Term
| What are the 2 makor functions of the prostate? |
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Definition
| TO secrete fluids that make up the ejaculate and secretions that may have antibacterial effect |
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Term
| What is the normal size of a prostate gland? |
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Definition
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Term
| What 3 types of tissue is the prostate comprised of and what horomones stimulate its growth? |
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Definition
Epithelial-androgens (testosterone and androstenedione)
Stromal- estrogen
Capsule- α1receptors |
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Term
| What is the role of 5α reductase? |
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Definition
| it converts testosterone and androstenedione into DHT |
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Term
| What are the dynamic and static factors of BPH? |
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Definition
dynamic- excessive a adrenergic tone which results in contraction of the prostate gland around the urethra--> urinary retention
static- anatomic enlargment producing a physical block |
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Term
What should serum PSA levels be?
What other laboratory values may be increased due to BPH? |
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Definition
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Term
What are the markers for the AUA scores?
What shoud PVR be? what is it? |
|
Definition
mild <7
Moderate 8-19
Severe 20-35
Postvoidal Volume retention: 0mL |
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Term
| What are the goals of therapy for BPH? |
|
Definition
restore adequate urinary flow without adverse effects
relieve symptoms of BPH
prevent complications of BPH |
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Term
| Under what conditions should a patient with BPH opt for watchful waiting therapy? |
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Definition
Mild BPH with no symptoms or complications
Return for reassessment in 6-12 mo |
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Term
| What behavior modifications can be made for patients with BPH? |
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Definition
Avoid caffeine and alcohol
Fluid restriction close to bedtime
frequent emptying of bladder during waking hours |
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Term
| What drugs exacerbate voiding symptoms? |
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Definition
Testosterone replacement agents
anticholinergics
diuretics
a-adrenergic agonists |
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Term
| What is the gold standard for tx of BPH in patients with complications? |
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Definition
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Term
What are the a-adrenergic antagonists used to tx BPH?
Brand and Generic |
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Definition
1st: phenoxybenzamine
2nd Prazosin(Minipress) Doxazosin(Cardura) Terazosin (Hytrin) Alfuzosin (Uroxatral)
3rd: Tamsulosin (Flomax) |
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Term
How do the a-antagonist work to tx BPH?
What effect do they have on PVR and PSA levels? |
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Definition
They relax smooth muscles in the prostate and bladder neck
They reudce PVR but have no effect on PSA values |
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Term
What is a common adverse effect of 2nd generation alpha antagonists for PBH?
Why does this occur?
How can it be avoided? |
|
Definition
Orthostatic Hypotention, Syncope, Tachycardia
antagonizes peripheral vasculature adrenergic receptors
Titrating the dose over several weeks |
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Term
What are a common adverse effects of 3rd generation alpha antagonists for BPH?
How is it better than 2nd gen?
Does it need to be titrated?
What is the 3rd gen. alpha antagonist? |
|
Definition
tiredness, ejaculatory dysfunction, flu-like symptoms
Less cardiovascular and hypotensive effects
Does NOT need to be titrated
Tamsulosin (Flomax) |
|
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Term
What are major drug interactions of the alpha antagonists for BPH?
Why? |
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Definition
CYP 3A4 inhibitors or inducers (the drugs are subtrates for CYP3A4)
Sildenafil, Varbenafil and Tadenafil (hypotenstive effects) |
|
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Term
What are the 5-a-reductase inhibitors?
How do they work?
What is their onset of action? Why should this be considered? |
|
Definition
Finasteride (Proscar) : Type II ezyme
Dutasteride (Avodart): Type I and II enzyme
Inhibit the enzyme converting testosterone and and. into DHT
takes 6months, shouldnt be used to relieve symptoms right away |
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Term
What are the adverse effects of 5-alpha reductase inhibitors?
Drug interactions? |
|
Definition
Impotence decrease libido
Pregnancy category X
Interats with strong inhibitors of CYP3A4 |
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Term
| What parameters should be monitored in patients with BPH? |
|
Definition
Prostate size, PVR, PSA, BUN, SrCr, AUA, DRE
Peak urinary flow rate, adverse effects |
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Term
How does the detrusor muscle act in urinary continence?
What receptors are responsible for the detrusor muscle contraction? |
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Definition
It contracts to empty the bladder and relaxes to fill it
Ach muscarinic receptors |
|
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Term
Match
a) SUI 1) Bladder Overactivity
b) UUI 2) Urethral Overactivity/Bladder Underactivity
c) Mixed 3) Urethral Underactivity
d) Overflow 4) Bladder Overactivity/Urethral Underactivity |
|
Definition
a) SUI 1) Urethral Underactivity
b) UUI 2) Bladder Overactivity
c) Mixed 3)Bladder Overactivity/Urethral Underactivity
d) Overflow 4) Urethral Overactivity/Bladder Underactivity |
|
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Term
What are major risk factors for...
a) SUI
b) UUI |
|
Definition
a) pregnancy, menopause, childbirth, age, obesity
b) neurologic disease, normal aging |
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Term
What drug classes exacerbate UI?
|
|
Definition
| anticholinergics, alcohol, antidepressants, narcotic analgesics, a-agonists/antagonist, Ca Channel blockers, ace inhibitors, sedative hypnotics |
|
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Term
UUI or SUI
a) patient complains of leaking during physical activity but rare nocturia |
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Definition
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Term
UUI or SUI
a) Patient complains of nocturnal incontinence, frequent stron sudden urges to void, and inability to reach the toilet in time to void |
|
Definition
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Term
| What are the goals of therapy for UI? |
|
Definition
Reduce # of UI episodes per day and restore continence
Min. signs and symptoms that are bothersome
Min. use of pads or other supplies
Min side effects of pharmacotherapy |
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Term
| What are the non-pharmacologic t for UI? |
|
Definition
Caffeine reduction, lose weight, smoking cessation
Scheduling regimen
Pelvic floor muscle exercises
Catheter or external occlusive devise
bedside commodes
absorbent products |
|
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Term
| What class of drugs are 1st line of therapy for UI? |
|
Definition
| Anticholinergics/ antispasmodic agents |
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