Lect 10 Flashcards
anatomy of prostate gland
chestnut-sized gland located below the urinary bladder; surrounds the proximal urethra
3 types of tissue in the prostate gland
- epithelial tissue= prod prostate secretions
- stromal tissue= smooth muscle contraction if alpha-adrenergic receptor stim
- capsule= fibrous connective tissue that also contracts when alpha-adrenergic receptor stim
static factors
growing prostate around the urethra
dynamic factors
alpha-adrenergic receptor stimulation in the urethra and bladder neck
detrusor factors
irritability of the detrusor secondary to long-standing BOO
sx of BPH
- obstructive= diminished stream, urinary hesitancy, incomplete bladder emptying
- irritative= urinary frequency and urgency, nocturia
mild BPH
asymptomatic
peak urinary flow rate less than 10
postvoid residual volume 25-50 mL
mod BPH
mild + obstructive or irritative sx
severe BPH
mod + complication of BPH
treatment for mild
watchful waiting
behavior modification
treatment for mod-severe
pharmacologic treatment
surgery for severe sx and complications
alpha-adrenergic antagonists
do not reduce prostate size
relax intrinsic urethral sphincter and prostatic smooth muscle
ex of alpha-adrenergic antagonists
-zosin= 2nd gen
3rd gen= tamsulosin (Flomax) and silodosin
ex of alpha-adrenergic antagonists
-zosin= 2nd gen
3rd gen= tamsulosin (Flomax) and silodosin
ADR’s for 2nd gen alpha-adrenergic antagonists
1st dose orthostatic hypotension, dizziness
start slow and titrate up over several weeks
terazosin or doxazosin IR 1mg PO at bedtime
when do you use 3rd gen alpha-adrenergic antagonists?
pts at risk of hypotension or who cannot tolerate hypotension, liver failure
AVOID IN SULFA ALLERGY
tamsulosin 0.4 mg PO daily
5-alpha-reductase inhibitors
reduce prostate size
decreases DHT
considered 2nd line in sexually active males
something special with 5-alpha-reductase inhibitors
may take an extended period of time to take effect! (6-12 months)
ADR’s of 5-alpha-reductase inhibitors
sexual dysfunction, decreased libido, gynecomastia
PREGNANCY CAT X= counsel both males and females!!
ex of 5-alpha-reductase inhibitors
dutasteride (Avodart) 0.5 mg PO daily
finasteride (Proscar) 5 mg PO daily
what are not commonly used for BPH?
GNrH antagonists
antiandrogens
1st line treatment for general pts
alpha-adrenergic antagonists
(most pts with eventually need both this and 5a-reductase inhibitor to relieve sx, delay progression, and reduce need for surgical intervention)
1st line treatment for pts with significantly enlarged prostate
5alpha-reductase inhibitors
