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IPDM I WK 4 BPH Part 2

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alchemist04's version from 2016-04-30 05:16

Section

Question Answer
What are the medications that worsen BPH?(1) Sympathomimetic (2) Anticholinergic (3) Opioids (4) Diuretics
Sympathomimetic examples are (1)Decongestants (Alpha 1-adrenergic agonists) like Phenylephrine and Psuedoephedrine
Sympathomimetic examples are (2)Antihypertensive (Alpha 2-adrenergic agonists like Clonidine and Methyldopa
Diuretics examples are(1) Furosemide (Loop diuretic) (2) Thiazides (HCTZ)
Anticholinergic Examples are(1) Antihistamine (Diphenhydramine), (2) Tricyclic antidepressants (Amitriptyline) (3) Antipsychotics (4) Muscle relaxants (5) Antispasmodics (Tolterodine / Detrol)
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Question Answer
What is the MOA of Alpha1-Adrenergic Receptor Antagonists?(1) cause relaxation of smooth muscle of Prostate (2) cause smooth relaxation of bladder neck (3) cause smooth relaxation of prostatic urethra (4) reduces dynamic factors
What are the subtypes of Alpha 1-Adrenergic Receptor Antagonists?Alpha 1A, Alpha 1B and Alpha 1D.
Where is Alpha 1A located?In the prostate and urethra (desired effects of medication)
Where is Alpha 1B located?localized in the vascular smooth muscle
Where is Alpha 1D located?Localized in the bladder
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Question Answer
A patient always have hypotension, what kind of Alpha 1 adrenergic receptor antagonist are you going to give the patient? Is it Uroselective or non uroselective?Uroselective is preferred over non-uroselective for patients not tolerating hypotension
Two important things to know about Alpha 1B Adrenergic receptor antagonist subtype (1)Orthostatic hypotension due to first syncope (drop in BP and loss of consciousness)
Two important things to know about Alpha 1B Adrenergic receptor antagonist subtype (2)Start at low and titrate up slowly
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Question Answer
List 2nd generation Alpha 1 adrenergic receptor antagonists (1)Prazosin (Minipress)
List 2nd generation Alpha 1 adrenergic receptor antagonists (2)Terazosin (Hytrin)
List 2nd generation Alpha 1 adrenergic receptor antagonists (3)Doxazosin (Cardura, Cardura XL)
List 2nd generation Alpha 1 adrenergic receptor antagonists (4)Alfuzosin (Uroxatral)
List 3rd generation Alpha 1 adrenergic receptor antagonists (1)Tamsulosin (flomax)
List 3rd generation Alpha 1 adrenergic receptor antagonists (2)Silodosin (Rapaflo)
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Question Answer
Which of the 2nd generation is the most uroselective of the second generation?Alfuzosin/Uroxatrial
Which of the Alpha 1 Adrenergic receptor antagonists is Non-Uroselective and which ones are uroselective?Tamsulosin (flomax) and Silodosin are Uroselective. The rest (DTAP) are non-uroselective
Four things about Alfuzosin/Uroxatral (1)Most Uroselective of 2nd generation Alpha 1-reductase antagonist
Four things about Alfuzosin/Uroxatral (2)10 mg qd (for initial and Usual dose)
Four things about Alfuzosin/Uroxatral (3)No dose titration needed
Four things about Alfuzosin/Uroxatral (3)Do not Chew or crush
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Question Answer
Important counsel point for Tamsulosin/Flomax (1)Initial dose is 0.4 mg QD.
Important counsel point for Tamsulosin/Flomax (2)Usual dose is 0.4-0.8 mg QD
Important counsel point for Tamsulosin/Flomax (3)Caution in severe SULFA allergy
Important counsel point for Tamsulosin/Flomax (4)Off label use for nephrolithiasis
Important counsel point for Tamsulosin/Flomax (5)Take 30 mins after a meal
Important counsel point for Tamsulosin/Flomax (6)Do not chew or crush
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Question Answer
Important counsel point for Silodosin/Rapaflo (1)Initial dose is 8 mg QD, Usual dose is 8 mg QD
Important counsel point for Silodosin/Rapaflo (2)needs renal impairment adjustment
Important counsel point for Silodosin/Rapaflo (3)In CrCl 30-35ml/min, decrease dose by half (40 mg)
Important counsel point for Silodosin/Rapaflo (4)In CrCl < 30 ml/min, do not use, it is contraindicated
Important counsel point for Silodosin/Rapaflo (5)In Hepatic impairment, reduce dose by half (40 mg)
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Question Answer
Important counsel point for Prazosin/Minipress (1) Initial dose is 0.5 mg BID, (2) Usual dose is 1-5 mg BID, (3) FDA indicated for hypertension (4) Off label use for BPH
Important counsel point for Terazosin/Hytrin(1) Initial dose is 1 mg Qhs, (2) Usual dose is 10-20 mg QD (3) FDA indicated for hypertension
Important counsel point for Doxazosin/Cardura(1) Initial dose is 1 mg QD, (2) Usual dose is 8mg QD (3) FDA indicated for hypertension
Important counsel point for Doxazosin/Cardura XL(1) Initial dose 4 mg QD, (2) Usual dose is 4-8 mg QD (3) FDA indicated for hypertension
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Question Answer
Counsel point for Alpha 1 Adrenergic Receptor antagonist (1)Usually 1st line for symptomatic relief
Counsel point for Alpha 1 Adrenergic Receptor antagonist (2)Takes 1-6 wks to see results/benefits
Counsel point for Alpha 1 Adrenergic Receptor antagonist (3)Does NOT affect prostate size or PSA
Counsel point for Alpha 1 Adrenergic Receptor antagonist (4)May cause Orthostatic hypotension, syncope, lightheadedness
Counsel point for Alpha 1 Adrenergic Receptor antagonist (5)Could case IFIS (intraoperative Floppy Iris Syndrome.
Counsel point for Alpha 1 Adrenergic Receptor antagonist (6)Avoid use if anticipating cataract surgery
Counsel point for Alpha 1 Adrenergic Receptor antagonist (7)Priapism (painful and prolonged erection ( > 4 hours)
Counsel point for Alpha 1 Adrenergic Receptor antagonist (8)May cause hypotension
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Question Answer
5 Alpha reductase MOAthe enzyme inhibits conversion of of Testosterone to DHT, thereby shrinking the prostate and reducing static factor.
5 Alpha reductase BENEFITthe greatest benefit is for pt with enlarge prostate > 40 g (OMG)
5 Alpha reductase ONSETtakes about 3-6 months for onset, unlike Alpha 1-reductase that takes 6 wks
5 Alpha reductase TYPEShas Type I and Type II
5 Alpha reductase EFFECT on PSAIt shrinks Prostate. it reduces PSA by 50% in 6-12 months after therapy. If no 50% reduction in PSA after6-12 months, evaluate patient for Prostate cancer
5 Alpha reductase PREG CategoryPregnancy category X
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Question Answer
What are the names of the two 5 Alpha Reductase inhibitors discussed in class?(1) Finasteride (Proscar) (2) Dutastreride (Avodart)
Three things about Finasteride (Proscar®) (1)Inhibits type II
Three things about Finasteride (Proscar®) (2)FDA approved for Alopecia (Propecia)
Three things about Finasteride (Proscar®) (3)5 mg PO QD
Three things about Dutasteride (Avodart®) (1)Inhibits type I and II
Three things about Dutasteride (Avodart®) (2)Also available in combination with Talsulmosin (Jalyn)
Three things about Dutasteride (Avodart®) (3)0.5 mg PO QD
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Question Answer
Patient Counseling 5 Alpha -Reductase Inhibitors (1)Take 6-12 mo to see benefits and used indefinitely to sustained effects (must be used forever)
Patient Counseling 5 Alpha -Reductase Inhibitors (2)must not have sex unprotected
Patient Counseling 5 Alpha -Reductase Inhibitors (3)order PSA level before starting therapy
Patient Counseling 5 Alpha -Reductase Inhibitors (4)Could cause Gynecomastia (man boob)
Patient Counseling 5 Alpha -Reductase Inhibitors (5)decreased libido, erectile dysfunction and ejaculation
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Question Answer
Phosphodiesterase 5 inhibitor (PDE5) MOAcause smooth muscle relaxation of prostate, bladder neck and prostatic urethra
Phosphodiesterase 5 inhibitor (PDE5) TYPESTadalafil (Cialis and Adcirca)
Adcirca indicationPulmonary hypertension
Adcirca direction40 mg PO QD
Cialis indication (1)Erectile dysfunction
Cialis indication (2)Benigh Prostatic Hyperplasia (BPH)
Cialis direction5 mg PO QD
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Question Answer
Patient Counseling for Phosphodiesterase 5 (PDE5) Inhibitors (1) Medication helps with erectile dysfunction
Patient Counseling for Phosphodiesterase 5 (PDE5) Inhibitors (2)Do not take with Nitrates, wait a tleast 48 hrs (2 days) b4 taking nitrate
Patient Counseling for Phosphodiesterase 5 (PDE5) Inhibitors (3)could cause HDHD (headache, dizziness, hearing loss and Dyspepsia
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