Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pamela - Naplex 2023 > Chapter 51 - Benign Prostatic Hyperplasia (BPH) > Flashcards

Chapter 51 - Benign Prostatic Hyperplasia (BPH) Flashcards

1
Q

The main function of the prostate is to

A

secrete fluid that becomes part of the seminal fluid carrying sperm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  • What hormone is the prostate dependent on?
  • How is this hormone metabolized?
A
  • Androgens (mainly testosterone) for development, maintenance of size and function.
  • Testosterone is metabolized to dihydrotestosterone (DHT) by 5 alpha-reductase.
  • DHT is responsible for normal and hyperplastic growth (increase in the number of cells).
  • Benign prostatic hyperplasia (BPH) results from overgrowth of the stromal and epithelial cells of the prostate gland.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

diagnosis:

A
  • Medical history (surgeries, trauma and current medications, including herbal and OTC drugs)
  • A physical exam:
    – Digital rectal exam (DRE) to determine the size of the prostate and identify any lumps or nodules.
    – A urinalysis
    – Serum prostate-specific antigen (PSA) are used to rule out conditions other than BPH.

note: PSA, a protein produced by prostate cells, is frequently increased in prostate cancer. It can increase when the prostate becomes larger due to BPH, though BPH is a benign (non-cancerous) condition and does not increase prostate cancer risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Drugs that can worsen BPH

A
  • Centrally-acting anticholinergics (e.g., benztropine)

Drugs with anticholinergic effects:
- Antihistamines (diphenhydramine)
- Decongestants (pseudoephedrine - causes urinary contraction)
- Phenothiazines (prochlorperazine - causes urinary contraction)
- TCAs (amitriptyline)

  • Caffeine
  • Diuretics (Make you pee more)
  • SNRls
  • Testosterone products
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
A

The signs and symptoms of BPH are mainly LUTS, which include:

■ Hesitancy, intermittent urine flow, straining or a weak stream of urine.

■ Urinary urgency and leaking or dribbling.

■ Incomplete emptying of the bladder (bladder feels full).

■ Urinary frequency, especially nocturia (urination at night).

■ Bladder outlet obstruction.

  • If the blockage is severe, the urine could back up into the kidneys and result in acute renal failure.
  • Urinary tract infections: uncommon.
  • Symptoms can be similar to prostate cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Treatment Principles:

A
  • Questionnaires: Used to quantify sx
  • Mild disease is generally treated with watchful waiting and yearly reassessments.
  • Moderate/severe disease is generally treated with medications or a minimally invasive procedure or surgery, such as transurethral resection of the prostate (TURP).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

NATURAL PRODUCTS

A

The American Urological Association (AUA) guidelines do not recommend natural products for the treatment of BPH symptoms

  • Lycopene is used for prostate cancer prevention, but there is no good evidence for use in BPH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

DRUG TREATMENT

A
  • Alpha-blockers (works quickly but doesnt shrink prostate) (selective and non- selective), used alone or in combination with
  • 5 alpha- reductase inhibitor (Dec prostate size but have delayed onset)
  • Peripherally-acting anticholinergic drugs used for overactive bladder (such as tolterodine) are sometimes a reasonable option for men without an elevated post void residual (PVR) urine and when LUTSare predominately irritative.
  • If anticholinergics are used, the PVRshould be< 250 - 300 mL
  • Phosphodiesterase-5 (PDE-5) inhibitor tadalafil, with or without finasteride. This can be used in men with BPH alone, and can be an attractive option for men with both BPHand erectile dysfunction (ED).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ALPHA-BLOCKERS

A
  • Alpha-1 blockers are first-line treatment for moderate-to- severe sx
    – They inhibit alpha-1 adrenergic receptors, causing relaxation of smooth muscle in the prostate & bladder neck
    – This reduces bladder outlet obstruction and improves urinary flow.
  • There are three types of alpha-I receptors.
    – Alpha-IA receptors: prostate
    – Alpha-lB and alpha-ID receptors: heart & arteries
    – The non-selective alpha-I blockers (terazosin, doxazosin) have more side effects (orthostasis, dizziness, headache) than the selective alpha-IA blockers (tamsulosin, alfuzosin, silodosin).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

lntraoperative Floppy Iris Syndrome

A
  • Alpha-blockers relax the smooth muscle of the prostate and bladder neck.
  • The same receptors are present on the iris dilator muscle in the eye.
  • Patients using alpha-blockers are at risk of developing intraoperative floppy iris syndrome (IFIS) during cataract surgery.
  • With alpha-I blockade, the iris becomes floppy, has a risk of prolapse and the pupils do not dilate well, complicating the procedure.
  • If cataract surgery is planned, alpha-blocker treatment should be delayed until the surgery has been completed.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Non-Selective Alpha-1 Blockers

A
  • Doxazosin (Cardura, CarduraXL)
  • Terazosin

– bedtime; titrate slowly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Selective Alpha-1A Blockers

A
  • Tamsulosin (Flomax): 0.4 mg daily
  • Alfuzosin
  • Silodosin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CI of alpha 1A blockers

A
  • Silodosin or alfuzosin with strong CYP3A4 inhibitors
  • Hepatic impairment (Child-Pugh class C for silodosin, class B/C for alfuzosin)
  • Severe renal impairment (silodosin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Warnings of alpha 1 blockers

A
  • Orthostatic hypotension/syncope, typically with the first dose, if therapy is interrupted for several days, if the dosage is increased too rapidly, or if another antihypertensive drug or PDE-5 inhibitor is started
  • lntraoperative floppy iris syndrome (IFIS) can occur in cataract surgery if currently on or previously treated with an alpha-1 blocker
  • Priapism, seek medical attention if an erection lasts > 4 hours
  • Angina, discontinue if symptoms of angina begin or worsen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

SE of alpha 1 blockers

A

Dizziness,fatigue, headache,abnormal ejaculation (especiallywith tamsulosin and silodosin), fluid retention, rhinitis (tamsulosin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MONITORING

A

BP, PSA, urinary symptoms

17
Q
  • When are non selective alpha 1 drugs given? Why? What should we counsel the patient on?
  • How long does it take for them to work? How long it takes for us to assess if the ttmt is beneficial?
  • What drug can leave a ghost tablet?
  • What drug can cause retrograde ejaculation?
  • What should you not use if the pt is at risk of QT prolongation?
A
  • non-selective drugs: bedtime to help minimize the initial “first-dose” effect of orthostasis/dizziness.

– This requires careful counseling, as nocturia is common, and getting up at night to use the bathroom can be dangerous if dizziness and orthostasis occur.

  • Alpha-blockers work right away, but 4-6 weeks may be required to assess whether beneficial effects have been achieved; they do not shrink the
    prostate and do not change PSA levels.
  • Cardura XL is an OROS formulation and can leave a ghost tablet (empty shell) in the stool.
  • Silodosin can cause retrograde ejaculation in -30% of patients. It is reversible upon drug discontinuation.
  • Do not use alfuzosin if at risk for QT prolongation.
  • Alpha-blockers can be used for bladder outlet obstruction in women (off-label).
18
Q

DDI with alpha 1 blockers

A

■ Use caution when co-administered with PDE-5 inhibitors used for erectile dysfunction (sildenafil, tadalafil, vardenafil, avanafil) due to additive hypotensive effects.
If tadalafil (Cialis) is being used to treat BPH, do not use in combination with alpha-I blockers.

■ Use caution with other drugs that lower BP.

■ Tamsulosin, alfuzosin and silodosin are major CYP450 3A4 substrates; do not use with strong CYP3A4 inhibitors.

■ Silodosin cannot be used with strong P-gp inhibitors, such as cyclosporine.

■ Alfuzosin can cause QT prolongation; do not use with other QT-prolonging drugs. Use with caution in patients with cardiovascular disease.

19
Q

5 ALPHA-REDUCTASE INHIBITORS moa

A
  • These medications inhibit the 5 alpha-reductase enzyme, which blocks the conversion of testosterone to dihydrotestosterone (DHT).
  • Finasteride is selective for the 5 alpha-reductase type II enzyme (the more prevalent type within the prostate), while dutasteride inhibits both type I and type II.
  • This class of medications is indicated for the treatment of symptomatic BPH in men with an enlarged prostate.
  • They are used in combination with alpha-blockers to improve symptoms, decrease the risk of acute urinary retention and decrease the need for surgery (TURP, prostatectomy).
20
Q

Finasteride brand

A

Proscar

21
Q

List the 5 ALPHA-REDUCTASE INHIBITORS drugs

A
  • Finasteride(Proscar} Inhibits 5 alpha-reductase enzyme, type 2
  • Propecia- for alopecia (hair
    loss) at lower doses (1 mg daily)
  • Dutasteride
22
Q

CI of 5 alpha red inh

A

Women of child-bearing potential, pregnancy, children

23
Q

SE of 5 alpha red inh

A

Impotence, dec libido, ejaculation disturbances, breast enlargement and tenderness, rash

24
Q

monitoring of 5 alph

A

PSA, urinary symptoms

25
Q

notes with 5 alpha red inh
- Pregnancy?
- Duration for maximal effect
- Effect on prostate size & PSA levels?
- Which one should you swallow as whole and why?

A
  • Pregnant women should not take or handle these medications as they can be absorbed through the skin and can be detrimental to the fetus.
  • They are on the NIOSH list of hazardous drugs.
  • Delayed onset, treatment for 6 months (or longer) may be required for maximal efficacy.
  • 5 alpha-reductase inhibitors shrink the prostate and dec PSA levels.
  • Swallow dutasteride whole. Do not chew or open as contents can cause oropharyngeal irritation.
26
Q

5 Alpha-Reductase Inhibitor Drug Interactions

A

■ Finasteride and dutasteride are minor CYP3A4 substrates; strong CYP3A4 inhibitors can i levels.

■ Do not use Proscar if using Propecia for hair loss.

27
Q

PHOSPHODIESTERASE-5 INHIBITORS moa, indications

A
  • MOA: They likely decrease smooth muscle and endothelial cell proliferation, decrease nerve activity, increase smooth muscle relaxation and tissue perfusion of the prostate and bladder.
  • Tadalafil is the only PDE-5 inhibitor that is FDA-approved for the treatment of BPH with or without erectile dysfunction.
  • It has been studied alone and in combination with finasteride.
  • Due to the risks for hypotension, tadalafil should not be used in combination with an alpha-blocker for the treatment of BPH.
28
Q

Tadalafil brand

A

Cialis
- also used for ED

29
Q

What is Adcirca, Alyq (tadalafil) used for?

A

For pulmonary arterial hypertension (PAH)

30
Q

CI of PDE5I

A

Do not use with nitrates or riociguat (a guanylate cyclase stimulator)

31
Q

Warnings of PDE5I

A
  • Impaired color discrimination (dose-related), higher risk with retinitis pigmentosa
  • Hearing loss, with or without
    tinnitus/dizziness
  • Vision loss, rare, can be due to nonarteritic anterior ischemic optic neuropathy (NAION)
  • Hypotension, due to vasodilation; higher risk with resting BP < 90/50 mmHg, fluid depletion or autonomic dysfunction
  • CVD, caution with low or very high BP or recent CV events; seek immediate medical help for chest pain
  • Priapism, seek emergency medical care if an erection lasts > 4 hrs
32
Q

monitoring of pde5i

A

BP,PSA,urinary symptoms

33
Q

ALPHA-BLOCKERS counseling

A

■ Can cause orthostasis.

■ Tell your healthcare provider about the use of this medication if having cataract surgery.

34
Q

Doxazosin and Terazosin (Non-Selective) counseling

A

■ Take at bedtime.
■ Ghost tablet in stool (Cardura XL - doxazocin).

35
Q

Silodosin counseling

A

■ Can cause sexual dysfunction (retrograde ejaculation).

36
Q

5 ALPHA-REDUCTASE INHIBITORS counseling

A

■ Can cause sexual dysfunction (decreased libido, ejaculation
disturbances and erectile dysfunction}.

■ Avoid in pregnancy (teratogenic). Women who are or may become pregnant should not handle the tablets.

Pamela - Naplex 2023 (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions