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13 Cards in this Set
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Annual PSA & DRE exam
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For men >/= 50 yo w/ life expectancy >/=10yr
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PSA normal 0-4 ng/mL
Further eval if >4ng/mL High suspicion of malignancy if >10ng/mL |
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Alpha-1 Adrenergic Receptor ANTAGONISTS
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alpha 1 antagonism: reversible relaxation of the SM in prostate/bladder neck--> decrease in urethral resistance-->imprv in voiding fx
"1st dose response"-->caution orthostatic hypotension Does not affect PSA levels ADRSs: dizzy, drowsy, orthostasis, priapism, QT prolongation,peripheral edema,rhinitis *alpha1a more specific in specific *alpha 1b receptors is throughout vasculature |
BPH pathophys: alpha-1 receptors in prostatic stroma/capsule and bladder neck; increases in smth muscle in tone regulated by the sympatthetic nervous system
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Cardura
Cardura XL |
doxazosin
longest DOA |
dosing 1-8mg qhs
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Hytrin
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terazosin 1-10mg qhs
2nd longest DOA |
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Minipress
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prazosin 1-2 mg bid
short acting DOA |
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UroXatral
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alfuzosin
short acting, selective alpha 1 low incidence of hypotension and sexual dysfunction |
utilizes Skyepharma PLC's oral drug delivery tech known as 'Geomatrix' to allow for once-daily dosing
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Flomax
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tamsulosin 0.4-0.8mg qd
7-38 fold greater afficity for alpha 1a receptors |
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Rapaflo
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silodosin 4-8mg qd
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caution: Crcl 30-50: 4mg daily; Contraindicated in Crcl<30
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Alpha Blockers DDIs
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Cimetidine dec clearance of flomax
CYP3a4 inh w/alfuzosin PDE inhibitors Caution concomitant antihypertensives |
CI: tadalafil or vardenafil with an alpha blocker
*EXCEPTION: tadalafil & tamsulosin 0.4mg daily *NTE 25mg sildenafil if taken w/in 4hrs of an alpha blocker |
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5 alpha reductase inhibitors
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5 alpha reductase converts testosterone to DHT
Results in stimulation of hyperplastic growth of prostate |
Use of inhibitor associated w/prostate volume shrinkage (20-25%) and sx imprvmt
Delayed onset of action DDIs: CYP3A4 substrate |
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5 alpha reductase inhibitors
precautions/counseling points |
6-12mo of tx needed for evidence of imprvmt (greatest benefit in prostates >40gm)
Must be cont indef for sustained effect Reserve use for men with lower urinary tract sxs ADR: sexual dysfx (dec libido,impotence, dec ejac vol), breast swelling/tender |
Precaution: Cat X
Avoid contact w/crushed tabs Men should avoid donating bld w/in 6mo of d/c tx Lab: 50% of pts will experience decrease in PSA levels w/in 1st mo of tx |
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Proscar
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finasteride 5mg daily
inhibits only type 2 isoenzyme which is prostate specific |
Propecia marketed for androgenic alopecia
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Avodart
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dutasteride 0.5mg daily
inh both type 1 (periphery) & 2 isoenzymes thus more effective in lowering DHT serum levels |
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