Men's Health - BPH Flashcards
static component of BPH
conversion of tts to dht via 5a reductase, causing enlargement of prostate tissue
dynamic component of BPH
increased agonism of a1 on SM tissue, leading to VC of arteries and narrowing of urethra outlet
long term consequence of untreated bph
- increased contraction of bladder muscle due to narrowed urethra
- hypertrophy of bladder muscle
- decompensation of muscle
- muscle becomes irritable and sensitive
- abnormal contraction causing frequent urination
prostate specific antigen levels
when >1.5 ng/ml, signs and symptoms of BPH start to occur
mild, moderate, severe classifx
mild <8
moderate 8-19
severe >19 (usually has complications eg UTI, bladder stones, haematuria)
medications worsening BPH
antichol (antihist, tricyclic antidep)
a1 adrenergic agonist (decongestants)
opioid analgesics (tramadol)
diuretics
testosterone
alpha adrenergic antagonist uses
reduces LUTS, effective for small prostate, does not reduce prostate size
alpha ad antagonist side effects
muscle weakness, fatigue, orthostatic hypoT
(nonselective) dizziness
(uroselective) ejaculatory disturbance
alpha ad non selective examples
doxazosin, terazosin
alpha ad selective examples
alfuzosin, tamsulosin, silodosin
alpha ad onset
days to weeks
alpha ad non selective additional benefits
bp lowering (avoid in pts with fainting)
5ari moa
inhibits 5a reductase, reduces conversion from tts to dht, reduces prostate size and LUTS
5ari uses
large prostate (>40g)
avoidance of surgery
cannot tolerate SE of a1
5ari what to measure before initiation
psa
5ari onset
6 to 12 months
5ari SE
ejaculatory disorders
decreased libido
ED
hypoT (less than a1)
PDE5i tadalafil uses
LUTS, does not affect prostate size
PDE5i SE
hypoT
antimuscarinic agents
oxybutynin, tolterodine, solifenacin
antimuscarinic moa
decrease involuntary contraction for pts with overactive bladder
combi: a1 + 5ari uses
dilate blood vessels (a1a) while reducing size (5ari)
for pts with enlarged prostate
combi: 5ari + pde5i uses
pde5i helps to counteract ED effects of 5ari
combi: a1a (uroselective) + pde5i (rare) issues
LT hypoT (two VD)
not for patients with large prostate
