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BPH > Medical treatment > Flashcards

Medical treatment Flashcards

1
Q

PDE5i
3 CI
6 medical conditions

A

Nitrates
Nicorandil
α1-blockers doxazosin and terazosin
unstable angina pectoris
recent myocardial infarction (< three months) or stroke (< six months)
myocardial insufficiency (New York Heart Association stage > 2)
hypotension
poorly controlled blood pressure
significant hepatic or renal insufficiency
anterior ischaemic optic neuropathy with sudden loss of vision is known or was reported after previous use of PDE5Is

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2
Q

conservative watchful waiting treatment

A

Recommended for - Mild to moderate LUTS, low bother:
Education and reassurance
Reasonable fluid intake – avoidance/reduction in alcohol and caffeine intake
Earlier last drink of the day
Timed voiding (bladder re-training)
Double voiding, urethral milking
Distraction techniques
Monitor with flow rate and PMBS and FVC/IPSS
Address reversible factors for example, metabolic syndrome, co-morbidity, medication

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3
Q

% stable on watcful waiting

A

81% stable after f/u 17 months WW

Netto 1999

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4
Q

natural history of prostatism
Ball
1981

A 
40% stable
25% got better
30% got worse
2% AUR
10% progress to surgical intervention
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5
Q

efficacy of alpha blockers

A

reduce IPSS by 4 points in 30%
Djavan increase IPSS in 30-40%
increase flow rate 16-25%

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6
Q

tamulosin type

A

Alpha 1a selective
less hypotension than alfuzosin
retrograde ejaculation greater with tamsulosin

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6
Q

tamulosin type

A

Alpha 1a selective
less hypotension than alfuzosin
retrograde ejaculation greater with tamsulosin

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7
Q

retrograde ejaculation incidence tamsulosin

A

8.4%

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8
Q

side effects tamsulosin

A 
asthenia
dizziness
postural hypotension
retograde ejaculation
rhinitis
floppy iris syndrome
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9
Q

% stop takin tam due to lack efficacy

A

30% stop taking due to lack of efficacy or side effects

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10
Q

5ARi reduction in symptom score

A

by 15% but not better placebo if prostate less than 40cc

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11
Q

side effect 5ARI (4)

A

decreased libido
impotence
breast enlargement
rash

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12
Q

ALFAUR

A 
10mg od
age >50
no previous AUR
RV 500-1500mls
360 patients
ALF vs PLACEBO
2 x higher change successful TWOC with alfuzosin
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13
Q

theoretical risk retention anti cholinergics if pvr and qmax

A

pvr more than 200mls

qmax less than 5

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14
Q

nocturia desmopressin dosing licence

A 
50mcg in men
25mcg in women
once daily
before sleeping
avoid fluid one hour before and 8 hours after

in over 65s can consider start low dose 10mcg and then increase to 50mcg

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15
Q

action of desmopressin

A

AVP synthetic analogue for V2 receptor

avoids V1 receptor -hypertension

16
Q

side effects desmopressin 4

A

3 % hyponatraemia
1% hypertension
10% headache
3% nausea

17
Q

EAU recommendation for desmopressin

A 
check sodium at baseline
day 3
day 7 
one month
stop if below range <135
inclusion some trials sodium above 130
18
Q

NICE desmopressin guidance

A

• The 50 μg dose of desmopressin (oral lyophilisate) is licenced for men with nocturia due to idiopathic nocturnal polyuria in all adults, including the over 65’s.

  • Serum sodium monitoring is recommended only in the over 65’s before initiating treatment, in the first week (4-8 days after initiation) and again at one month.
  • Treatment should be discontinued if the serum sodium falls below the lower range (<135)
  • Clinically significant (moderate to severe) hyponatraemia occurred in 2% of patients receiving low dose desmopressin in the phase III clinical trials
19
Q

forms of 5AR

A

two isoforms of the 5alpha reductase enzyme
type 1 minor expression in prostate mainly in skin and liver
type 2 in prostate
5ARI competative inhibition of enzme

20
Q

NNT of finasteride to prevent AUR

A

25

21
Q 
after 2 -4 years of 5ARi treatment
improvement
IPSS
decrease prostate volume
increase flow rate
A

15-30%
volume <28%
qmax less than 2

22
Q

finasteride vs placebo for prostate less than 40mls

A

same as placebo

23
Q

how does finasteride reduce bleeding 3

A

micro vessel density
decrease VEGF expression
decrease prostatic blood flow

BPH (6 decks)

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