Chapter 51: BPH COPY

Question 1

testosterone is metabolized to __ by __

Answer 1

dihydrotestosterone (DHT)
5-alpha reductase

Question 2

Drugs that can worsen BPH

Answer 2

• Centrally-acting anticholinergics (e.g., benztropine)
• Drugs with anticholinergic effects: antihistamines, decongestants, phenothiazines, TCAs
• Caffeine
• Diuretics
• SNRIs
• Testosterone products

Question 3

What tests are used to diagnose BPH

Answer 3

Digital rectal exam and PSA

Question 4

Symptoms of BPH

Answer 4

• Hesitancy, intermittent urine flow, straining or a weak stream of urine
• Urinary urgency & leaking or dribbling
• Urinary frequency, especially nocturia

Question 5

How is mild BPH treated

Answer 5

watchful waiting and yearly assessments

Question 6

Which natural products can be used for BPH

Answer 6

Saw palmetto

Lycopene (prostate cancer prevention)

Question 7

Drug treatment for BPH consists of

Answer 7

alpha-blockers +/- 5-alpha reductase inhibitors

or tadalafil +/- finasteride

Question 8

5-ARI MOA

Answer 8

decrease prostate size by blocking 5-alpha reductase enzyme which blocks conversion of testosterone to DHT

decreases prostate size

Question 9

5-ARIs should NOT be used in:

Answer 9

men who have bladder outlet obstruction symptoms without prostate enlargement

Question 10

What is the first-line treatment for mod-severe BPH

Answer 10

alpha blockers
1: terazosin, doxazosin
1A: tamsulosin, alfuzosin, silodosin

Question 11

Alpha-blocker MOA

Answer 11

Inhibit alpha-1 adrenergic receptors, causing relaxation of smooth muscle in the prostate bladder neck, reducing bladder outlet obstruction and improves urinary flow

Question 12

Which alpha receptor is primarily found in the prostate

Answer 12

Alpha-1A

Question 13

What are the non-selective alpha-1 blockers

Answer 13

terazosin and doxazosin

Have more side effects

Question 14

Doxazosin brand name

Answer 14

Cardura

Question 15

What time of day are non-selective alpha-blockers taken

Answer 15

at bedtime (to minimize initial first-dose effect of orthostasis/dizziness)

Question 16

Tamsulosin brand name

Answer 16

Flomax

Question 17

Alpha-blockers warnings

Answer 17

Orthostatic hypotension/syncope
Intraoperative floppy iris syndrome can occur in cataract surgery

Question 18

Alpha-blockers SE

Answer 18

dizziness, fatigue, HA, abnormal ejaculation

Question 19

Alpha-blockers may need __-__ weeks to assess whether beneficial effects have been achieved

Answer 19

4-6 weeks

Question 20

T/F: Alpha-blockers do not shrink the prostate or change PSA levels

Answer 20

True

Question 21

Cardura XL counseling point

Answer 21

OROS formulation - leaves a ghost tablet

Question 22

Silodosin can cause

Answer 22

retrograde ejaculation

reversible upon drug discontinuation

Question 23

Tamsulosin dosing

Answer 23

0.4 mg daily

Question 24

Finasteride brand name

Answer 24

Proscar

Propecia for alopecia

Question 25

5-ARI CI

Answer 25

women of childbearing age, pregnancy

5-ARI = finasteride, dutasteride

Question 26

5-ARI SE

Answer 26

impotence, ↓ libido, ejaculation disturbances, breast enlargement and tenderness

Question 27

How long do 5-ARI take for maximal efficacy

Answer 27

6 months

Question 28

T/F: 5-ARI shrink the prostate and decrease PSA levels

Answer 28

True