Therapeutics - BPH 1

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Therapeutics - BPH 1
2014-08-22 08:15:21
Therapeutics BPH
Therapeutics - BPH
Therapeutics - BPH
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  1. What are the obstructive symptoms of BPH?
    • Intermittency
    • Dribbling
    • Weak Stream
    • Incomplete voiding
    • Straining
    • Hesitancy
    • (I’d wish)
  2. What are the irritative symptoms of BPH?
    • Frequency
    • Urgency
    • Nocturia
    • Incontinence
    • (FUNI)
  3. What tests/data are standard for BPH evaluation?
    • Digital rectal exam
    • Symptom history
    • Urinalysis
    • Drug-induced symptoms
  4. What tests/data are optional or used in follow-up evaluation for BPH?
    • Serum PSA
    • Ultrasound
    • Biopsy
  5. What drugs cause urinary hesitation or outflow obstruction?
    • BB
    • Alpha adrenergic stimulants
    • Anticholinergic agents (antihistamines, antidepressants/TCAs, antipsychotics)
  6. What test is used to determine BPH symptom levels?
    AUA symptom index (AUASI)
  7. What are the symptoms asked about on the AUASI?
    • In the past month have you had:
    • Sensation of incomplete emptying
    • Urinate > 2 hrs
    • Stop and start several times
    • Difficult to postpone
    • Weak stream
    • Push or strain to begin
    • Get up at night
  8. What is a mild AUASI Score?
  9. What is a Moderate AUASI score?
  10. What is a Severe AUASI score?
  11. An AUASI score of < or = 7 requires what treatment?
    • Behavioral modification
    • Watchful waiting
  12. An AUASI score of > 7 requires what treatment?
    • Behavioral modification
    • Watchful waiting
    • Medical treatment
    • Minimally invasive treatment
    • Surgical treatment
  13. What are the behavioral modifications for BPH?
    • Avoid exacerbating drugs
    • Avoid frequent urination while awake
    • Restrict alcohol and caffeine
    • Do not consume fluids near bedtime
  14. What is the mechanism of action for alpha-adrenergic blockers?
    Relax prostatic smooth muscle (bladder neck, prostate capsule and prostatic urethra)
  15. What is the mechanism of action for 5-alpha reductase inhibitors?
    • Interfere with testosterone’s involvement in gland enlargement
    • Decrease conc. of dihydrotestosterone (DHT)
    • Creates androgen deficiency in prostate
    • Decreases prostate size
    • Increases testosterone concentrations
  16. What is the mechanism of action for Anticholinergic agents?
    Relax bladder detrusor muscle
  17. What is the mechanism of action for phosphodiesterase inhibitors?
    • Relax prostatic smooth muscle
    • Relax bladder detrusor muscle
    • Relax prostate smooth muscle through an interaction with NO
  18. What are the drug classes used to treat BPH?
    • Alpha adrenergic blockers
    • Phosphodiesterase inhibitors
    • 5-alpha reductase inhibitors
    • Anticholinergic agents
  19. Do alpha adrenergic blockers effect prostate size?
  20. What is the OOA of alpha adrenergic blockers?
    2 weeks
  21. What are the therapeutic effects of alpha adrenergic blockers?
    50-70% Symptom improvement with 30-50% improvement in AUASI score
  22. Do alpha adrenergic blockers halt disease progression?
  23. Do alpha adrenergic blockers reduce the need for surgery?
  24. Why should you choose alpha1a selective alpha adrenergic blockers?
    To reduce the risk of hemodynamic side effects like orthostatic hypotension, first syncope and dizziness caused by peripheral vascular relaxation
  25. What are the non-selective alpha adrenergic blockers?
    Terazosin (Hytrin) and Doxazosin (Cardura)
  26. What is the ending for alpha adrenergic blockers?
  27. What are the selective alpha adrenergic blockers?
    • Tamsulosin (Flomax)
    • Alfuzosin (Uroxartal)
    • Silodosin (Rapaflo)
  28. What is the dose for Tamsulosin (Flomax)?
    0.4-0.8 mg/day
  29. What is the dose for Alfuzosin (Uroxartal)?
    10 mg/day
  30. What is the dose for Silodosin (Rapaflo)?
    8 mg/day with a meal
  31. Which alpha adrenergic blocker should be given with a meal?
    Silodosin (Rapaflo)
  32. Tamsulosin brand name
  33. Alfuzosin brand name
  34. Silodosin brand name
  35. Terazosin brand name
  36. Doxazosin Brand name
  37. What are the AE of alpha adrenergic blockers?
    • ED
    • Decreased ejaculate or retrograde ejaculation
    • Fatigue
    • (CHF…?)
    • Non-selective: orthostatic hypotension, lightheadedness/dizziness
  38. What are the CIs for alpha adrenergic blockers?
    • Hypotension
    • Alfuzosin – Other CYP3A4 inhibitors, hepatic insufficiency, prolonged QTand CrCl <30
    • Silodosin – CrCl <30, Child-Pugh >10