Urology- BPH

Question 1

Patho of BPH: what’s static?

Answer 1

Proliferation of stromal and epithelial cells (due to hormonal and aging process)

Question 2

Proliferation of what increases prostate size?

Answer 2

Smooth muscle cells

Question 3

What is dynamic?

Answer 3

Smooth muscle tone

Question 4

What types of cells increase in BPH?

Answer 4

alpha-1-A receptors

Question 5

Drugs used to treat BPH (the drug classes)

Answer 5

Alpha-1 blockers
Alpha-1A-specific blockers
5-alpha-reductase inhibitors

Question 6

Alpha-1 blockers MoA

Answer 6

block alpha-1 in the prostate

Question 7

5-alpha-reductase inhibitors MoA

Answer 7

inhibits 5-alpha-1-reductase

Question 8

Finasteride MoA

Answer 8

inhibits Type II 5-alpha-1-reductase, decreases DHT

Question 9

Dutaseride MoA

Answer 9

inhibits Type I and Type II 5-alpha-reductase; more potent

Question 10

Alpha-blocker drugs

Answer 10

terazosin, doxazosin, prazosin (terazosin is the most effective)

Question 11

Alpha-1A-specific blockers

Answer 11

silodosin > alfuzosin ~ tamsulosin

Question 12

5-alpha-reductase inhibitor drugs

Answer 12

finasteride, dutasteride

Question 13

Trial of 5-alpha-reductase inhibitor drugs

Answer 13

3-6 months

Question 14

Saw palmetto for BPH

Answer 14

Nope, not effective

Question 15

BPH treatment algorithm: 1st step

Answer 15

Alpha-blocker; can start with PDE5 if patient also has ED

Question 16

BPH treatment algorithm: 2nd step if initial treatment doesn’t work

Answer 16

Try PDE5, or add a 5-alpha-reductase inhibitor if the prostate is >30cc

Question 17

BPH treatment algorithm: 3rd step if previous ones didn’t work

Answer 17

Surgical options

Question 18

Alpha-blocker side effects

Answer 18

postural hypotension, dizziness/vertigo, blurred vision, drowsiness, asthenia, “first dose” effect → added effect with other HTN meds

Question 19

Alpha-1A specific blockers side effects

Answer 19

rarely hypotension, vertigo, drowsiness, floppy iris syndrome, ejaculatory dysfunction (delayed ejaculation, retrograde ejaculation, anejaculation/anorgasmia)

Question 20

5-alpha-reductase inhibitors side effects

Answer 20

impotence, libido, ejaculation volume, gynecomastia/mastalgia

Question 21

5-alpha-reductase inhibitors CI

Answer 21

Pregnancy/people trying to get pregnant

Question 22

Nonpharm options for BPH

Answer 22

Incontinence pads, TURP, urethral dilation, foley catheters, other (TUIP, TUDP, VLAP, microwave hyperthermia, enzyme injection

Question 23

Medications affecting BPH

Answer 23

TCAs, diphenhydramine, disopyramide, pseudoephedrine, ephedrine, anticholinergics (including OTCs)

Question 24

Alpha-1A specific blockers DDIs

Answer 24

Tamsulosin (warfarin (?), inhibits theophylline metabolism, induces cimetidine); alfuzosin is a 3A4 substrate