Urinary retention in benign prostatic hyperplasia ?

Question 1

What happens in benign prostatic hyperplasia ?

Answer 1

prostate enlarged: causes urinary retention, difficult to pass urine

Question 2

How does alpha-blockers work ?

Answer 2

The alpha1-selective adrenoceptor blockers relax smooth muscle in benign prostatic hyperplasia producing an increase in urinary flow-rate and an improvement in obstructive symptoms.

Question 3

Name alpha-blockers?

Answer 3

alfuzosin hydrochloride, 
doxazosin,
tamsulosin hydrochloride
terazosin,
indoramin

Question 4

In patients with an enlarged prostate, a raised prostate specific antigen concentration, and who are considered to be at high risk of progression (such as the elderly), what drug treatment is recommended ?

Answer 4

a 5α-reductase inhibitor (such as finasteride or dutasteride).

Question 5

What are the side effects of alpha-blockers?

Answer 5

• hypotension
• postural hypotension (dizziness, fainting, blurred vision, tachycardia, palpitations )
• intra-operative floppy iris syndrome (cataract surgery)

Question 6

When would alpha-blockers be contraindicated ?

Answer 6

postural hypotension, micturition syncope

Question 7

How should you counsel patient who is taking alpha-blockers?

Answer 7

take first dose at bedtime

driving may be impaired

Question 8

What are the common side effects of tamsulosin ?

Answer 8

Common or very common — dizziness and sexual dysfunction.

Question 9

What are the common side effects of Alfuzosin ?

Answer 9

Common or very common — asthenia, diarrhoea, dizziness, dry mouth, headache, malaise, nausea, postural hypotension, vertigo, and vomiting.

Question 10

What are the common side effects of Doxazosin ?

Answer 10

Common or very common — arrhythmias, asthenia, chest pain, cough, cystitis, dizziness, drowsiness, dry mouth, dyspnoea, gastrointestinal discomfort, headache, increased risk of infection, influenza like illness, muscle complaints, nausea, oedema, pain, palpitations, skin reactions, urinary disorders, and vertigo.

Question 11

In which patient group Doxazosin MR should not be prescribed ?

Answer 11

In people with gastrointestinal obstruction, oesophageal obstruction, or any degree of stricture — the outer membrane of the formulation is not digested

Question 12

How does finasteride and dutasteride work ?

Answer 12

5alpha-reductase inhibitors: A specific inhibitors of the enzyme 5α-reductase, which metabolises testosterone into the more potent androgen, dihydrotestosterone.

Question 13

How does finasteride work on prostate and help with hair loss in men ?

Answer 13

It works by stopping testosterone (a sex hormone) turning into another hormone called dihydrotestosterone (DHT). DHT can cause your prostate to grow bigger. It can also stop your hair growing. Finasteride stops DHT being produced and this helps shrink your prostate and reduce hair loss.

Question 14

What is recommendation regarding contraception and conception and handling of it by women of childbearing potential when patients are using finasteride or dutasteride ?

Answer 14

• both are excreted in semen and use of a condom is recommended if sexual partner is pregnant or likely to become pregnant
• avoid handling crushed or broken tablets of finasteride, and leaking capsules of dutasteride

Question 15

What is patient and carer advice regarding dutasteride/finasteride ?

Answer 15

cases of male breast cancer: promptly report to GP any changes in breast tissue such as lumps, pain or nipple discharge.

Question 16

When patients are taking dutasteride, what are the monitoring requirements ?

Answer 16

patients should be regularly evaluated for prostate cancer

Question 17

What is MHRA advice/warning regarding finasteride ?

Answer 17

rare reports of depression and in rare cases suicidal thoughts. Patient should be advised to stop finasteride immediately and inform healthcare professional if they develop depression.