains small amounts of urine
BPH: Signs & Symptoms
Hesitant, interrupted, weak stream of urine
Urgency and leaking or dribbling
Incomplete emptying of the bladder
More frequent urination (especially at night)
Rare: acute renal failure or UTI
Drugs that Worsen BPH Symptoms
Combination cold medicines, decongestants, antihistamines, and medications with anticholinergic
testosterone
Diuretics
Caffeine
Treatment of BPH
International Prostate Symptom Score (IPSS) is used to determine how bothered a patient’s symptoms are and guides therapy
Alpha blockers
5 alphareductase inhibitors
Tadalafil
Natural products
Natural Products for BPH
Saw palmetto
Pygeum
Beta sitosterol
Rye grass pollen
Alpha Blockers
Inhibit alpha1 adrenergic receptors and relax the smooth muscle of the prostate and bladder neck to improve urinary flow
NonSelective Alpha blockers: two
terazosin (Hytrin), doxazosin (Cardura)
Selective alpha1A blockers: three
tamsulosin (Flomax), alfuzosin (Uroxatral), silodosin (Rapaflo)
when to take alpha blockers ?
Usually taken at bedtime (to minimize the initial “first dose effect” of orthostasis/dizziness)
se of alpha blockers
SE: orthostatic hypotension, dizziness, fatigue, floppy iris syndrome
when do alpha workers start working for bph?
Start to work right away, but maximal efficacy may take weeks to months
do the alpha blockers shrink the prostate ?
They do not shrink the Prostate or change PSA levels
Selective Alpha1A Blockers names
Tamsulosin (Flomax), Tamsulosin/dutasteride (Jalyn), alfuzosin (Uroxatral), sidodosin (Rapaflo)
ci of selective alpha 1a blockers
CI: concurrent use with strong 3A4 inhibitors and hepatic insufficiency (with alfuzosin and silodosin), severe renal impairment (silodosin)
se of alpha 1a blockers
SE: orthostatic hypotension, dizziness, fatigue, floppy iris syndrome
who should not use alfusozin?
do not use alfuzosin in patients at risk of QTprolongation
what is the problem with silodosin ?
Silodosin can cause retrograde ejaculation
which of the selective 1 a alpha blockers require renal dosing?
alfuzosin and Silodosin need renal dose adjustments
Alpha Blocker Drug Interaction
Caution with PDE5 inhibitors (hypotension)
Silodosin cannot be used with strong Pgp inhibitors (cyclosporin)
alfuzosin should not be used with drugs that can cause Qtprolongation
Alpha Blocker Counseling
Should see improvement in symptoms within 12
Watch for drop in BP
Notify doctor if experiencing any side effects
Avoid cold medicines and decongestants
take with food same time each day
alfuzosin: do not crush, chew, or break
5Alpha Reductase Inhibitors names and brands
Finasteride (Proscar), dutasteride (Avodart)
moa of 5 alpha reductase inhibitors
Inhibit the 5alpha reductase enzyme which blocks the conversion of testosterone to DHT
ci of 5 alpah reductase inhibitors
CI: pregnancy (X) and children
se of 5 alpah reductase inhibitor
SE: decreased libido, decreased ejaculation, impotence (all decrease over time 1year)
moa of 5 alpah reductase inhibitor ; do they shrink the prostate?
These agents shrink the Prostate and lower PSA levels
how long for effectivenss of 5 alpah reductase inhibitor
May need to use for more than 6 months for maximum efficacy
5Alpha Reductase Inhibitors Counseling
Women who are or may become pregnant should not handle (male semen using These drugs may also be harmful)
can reduce the amount of PSA in the blood
Notify doctor if experiencing any side effects
Avoid cold medicines and decongestants
PDE5 Inhibitors used in BPH
Tadalafil (Cialis)
moa of PDE 5 inhibitos in BPH
decrease smooth muscle and endothelial cell proliferation and increase in smooth muscle relaxation and tissue perfusion of the Prostate and bladder
CI of cialis
CI: use with nitrates
se of cialis
SE: dizziness, hypotension, headache, flushing, runny nose, stomach pain, priapism, vision or hearing abnormalities
dose adjustment of cialis
renal dose adjust with CrCl <50
