Benign Prostatic Hyperplasia RxPrep

function of prostate gland

secrete fluid that becomes part of the seminal fluid carrying sperm

What enzyme metabolizes Testosterone to dihydrotestosterone?

5-alpha-reductase

BPH is due to

overgrowth of the stromal and epithelial cells of prostate

What caused lower urinary tract symptoms?

layer of tissue surrounding prostate stops it from expanding, causing it to press against urethra

Frequent urination

-Bladder wall gets thicker

-contracts with low amounts of urine

-bladder weakens and loses ability to empty

Drugs that worsen BPH (PAST ADD CT)

Centrally acting anticholinergics (benztropine)

-Antihistamines (diphenhydramine)

-TCAs

-Decongestants (Pseudoephedrine)

-Phenothiazines (Prochlorperazine)

-Caffeine

-Diuretics

-SNRIs

-Testosterone products

Tools for diagnosis of BPH

Digital Rectal Test - size of prostate/nodules

Prostate Specific Antigen

LUTS and BPH

Hesitancy

Intermittent urine flow

Straining

Weak stream of urine

Dribbling/Leaking

Urinary frequency (Nocturia)

Urinary urgency

acute renal failure

In BPH, due to severe blockage that causes urine to back up into kidneys

What guides treatment for BPH

severity of BPH symptoms

Treatment for mild BPH

treated with watchful waiting

Treamtent for moderate/severe BPH

Medication or transurethral resection off the prostate (TURP)

Natural products for BPH

Saw palmetto

Pygeum

Lycopene (used for prostate cancer prevention)

1st-line for moderate to severe BPH

Alpha-blockers

Alpha blockers MOA

-Inhibit alpha-1 adrenergic receptors

-relax smooth muscle of bladder neck/prostate

-reducing bladder obstruction and improving urinary flow

Where is alpha 1A primarily found

prostate

Non-selective alpha blockers

has more side effects

Intraoperative floppy iris syndrome

-alpha blockers bind to alpha receptors on iris dilator muscle in eye

-iris is floppy

For cataract surgery

delay alpha-blocker therapy until after surgery

Doxazosin

Cardura/Cardura XL

Non-selective alpha blocker

Terazosin

Hytrin

Non-selective alpha blocker

Dosing for non-selective alpha-blockers

Bedtime; titrate slowly

Tamsulosin

Flomax (0.4 mg)

Selective Alpha-1A blocker

tamsulosin + dutasteride

Jalyn

Alfluzosin

Uroxatral (not bolded in book)

Selective Alpha-1A blocker

Silodosin

Rapaflo (not bolded in book)

Selective Alpha-1A blocker

Warnings of alpha blockers

Orthostatic Hypotension/Syncope

• especially when use w/ PDE-5 inhibitor

IFIS in surgery

Side effects of alpha blockers

Dizziness

Fatigue

Headache

Abnormal ejaculation

Notes on Alpha blockers

4-6 weeks to assess efficacy

Alpha blockers DO NOT shrink prostate and don't reduce PSA

Cardura XL produces ghost tablet

Silodosin - retrograde ejaculation

Alfuzosin

cause QT prolongation

5-alpha reductase MOA

inhibit 5 alpha reductase blocking conversion of testosterone to DHT

Finasteride is selective for

5-alpha reductase (type 2) enzyme

Dulasteride

inhibits Type 1 and Type 2 5-alpha reductase

Alpha blockers has ______ onset?

5-alpha-reductase has ______ onset?

1. Fast onset

2. Slower onset

Finasteride

Proscar,

Propecia (alopecia)

Contraindications for 5-alpha reductase inhibitors

Women of child-bearing potential

Pregnancy

Side effects of 5-alpha reductase inhibitors

Impotence

Decreased libido

Ejaculation disturbances

Breast enlargement/tenderness

Notes on 5-alpha reductase

-Shrink prostate and decrease PSA

-Therapy for 6 months

Tadalafil FDA indications

BPH w/ or w/o erectile dysfunction

Tadalafil

Cialis

Adcirca (for pulmonary arterial hypertension)

Contraindications of PDE-5 inhibitor

use of nitrates

Warnings of PDE-5 inhibitors

Impaired color discrimination

Hearing loss

Vision loss

Hypotension

Seek help for chest pain

Priapism >4 hrs

side effects of PDE-5 inhibitors

Headache

Flushing

Dizziness

Dyspepsia

Back pain