Urology- BPH Flashcards
Patho of BPH: what’s static?
Proliferation of stromal and epithelial cells (due to hormonal and aging process)
Proliferation of what increases prostate size?
Smooth muscle cells
What is dynamic?
Smooth muscle tone
What types of cells increase in BPH?
alpha-1-A receptors
Drugs used to treat BPH (the drug classes)
Alpha-1 blockers
Alpha-1A-specific blockers
5-alpha-reductase inhibitors
Alpha-1 blockers MoA
block alpha-1 in the prostate
5-alpha-reductase inhibitors MoA
inhibits 5-alpha-1-reductase
Finasteride MoA
inhibits Type II 5-alpha-1-reductase, decreases DHT
Dutaseride MoA
inhibits Type I and Type II 5-alpha-reductase; more potent
Alpha-blocker drugs
terazosin, doxazosin, prazosin (terazosin is the most effective)
Alpha-1A-specific blockers
silodosin > alfuzosin ~ tamsulosin
5-alpha-reductase inhibitor drugs
finasteride, dutasteride
Trial of 5-alpha-reductase inhibitor drugs
3-6 months
Saw palmetto for BPH
Nope, not effective
BPH treatment algorithm: 1st step
Alpha-blocker; can start with PDE5 if patient also has ED
BPH treatment algorithm: 2nd step if initial treatment doesn’t work
Try PDE5, or add a 5-alpha-reductase inhibitor if the prostate is >30cc
BPH treatment algorithm: 3rd step if previous ones didn’t work
Surgical options
Alpha-blocker side effects
postural hypotension, dizziness/vertigo, blurred vision, drowsiness, asthenia, “first dose” effect → added effect with other HTN meds
Alpha-1A specific blockers side effects
rarely hypotension, vertigo, drowsiness, floppy iris syndrome, ejaculatory dysfunction (delayed ejaculation, retrograde ejaculation, anejaculation/anorgasmia)
5-alpha-reductase inhibitors side effects
impotence, libido, ejaculation volume, gynecomastia/mastalgia
5-alpha-reductase inhibitors CI
Pregnancy/people trying to get pregnant
Nonpharm options for BPH
Incontinence pads, TURP, urethral dilation, foley catheters, other (TUIP, TUDP, VLAP, microwave hyperthermia, enzyme injection
Medications affecting BPH
TCAs, diphenhydramine, disopyramide, pseudoephedrine, ephedrine, anticholinergics (including OTCs)
Alpha-1A specific blockers DDIs
Tamsulosin (warfarin (?), inhibits theophylline metabolism, induces cimetidine); alfuzosin is a 3A4 substrate