BPH
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Last updated 7:58 PM on 1/23/23
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20 Terms
1
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pathophysiology of BPH
growth spurt of prostate can occur due to conversion of testosterone and androstenedione to DHT by type II 5 alpha reductase
2
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meds that can worsen symptoms of BPH (7)
* anticholinergics
* antihistamines
* caffeine
* decongestants
* diuretics
* SNRI’s and TCA’s
* testosterone products
* antihistamines
* caffeine
* decongestants
* diuretics
* SNRI’s and TCA’s
* testosterone products
3
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how to diagnose BPH
* lower urinary tract symptoms
* physical exam
* physical exam
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examples of LUTS
* static factors
* dynamic factors
* dynamic factors
5
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lab values for diagnosis of BPH
* PSA > 1.4 mcg/L = enlarged prostate
* serum creatinine
* BUN
* urinalysis
* serum creatinine
* BUN
* urinalysis
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examples of 2nd generation alpha-antagonists
* prazosin
* terazosin
* doxazosin
* terazosin
* doxazosin
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what do 2nd gen alpha-antagonists have risk of
* hypotension
* dizziness
* syncope
* titrate doses up
* dizziness
* syncope
* titrate doses up
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when to take 2nd gen alpha-antagonists
before bed to decrease hypotension risk
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examples of 3rd generation alpha-antagonists
* alfuzosin
* tamsulosin
* silodosin
* tamsulosin
* silodosin
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special notes for alfuzosin
* do not crush
* take after meals
* take after meals
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special notes for tamsulosin
* do not crush
* take after meals
* **preferred in patients with renal/liver dysfunction**
* take after meals
* **preferred in patients with renal/liver dysfunction**
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special notes for silodosin
decrease dose daily when CrCl 30-50
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roles of alpha antagonists in treatment
* reduce urinary symptoms within 2-6 weeks
* increase urinary flow rate
* reduce post void urine volume
* does NOT reduce prostate size or halt disease progression
* increase urinary flow rate
* reduce post void urine volume
* does NOT reduce prostate size or halt disease progression
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common ADRs of alpha antagonists
* **neurologic:** dizzy, HA, asthenia, insomnia
* **cardiac:** hypotension (2nd gen)
* **ocular:** floppy iris syndrome. don’t use before cataract surgery
* **respiratory:** rhinitis
* **GI:** abnormal ejaculation
* **cardiac:** hypotension (2nd gen)
* **ocular:** floppy iris syndrome. don’t use before cataract surgery
* **respiratory:** rhinitis
* **GI:** abnormal ejaculation
15
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examples of 5 alpha reductase (-)
* finasteride
* dutasteride
* dutasteride
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ADRs of 5 alpha reductase (-) (4)
* ED
* decreased libido
* gynechomastia
* ejaculatory dysfunction
* decreased libido
* gynechomastia
* ejaculatory dysfunction
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monitoring for 5 alpha reductase (-)
PSA
* should see a 50% decrease at 6-12 months
* should see a 50% decrease at 6-12 months
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caution for 5 alpha reductase (-)
pregnant women should wear gloves when handling drugs and should not come in contact with semen from men on these agents
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non-pharm therapy for BPH
* lifestyle modifications
* TURPS
* TUIPS
* prostectomy
* TURPS
* TUIPS
* prostectomy
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lifestyle modifications for BPH
* avoid alpha agonists and anticholinergics
* limit hydration before bed
* limit hydration before bed