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AC- CLPT lectures > Management of BPH and Prostatitis 3.1.2 > Flashcards

Management of BPH and Prostatitis 3.1.2 Flashcards

1
Q

What are the treatment aims for BPH?

A
  • Improving symptoms (by decreasing urinary outflow resistance)
  • Reducing long-term complications
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2
Q

What are some treatment considerations for BPH? What is the international prostate symptom score?

A
  • Is BPH uncomplicated and patient not bothered by symptoms –> watchful waiting an option
  • Aggravating factors such as constipation
  • Prostate size
  • Symptoms severity

> International prostate symptom score = monitor symptoms

  • Mild 0-7
  • Moderate 8-19
  • Severe 20-35
  • Quality of life due to urinary symptoms (1 is pleased, 6 is terrible)
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3
Q

Why surgery for BPH? When is it preferred? What are the options?

A
  • More effective than drug treatment
  • Preferred when symptoms severe, drugs ineffecive, urinary retention
  • Transsurethral resection of the prostate (TURP) - gold standard
  • Open prostatectomy
  • Urolift
  • Minimially invasive techniques

> thermotherapy - TUMT ( transurethral microwave therapy), TUNA (trans-urethral needle ablation), laser treatment

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4
Q

When is drug therapy considered for BPH?

A

Considered when

  • symptoms troublesome
  • patient’s preference
  • surgery contraindicated/not indicated
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5
Q

What are some factors influencing drug selection?

A

Prostate size = crucial

Symptom relief

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6
Q

How long does selective alpha blockers take to work (APST)? What do they do?

A
  • Symptom improvement in 48 hours (full effect in 4-6 weeks)
  • Effective regardless of prostate size
  • Improve urinary flow
  • Indication: symptom relief in BPH and lasts for long term/time
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7
Q

When is alfuzosin (more selective for prostate) CI? I?

A
  • CI in hepatic impairment
  • Metabolised by CYP3A4
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8
Q

When to reduce dose for silodosin?

A

CrCL 30-60 mL/min?

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9
Q

Has terazosin been discontinued?

A

Yas

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10
Q

AE for alpha-1 blockers (APST)?

A

First dose hypotension (prazosin more common), dizziness, headache, urinary urgency, abnormal ejaculation

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11
Q

Which are three alpha-1 blockers that has less BP effects and the better choice in BPH?

A

Alfuzosin, silodosin, tamsulosin = better choice in BPH

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12
Q

Which alpha blocker have to take bd?

A

Prazosin (shorter DOA)

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13
Q

Which alpha blocker has higest rate of ejucalatory abnormalities?

A

Silodosin

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14
Q

Which alpha blocker causes floppy iris syndrome during cataract surgery?

A

all of them but tamsulosin especially

> high selectivity therefore have catarac surgery before starting alpha blocker

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15
Q

What to monitor for alpha blockers?

A

efficacy, BP, symptoms of hypotension

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16
Q

When to stop treatment if no benefits for alpha blockers?

A

after 4-6 weeks, should work beforte this period

17
Q

When are 5-alpha reductase inhibitors used? What benefits does it have in BPH?

A

Reserved for large prostates

> prostate greater than 30-40cm3

  • can improve prostate size, rates of urinary retention, urinary flow, srugery
18
Q

How long does it take for symptom improvement and full effects for 5a-reductase inhibitors?

A
  • 6 month for symptom improvement
  • 12-18 months full effects
19
Q

Compare dutasteride and finasteride (5-alpha reductase inhibitors)

A

dutasteride = inhibit type 1 and type 2 of 5a isozymes = 90% reduction in DHT

finasteride = inibit type 1 = 70% reduction in DHT

20
Q

What are AE of 5-alpha reductase inhibitors

A

Decreased libido, impotence, ejaculatory disorders

> decreased testosterone levels

> less common = gynaecomastia and breast tenderness

21
Q

What is the half life of dutasteride and finasteride

A

dutasteride = 3-5 weeks

finasteride = 6 hours

22
Q

Why should pregnant women or those planning to get pregnant wear gloves when handing dutasteride and finasteride?

A

Casuses feminisation of male foetus

23
Q

Prostate specific antigen reduced by 50%, how long does it take for dutasteride and finasteride? What happens if drugs are stopped? What to do if PSA increases during treatment?

A

6 months of dutasteride

1 year for finasteride

  • PSA returns to baseline after 6 months treatment cessation
  • If PSA increases during treatment –> assess for prostate cancer
24
Q

Why use combination therapy of Alpha blocker and 5a RI? How long for the maximum effect of selective alpha blocker?

A

Prostate greater than 30-40cm3 = 5a reductase inhibitor

Fast relief of symptoms needed = alpha blocker

Selective alpha-blocker can be stopped after 6-12 months maximum effect reached at this time

25
Q

Any other options for BPH? Is any complementary medicines effective for BPH?

A
  • Watchful waiting
  • Tadalafil
  • Anticholienrgic in continiuing bladder overactivity
  • CAMs

Only CAMs that are likely safe and likely effective are

  • Beta sitosterol
  • Pygeum
26
Q

How is beta-sitosterol helpful for BPH?

A

Improves urinary symptoms, maximum urinary flow, post-void residual urine volume

> no effect on prostate size

27
Q

How is pygeum helpful for BPH?

A

Shown to decrease nocturia (19%)

Increase peak urine flow (23%)

Residual urine volume (24%)

28
Q

Is saw palmetto an option for BPH?

A

Likely safe but possibly ineffective

> widely used but data conflicting

29
Q

Non-pharmacological considerations for BPH?

A
  • Avoid cold temperatures (urge to urinate), wetness
  • Relax when urinating, avoid letting bladder get full
  • Pelvic floor exercises
  • Stress reduction
  • Restrict fluid intake at bedtime
  • Reduce coffee, alcohol and spicy foods
  • No smoking
  • Avoid anticholinergic medications (eg OTC antihistamines, can promote urinary retention)
30
Q

Treatment aims for BPH?

A
  • Symptom relief
  • Cure infection
  • Reduce complications
31
Q

What to use for mild to moderate infection (empirical) for acute BP

A

Oral trimethoprim or ciprofloxacin for 2-4 weeks (AMH)

Oral trimethoprim or cefalexin for 2 weeks (eTG)

32
Q

What to use for severe infection for BP (short term empirical)? What to ensure for BP ?

A
  • IV antibiotics, fluid replacement
  • Amoxicillin/ampicillin plus gentamicin (renal considerations)
  • Ceftriaxone or cefotaxime (when gentamicin C/I)

Ensure: hydration, stool softener (constipation worsens pain), rest, analgesia (NSAID), paracetamol

33
Q

What to use for chronic bacterial prostatitis?

> penetration of AB is less in chronic so use strong ones

A

Trimethoprim, norlfoxacin or ciprofloxacin for 4-6 weeks (AMH), 4 weeks (eTG)

doxycycline and option (if Ureaplsama or C.trachomatis)

34
Q

What to use for chronic non-bacterial prostatitis?

A
  • Frequent relapses, difficult to manage
  • No proven treatment

> AB (as per CBG) if suspected undiagnosed bacterial infection

> Analgesia and address constipation

> Selective alpha-blockers for symptom relief

> Querrectin 500mg bd or pollen extract (cernilton)

35
Q

What is quercetin? What is its role in chronic NBP?

A

Flavonol, belonging to the class of flavonoids

  • occurs in red wine, onions, green tea, apple, berries, cababge, broccoli, cauliflower, turnips
  • also found in gingko biloba, St John’s wort, american elder

In chronic NBP:

  • reduces pain and improves QOL
36
Q

What are some considerations for prostatitis?

A
  • Avoid nitrofurantoin –> poor penetration for ABP
  • Rarely sexually transmitted or systemic pathogens are involved in acute prostatitis
  • Very rarely sexually transmitted pathogen in chronic bacterial prostatitis
  • Chronic non-bacterial prostatitis: reduce stress, physiotherapy, relaxation
37
Q

What to avoid during quinolone treatment?

A

Avoid quercetin –> reduced efficacy

AC- CLPT lectures (27 decks)

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