Tx of Urinary Incontinence/Retention & BPH

Watchful waiting

What is the first line treatment for BPH with no signs/minimal disruption?

a1 blockers, decrease SNS tone to prostate to relax/vasodilate and open sphincters leading to net increase in urine flow

What is the MOA of prazosin/doxazosin/terazosin?

First dose syncope, reflex tachycardia, orthostatic hypotension, asthenia

What are the untoward effects of prazosin?

a1A selective to prostate/bladder, so better tolerated with less vascular effects

What is the benefit of Tamsulosin over prazosin?

Ejaculatory problems, nasal stuffiness, asthenia

What are the untoward effects of Tamsulosin?

Prolonged QT

What are the untoward effects of Alfuzosin?

Inhibits type 2 5a reductase to decrease DHT

What is the MOA of Finasteride?

No

Does finasteride result in negative feedback on testosterone synthesis?

Inhibits both isoenzymes of 5a reductase to decrease DHT

What is the MOA of Dutasteride?

Alpha antagonists

Which BPH treatment would have the fastest onset with best efficacy?

Doxazoin & Finasteride

What BPH treatment combination shows the best results?

Alpha agonists (ex: pseudoephedrine), antimuscarinics, antihistamines

What medications are known to aggravate BPH?

M3

Which subtype of muscarinic receptors cause contraction of the bladder?

Anticholinergics (ex: Oxybutynin)

What is first line pharmacotherapy for urge incontinence?

Dry mouth, blurred vision, tachycardia, CNS confusion, urinary retention

What are the untoward effects of oxybutynin/tolterodine?

Men with BPH, tachycardia, gastric retention, narrow angle-closure glaucoma

What are contraindications for anticholinergics?

B3 agonist, causes detrusor relaxation

What is the MOA of Mirabegron?

B1

Which subtype of adrenergic receptors increases HR, contractility, and increases renin release?

B2

Which subtype of adrenergic receptors dilate bronchioles, dilate arterioles, and relax the uterus?

Topical estrogen

What is first line treatment for urge incontinence 2/2 atrophic vaginitis?

Local botulinum injection, prevents ACH release

What is the treatment for medication refractory urge incontinence? What is the MOA?