Lect 10

Question 1

anatomy of prostate gland

Answer 1

chestnut-sized gland located below the urinary bladder; surrounds the proximal urethra

Question 2

3 types of tissue in the prostate gland

Answer 2

1. epithelial tissue= prod prostate secretions
2. stromal tissue= smooth muscle contraction if alpha-adrenergic receptor stim
3. capsule= fibrous connective tissue that also contracts when alpha-adrenergic receptor stim

Question 3

static factors

Answer 3

growing prostate around the urethra

Question 4

dynamic factors

Answer 4

alpha-adrenergic receptor stimulation in the urethra and bladder neck

Question 5

detrusor factors

Answer 5

irritability of the detrusor secondary to long-standing BOO

Question 6

sx of BPH

Answer 6

• obstructive= diminished stream, urinary hesitancy, incomplete bladder emptying
• irritative= urinary frequency and urgency, nocturia

Question 7

mild BPH

Answer 7

asymptomatic
peak urinary flow rate less than 10
postvoid residual volume 25-50 mL

Question 8

mod BPH

Answer 8

mild + obstructive or irritative sx

Question 9

severe BPH

Answer 9

mod + complication of BPH

Question 10

treatment for mild

Answer 10

watchful waiting

behavior modification

Question 11

treatment for mod-severe

Answer 11

pharmacologic treatment

surgery for severe sx and complications

Question 12

alpha-adrenergic antagonists

Answer 12

do not reduce prostate size

relax intrinsic urethral sphincter and prostatic smooth muscle

Question 13

ex of alpha-adrenergic antagonists

Answer 13

-zosin= 2nd gen

3rd gen= tamsulosin (Flomax) and silodosin

Question 14

ex of alpha-adrenergic antagonists

Answer 14

-zosin= 2nd gen

3rd gen= tamsulosin (Flomax) and silodosin

Question 15

ADR’s for 2nd gen alpha-adrenergic antagonists

Answer 15

1st dose orthostatic hypotension, dizziness
start slow and titrate up over several weeks
terazosin or doxazosin IR 1mg PO at bedtime

Question 16

when do you use 3rd gen alpha-adrenergic antagonists?

Answer 16

pts at risk of hypotension or who cannot tolerate hypotension, liver failure
AVOID IN SULFA ALLERGY
tamsulosin 0.4 mg PO daily

Question 17

5-alpha-reductase inhibitors

Answer 17

reduce prostate size
decreases DHT
considered 2nd line in sexually active males

Question 18

something special with 5-alpha-reductase inhibitors

Answer 18

may take an extended period of time to take effect! (6-12 months)

Question 19

ADR’s of 5-alpha-reductase inhibitors

Answer 19

sexual dysfunction, decreased libido, gynecomastia

PREGNANCY CAT X= counsel both males and females!!

Question 20

ex of 5-alpha-reductase inhibitors

Answer 20

dutasteride (Avodart) 0.5 mg PO daily

finasteride (Proscar) 5 mg PO daily

Question 21

what are not commonly used for BPH?

Answer 21

GNrH antagonists

antiandrogens

Question 22

1st line treatment for general pts

Answer 22

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)

Question 23

1st line treatment for pts with significantly enlarged prostate

Answer 23

5alpha-reductase inhibitors