Benign prostatic hypertrophy pharmacotherapy

Constriction

Men with BPH have an increase in static factors that lead to ______ of the bladder neck due to an increase in prostate size leading to urine outflow obstruction

Contraction

Men with BPH have an increase in dynamic factors that lead to ______ of the prostate around the urethra and obstruction urine outflow.

Obstructive

Urine retention is an _______ symptom of BPH

Obstructive

Decreased urine flow is an ______ symptom of BPH

Obstructive

Suprapubic pain is an ______ symptom of BPH

Obstructive

IPSS score is an evaluation on how severe the ______ symptoms are and how much they affect the patient's quality of life.

Irritative

Urinary urgency is an ______ symptom of BPH

Irritative

Urinary frequency is an ______ symptom of BPH

Irritative

Nocturia is an ______ symptom of BPH

4 years

Patients with BPH tend to see a progression of symptoms until after ______ where symptoms may stabilize.

Negative

A urinalysis of a patient without BPH may show a ______ result for bacteria or white blood cells in the urine

Positive

A urinalysis of a patient with BPH may show a ______ result for bacteria or white blood cells in the urine

15-20g, mobile

A patient without BPH will show on a digital rectal exam a prostate size of _________ and the prostate is _______

>20g, rigid

A patient with BPH will show on a digital rectal exam a prostate size of ____ and the prostate is _______

Negative

A patient without BPH will have a prostate needle biopsy that would be _____ for biopsy evidence of BPH

Positive

A patient with BPH will have a prostate needle biopsy that would be ______ for biopsy evidence of BPH.

Contraction

Anticholinergics are a class of medication that can cause BPH because it blocks the muscarinic receptors on the detrusor muscle and inhibits its ______

Contraction

First generation antihistamines, such as Diphenhydramine and Chlorpheniramine, can cause BPH because it blocks the muscarinic receptors on the detrusor muscle and inhibits its ________

Contraction

Tricyclic antidepressants, such as Amitriptyline or Nortriptyline, may cause BPH because it blocks the muscarinic receptors on the detrusor muscle and inhibits its _______

Contraction, constriction

Alpha 2 adrenergic agonists, such as pseudoephedrine or phenylephrine, may cause BPH because it stimulates alpha receptors on the prostate that cause prostate gland ______ and bladder neck _______

Prostate size

Androgens may cause BPH because it can increase ______

Urine output

Diuretics may worse BPH symptoms because it can increase _______

Urine output

Stimulants may worsen BPH symptoms because it can increase ________

3

The goals of BPH treatment include symptom improvement by a reduction of _____ or more on the IPSS score, improve quality of life, slow disease progression and prevent disease complications.

5a reductase inhibitors, alpha adrenergic antagonists

What are the first line therapies of treating BPH?

Alpha adrenergic antagonists

This class of medication treats both obstructive and irritative symptoms of BPH where it has a fast onset of action, treat symptoms regardless of prostate size, but does not reduce risk of complications.

Alpha adrenergic antagonists

This class of medication can be used to treat obstructive and irritative symptoms of BPH and reduce blood pressure.

5a reductase inhibitors

This class of medication can be used to treat obstructive and irritative symptoms of BPH where it can reduce the risk of complications. However, this medication takes 6 months for full effect

30g

5a reductase inhibitors have a greater symptom improvement in patients with a prostate size greater than ______

5a reductase inhibitors

This BPH therapy is the only class of medication that can reduce prostate size and the risk of developing complications.

Irritative

Anticholinergics, such as Tolterodine or Darifenacin, are used to treat _______ symptoms of BPH. However, this medication does not reduce risk of developing complications.

PVR

Anticholinergics, such as Tolterodine or Darifenacin, should be used with caution in elderly patients due to increased risk of falls and in patients that have a ________ greater than 250 mL.

Tadalafil

_________, which is a phosphodiesterase 5 inhibitor, can be used to treat irritative symptoms of BPH with concomitant erectile dysfunction.

Beta 3 agonists

Mirabegron and Vibegron are ________ that can alleviate irritative symptoms of BPH however it is not FDA approved for BPH. These medications cannot reduce the risk of developing complications.

Relaxation

Alpha adrenergic antagonists promote ______ of the bladder neck, prostatic urethra and prostate smooth muscle by inhibiting activation of the alpha 1 receptor.

Tamsulosin, Silodosin, Alfuzosin

Which alpha adrenergic antagonists are uroselective where they have less effects on blood pressure reduction?

Hypotension, ejaculation disorders, floppy iris syndrome

What are the adverse reactions of alpha adrenergic antagonists?

Therapeutic interruption, first dose syncope, orthostasis precautions

What are the counseling points that you should tell a patient about alpha adrenergic antagonists?

Decrease

To evaluate the effectiveness of alpha adrenergic antagonists, there should be a _______ by 3 or more on their IPSS score and ______ in blood pressure

Nonselective

Is Terazosin a nonselective or uroselective alpha antagonist?

Nonselective

Is Doxazosin a nonselective or uroselective alpha antagonist?

Uroselective

Is Tamsulosin a nonselective or uroselective alpha antagonist?

Uroselective

Is Silodosin a nonselective or uroselective alpha antagonist?

Uroselective

Is Alfuzosin a nonselective or uroselective alpha antagonist?

5a reductase inhibitors

This drug class decreases prostate size by inhibiting the conversion of testosterone to DHT

Sexual dysfunction, gynecomastia, prostate cancer exacerbation

What are adverse effects of 5a reductase inhibitors?

Decrease

To evaluate the effectiveness of 5a reductase inhibitors, 5a reductase inhibitors should _____ PSA levels and ______ the IPSS score

Long onset of action, teratogenic effects

What are the counseling points you should tell a patient about 5a reductase inhibitors?

Darifenacin

Which is the most selective anticholinergic to treat BPH?

Anticholinergics

This drug class can treat BPH by blocking muscarinic receptors and inhibiting the contraction of the detrusor muscle

Dryness, dizziness, blurred vision, constipation, urinary retention

What are the common adverse effects of anticholinergics used to treat BPH?

PVR

When monitoring a patient on anticholinergics to treat their BPH, there should be a decrease in IPSS score, check for anticholinergic side effects, hepatic function and _______

Tadalafil

This is the only phosphodiesterase V inhibitor that is indicated to treat BPH because it can promote smooth muscle relaxation

Headache, dizziness, flushing, nausea, orthostasis

What are the common adverse effects of phosphodiesterase V inhibitors?

CrCl <30 mL/min

The use of phosphodiesterase V inhibitors is contraindicated in patients with renal impairment, _______, unstable angina, CHF, or arrhythmias.

Relaxation

Beta 3 agonists can be used to treat BPH because it can promote smooth muscle _______

Hypertension, tachycardia, constipation, dry mouth

What are common adverse effects of beta 3 agonists?

Increase

When monitoring a patient that is on beta 3 agonists, there may be an ________ in their blood pressure

CrCl <15 mL/min

Beta 3 agonists should be avoided in patients with renal impairment, _________, hypertension, bladder obstruction

TURP

What is the gold standard surgical intervention used to treat BPH?

Saw palmetto

What is a natural product that can manage BPH by inhibiting 5a reductase?