Fichas
BPH
Fichas del conjunto (27)
- 1Uroselective agents1. Tamsulosin
2. Alfazosin - 2Drugs that can worsen BPH *** Exam cases will include these 41. diuretics
2. decongestants
3. antihistamines
4. antidepressants - 3AUA snxs index for BPH 1. AUA < 8 (i.e. 0 - 7) = Mild LUTS 2. AUA =/> 8 = LUTS score >/= 8 w/o bordersome snxs 3. AUA =/> 8 = LUTS score >/= 8 w bordersome snxs 4. AUA 20 - 351. AUA < 8 = watchful waiting
2. UA =/> 8 = LUTS score >/= 8 w/o bordersome snxs = Watchful waiting
3. UA =/> 8 = LUTS score >/= 8 w/ bordersome snxs = Monotherapy with α1-adrenergic antagonists = 1st line therapy
AUA 20 - 35 = Severe snxs - 4DRE minimum PSA minimum1. 40 gram
2. < 1.5 ng/mL - 5Trt Algorithm for BPH management Mild Snxs (AUA 0 - 7)1. Watchful waiting
- 6Trt Algorithm for BPH management Mod snx + ED (AUA 8 - 19)1. A-adrenergic antagonist
2. PDE-5
3. Both - 7Trt Algorithm for BPH management Mod snx + small prostate and low PSA (AUA 8 - 19)A-adrenergic antagonist
- 8Trt Algorithm for BPH management Mod snx + large prostate and high PSA AUA 8 - 195-A-reductase Inhibitor + A-adrenergic antagonist
- 9Trt Algorithm for BPH management Mod snx + irritative voiding snxs AUA 8 - 191. A-adrenergic antagonist + Anticholinergic
2. A-adrenergic antagonist + mirabegron - 10Trt Algorithm for BPH management Severe Snxs = Complications of BPH AUA = 20 - 35 DRE = > 40 g PSA = > 1.5 ng/dL1. Minimally invasive surgery or prostatectomy
- 11α1-adrenergic antagonists drugs ("Zosins")1. Alfuzosin (Uroxatral®)
2. Doxazosin (Cardura®) 2-6 weeks ***
3. Doxazosin (Cardura-XL®)
4. Tamsulosin (Flomax®)
5. Terazosin (Hytrin®) 2-6 weeks ***
6. Silodosin (Rapaflo®) - 125α-Reductase Inhibitors1. Dutasteride (Avodart®)
2. Finasteride (Proscar®) - 13Combination 5α-Reductase Inhibitor/α-Adrenergic Receptor AntagonistDutasteride and Tamsulosin (Jalyn®)
- 14phosphodiesterase inhibitors (PDE-5 inhibitors)1. tadalafil (Cialis®),
2. vardenafil (Levitra®)
3. sildenafil (Viagra®) - 15Antimuscarinic agents1. mirabegron
2. tolterodine
3. oxybutynin
4. trospium
5. solifenacin
6. darifenacin
7. fesoterodine - 16What do you give a patients with an enlarged prostate of greater than 40 grams and/or a PSA elevated to > 1.5 ng/mL?Combined therapy of 5-A-reductase Inhibitor + A-adrenergic antagonist
- 17TURP1. reduction in AUA-SI score of 15 points
- 18Open prostatectomy1. typically reserved for males with prostate size > 80 grams
- 19TUIP1. a surgical option in men with a prostate size of < 30 grams
- 20TUNA1. TUNA uses radiofrequency waves to heat the prostate causing necrosis of the tissue.
- 21TUMT1. delivers heat to the prostate via a urethra catheter, causing necrosis of prostate tissue.
- 22Lifestyle Modification / Behavioral changes for BPH pts. (1)Fluid restriction (1500-2000 mL/day), or fluid restriction at bedtime or prior to times when symptoms are bothersome (e.g., long trips or in public)
- 23Lifestyle Modification / Behavioral changes for BPH pts. (2)1. Avoidance of caffeinated beverages, alcoholic beverages, and spicy foods
2. Replacement of large volume alcoholic beverages with small volume alcoholic beverages - 24Lifestyle Modification / Behavioral changes for BPH pts. (3) ***Avoidance or adjustment of certain medications e.g.,
1. diuretics
2. decongestants
3. antihistamines
4. antidepressants - 25Lifestyle Modification / Behavioral changes for BPH pts. (4)1. Timed or scheduled voiding (bladder retraining)
2. Pelvic floor exercises
3. Avoidance of constipation
4. Use of frequency and volume charts
(diary) to monitor symptoms and for
progression of symptoms - 26What is the trt option in men with VEGF and hematuria due to prostatic bleeding1. 5α-Reductase Inhibitor
2. Finasteride - 273rd Gen 5α-Reductase Inhibitors Selective α1 Inhibitors1. Silodosin
2.Tamsulosin