Chapter 51: BPH Flashcards
testosterone is metabolized to __ by __
DHT
5-alpha reductase
Drugs that can worsen BPH
- Centrally-acting anticholinergics (e.g., benztropine)
- Drugs with anticholinergic effects: antihistamines, decongestants, phenothiazines, TCAs
- Caffeine
- Diuretics
- SNRIs
- Testosterone products
What tests are used to diagnose BPH
Digital rectal exam and PSA
Symptoms of BPH
- Hesitancy, intermittent urine flow, straining or a weak stream of urine
- Urinary urgency & leaking or dribbling
- Urinary frequency, especially nocturia
How is mild BPH treated
watchful waiting
Which natural products can be used for BPH
Saw palmetto
Lycopene (prostate cancer prevention)
Drug treatment for BPH consists of
alpha-blockers +/- 5-ARI
or tadalafil +/- finasteride
5-ARI MOA
decrease prostate size by blocking 5-alpha reductase enzyme which blocks conversion of testosterone to DHT
5-ARIs should NOT be used in:
men who have bladder outlet obstruction symptoms without prostate enlargement
What is the first-line treatment for mod-severe BPH
alpha blockers
Alpha-blocker MOA
Inhibit alpha-1 adrenergic receptors, causing relaxation of smooth muscle in the prostate bladder neck, reducing bladder outlet obstruction and improves urinary flow
Which alpha receptor is primarily found in the prostate
Alpha-1A
What are the non-selective alpha-1 blockers
terazosin and doxazosin
Have more side effects
Doxazosin brand name
Cardura
What time of day are non-selective alpha-blockers taken
at bedtime (to minimize initial first-dose effect of orthostasis/dizziness)
Tamsulosin brand name
Flomax
Alpha-blockers warnings
Orthostatic hypotension/syncope
Intraoperative floppy iris syndrome can occur in cataract surgery
Alpha-blockers SE
dizziness, fatigue, HA, abnormal ejaculation
Alpha-blockers may need __-__ weeks to assess whether beneficial effects have been achieved
4-6 weeks
T/F: Alpha-blockers do not shrink the prostate or change PSA levels
True
Cardura XL counseling point
OROS formulation - leaves a ghost tablet
Silodosin can cause
retrograde ejaculation
Tamsulosin dosing
0.4 mg daily
Finasteride brand name
Proscar
5-ARI CI
women of childbearing age, pregnancy
5-ARI SE
impotence, ↓ libido, ejaculation disturbances, breast enlargement and tenderness
How long do 5-ARI take for maximal efficacy
6 months
T/F: 5-ARI shrink the prostate and decrease PSA levels
True
