Pharm Approach for LUTD Flashcards
BPH
Increase in number of peri-urethral epithelial and stromal cells (transition or central zone)
Imbalance between proliferation and apoptosis
Growth dependent on DHT
Symptoms of BPH
Hesitancy Intermittency Post-void dribbling Straining Nocturia Weak stream Incomplete emptying
Alpha blockers
Used to treat BPH
Alpha adrenergic receptors at the bladder neck and in the prostatic fossa (smooth muscle)
Smooth muscle contracts in the presence of NE, increasing urethra resistance
Onset 1-2 weeks
Ex: tamsulosin, silodosin, alfuzosin
Side effects of alpha blockers
Dizziness Weakness (asthenia) Flushing Rhinitis Headache Retrograde ejaculation Syncope
Where are types
1
2
5a-reductase enzymes found in the body?
- Skin, scalp
2. Prostate
What is the best combo of treatment for BPH?
Alpha blocker and 5a-reductase inhibitor
PDE5 inhibitors and BPH
NO has a role in the relaxation response
Results in smooth muscle relaxation and increased pelvic blood flow
Relaxes prostate, bladder neck, and urethra
Not standard treatment currently
Criteria for an overactive bladder
Urgency (sudden urge to void, difficult to defer)
Frequency (8+ voids per 24 h)
Nocturia (2+ voids a night)
Urge incontinence
Conservative managements of overactive bladder
Lifestyle modification (avoid caffeine, fluid reduction)
Bladder training
Biofeedback
2 types of pharmacologic treatment for overactive bladder
Oral (anti muscarinics, B3 adrenergic agonists)
Intravesical (botox)
Effect on bladder via
1. Cholinergic
2. B3
receptors
- Contraction
2. Relaxation
What type of muscarinic receptor is
- most common in bladder
- most important for bladder contraction
- M2
2. M3
Main anticholinergic side effects
Blurred vision* Dry mouth* Constipation* Urinary retention Altered mental status Tachycardia Skin rash/erythema
Contraindications to anticholinergics
Acute angle glaucoma Myasthenia gravis Tachyarrhythmia Gastric outlet obstruction Bowel obstruction
Main side effect of B3 agonists
Hypertension
