BPH

Question 1

What are agents for BPH?

Answer 1

1st line: alpha-blockers +/- 5 alpha-reductase inhibitor
2nd line: PDE-5 inhibitors +/- finasteride

Question 2

When should 5-alpha reductase inhibitors not be used?

Answer 2

Bladder obstruction without prostate enlargement (delayed onset, but decreased prostate size and PSA)

Question 3

What agents are alpha-1 blockers?

Answer 3

Non-selective alpha 1 blocker: Terazosin/Doxazosin
Selective alpha-1 blocker: Tamsulosin, Alfuzosin, Silodosin

Question 4

What are Warnings/SEs with alpha-1 blockers?

Answer 4

Warnings:
1. Orthostatic hypotension/syncope with 1st dose/dose changes
2. Intraoperative floppy iris syndrome (IFIS) can occur during cataract surgery
3. Angina (D/C if begins/worsens)
4. priapism (emergency if >4h)
SE:
1. Dizziness/Fatigue
2. Headache
3. Abnormal ejaculation
4. fluid retention/rhinitis

Question 5

What are counseling points for alpha blockers?

Answer 5

1. Take at bedtime to minimize orthostasis/dizziness (non-selective)
2. May take 4-6 weeks for effectiveness
3. DOES NOT shrink prostate or change PSA levels only improves LUTS
4. DO NOT use alfuzosin if at risk for QT prolongation
5. DO NOT use with tadalafil
6. Avoid strong 3A4 inhibitors
7. Caution in renal/hepatic impairment (alfluzosin/silodosin)

Question 6

Doxazosin

Answer 6

Cardura
Cardura XL

Question 7

Tamsulosin

Answer 7

Flomax

Question 8

What is the MOA of 5-alpha reductase inhibitors?

Answer 8

inhibits 5-alpha reductase, blocking conversion of testosterone to DHT shrinking prostate and lowering PSA

Question 9

What are the CI/Warning/SEs with finasteride?

Answer 9

CI: Women of childbearing potential, pregnancy, children
Warning: may increase risk of high-grade prostate cancer; Pregnant women should not handle these medications
SE:
1. Impotence/ decreased libido/ejaculation disturbances (usually return to baseline after a year)
2. Breast enlargement/tenderness
3. rash

Question 10

Finasteride

Answer 10

Proscar
Propencia (alopecia)

Question 11

Dutasteride

Answer 11

Avodart

Question 12

Which PDE-5 inhibitor is approved for BPH with or without ED?

Answer 12

Tadalafil (avoid with alpha-blockers)