BPH

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Final Exam Prep
Sam Adeyiga
Flashcards by Sam Adeyiga, updated more than 1 year ago
Sam Adeyiga
Created by Sam Adeyiga about 4 years ago
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Uroselective agents 1. Tamsulosin 2. Alfazosin
Drugs that can worsen BPH *** Exam cases will include these 4 1. diuretics 2. decongestants 3. antihistamines 4. antidepressants
AUA 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 - 35 1. 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
DRE minimum PSA minimum 1. 40 gram 2. < 1.5 ng/mL
Trt Algorithm for BPH management Mild Snxs (AUA 0 - 7) 1. Watchful waiting
Trt Algorithm for BPH management Mod snx + ED (AUA 8 - 19) 1. A-adrenergic antagonist 2. PDE-5 3. Both
Trt Algorithm for BPH management Mod snx + small prostate and low PSA (AUA 8 - 19) A-adrenergic antagonist
Trt Algorithm for BPH management Mod snx + large prostate and high PSA AUA 8 - 19 5-A-reductase Inhibitor + A-adrenergic antagonist
Trt Algorithm for BPH management Mod snx + irritative voiding snxs AUA 8 - 19 1. A-adrenergic antagonist + Anticholinergic 2. A-adrenergic antagonist + mirabegron
Trt Algorithm for BPH management Severe Snxs = Complications of BPH AUA = 20 - 35 DRE = > 40 g PSA = > 1.5 ng/dL 1. Minimally invasive surgery or prostatectomy
α1-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®)
5α-Reductase Inhibitors 1. Dutasteride (Avodart®) 2. Finasteride (Proscar®)
Combination 5α-Reductase Inhibitor/α-Adrenergic Receptor Antagonist Dutasteride and Tamsulosin (Jalyn®)
phosphodiesterase inhibitors (PDE-5 inhibitors) 1. tadalafil (Cialis®), 2. vardenafil (Levitra®) 3. sildenafil (Viagra®)
Antimuscarinic agents 1. mirabegron 2. tolterodine 3. oxybutynin 4. trospium 5. solifenacin 6. darifenacin 7. fesoterodine
What 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
TURP 1. reduction in AUA-SI score of 15 points
Open prostatectomy 1. typically reserved for males with prostate size > 80 grams
TUIP 1. a surgical option in men with a prostate size of < 30 grams
TUNA 1. TUNA uses radiofrequency waves to heat the prostate causing necrosis of the tissue.
TUMT 1. delivers heat to the prostate via a urethra catheter, causing necrosis of prostate tissue.
Lifestyle 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)
Lifestyle 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
Lifestyle Modification / Behavioral changes for BPH pts. (3) *** Avoidance or adjustment of certain medications e.g., 1. diuretics 2. decongestants 3. antihistamines 4. antidepressants
Lifestyle 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
What is the trt option in men with VEGF and hematuria due to prostatic bleeding 1. 5α-Reductase Inhibitor 2. Finasteride
3rd Gen 5α-Reductase Inhibitors Selective α1 Inhibitors 1. Silodosin 2.Tamsulosin
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