Tag: Benign Hypertrophy of Prostate (BHP)

Benign Hypertrophy of Prostate (BHP)

BENIGN HYPERTROPHY OF PROSTATE (BHP)

Q. 1 Therapeutic  uses  of  α  –  adrenoreceptor blockers include all of the following except-
 A Hypertension
 B Anxiety
 C Peripheral vascular disease
 D Benign prostatic hypertrophy
Q. 1 Therapeutic  uses  of  α  –  adrenoreceptor blockers include all of the following except-
 A Hypertension
 B Anxiety
 C Peripheral vascular disease
 D Benign prostatic hypertrophy
Ans. B

Explanation:

            

Uses of α -blockers
Uses of β -blockers

•Pheochromocytoma

•Hypertension

•Secondary Shock

•Peripheral vascular disease

•Congestive heart failure

•Benign prostatic hypertrophy

•Migraine

• Hypertension

•Angina

• Cardiac arrhythmias

• Myocardial Infarction

• Pheochromocytoma

• Congestive Heart Failure

 

•Anxiety

• Dissecting aortic aneurysm

• Essential tremor

• Glaucoma

• Hypertrophic cardiomyopathy

• Thyrotoxicosis

• Migraine



 


Q. 2 Alpha 1 blocker used for BHP is:
 A Tamsolusin
 B Prazosin
 C Oxazosin
 D Dolazoline
Q. 2 Alpha 1 blocker used for BHP is:
 A Tamsolusin
 B Prazosin
 C Oxazosin
 D Dolazoline
Ans. A

Explanation:

Tamsolusin


Q. 3 Alpha 1 blocker used for BHP without any effect on blood pressure is:
 A Tamsolusin
 B Terazosin
 C Oxazosin
 D Dolazoline
Q. 3 Alpha 1 blocker used for BHP without any effect on blood pressure is:
 A Tamsolusin
 B Terazosin
 C Oxazosin
 D Dolazoline
Ans. A

Explanation:

Tamsolusin

Quiz In Between


Q. 4

Finasteride is a:

 A

5 alpha reductase inhibitor

 B

PDE inhibitor

 C

Alpha la blocker

 D

Androgen receptor blocker

Q. 4

Finasteride is a:

 A

5 alpha reductase inhibitor

 B

PDE inhibitor

 C

Alpha la blocker

 D

Androgen receptor blocker

Ans. A

Explanation:

Finasteride is a competitive inhibitor of the enzyme 5-alpha reductase which is responsible for the conversion of testosterone into a more active dihydrotestosterone responsible for the androgen action.

When used in benign prostatic hypertrophy, it reduces the prostate size and increased peak urinary flow rate.

It is also used in male pattern baldness and as a palliative treatment in prostatic carcinoma.

Ref: K D Tripathi Textbook of Pharmacology, 5th Edition, Page 272


Q. 5

The following statements regarding finasteride are true, EXCEPT:

 A

It is used in the medical treatment of benign Prostatic hypertrophy (BPH)

 B

Impotence is well documented after its use

 C

It blocks the conversion of dihydrotestosterone to testosterone

 D

It is a 5-a reductase inhibitor

Q. 5

The following statements regarding finasteride are true, EXCEPT:

 A

It is used in the medical treatment of benign Prostatic hypertrophy (BPH)

 B

Impotence is well documented after its use

 C

It blocks the conversion of dihydrotestosterone to testosterone

 D

It is a 5-a reductase inhibitor

Ans. C

Explanation:

Finesteride is a 5-a reductase inhibitor that blocks the formation of dihydrotestosterone from testesterone.

It does not block the reverse reaction i.e. conversion of dihydrotestosterone to testosterone.

Ref: KDT, 5th Edition, Page 272; Goodman Gillman’s The Pharmacological Basis of Therapeutics, Page 1646


Q. 6

The following statements regarding Finasteride are true except –

 A

It is used in the medical treatment of benign prostatic hypertrophy (BPH)

 B

Impotence is well documented after its use

 C

It blocks the conversion of dihydrotestosterone to testosterone

 D

It is a 5a-reductase inhibitor

Q. 6

The following statements regarding Finasteride are true except –

 A

It is used in the medical treatment of benign prostatic hypertrophy (BPH)

 B

Impotence is well documented after its use

 C

It blocks the conversion of dihydrotestosterone to testosterone

 D

It is a 5a-reductase inhibitor

Ans. C

Explanation:

Ans. is ‘c’ i.e., Blocks conversion of dihydrotestosterone to testosterone

Quiz In Between


Q. 7

Finasteride is a –

 A

5-α reductase inhibitor

 B

PDE inhibitor

 C

Alpha blocker

 D

Androgen receptor blocker

Q. 7

Finasteride is a –

 A

5-α reductase inhibitor

 B

PDE inhibitor

 C

Alpha blocker

 D

Androgen receptor blocker

Ans. A

Explanation:

Ans. is ‘a’ i.e., 5-alpha reductase inhibitor


Q. 8

An old man has enlarged prostate. Which of the following may be use to suppress his prostatic growth –

 A

Spironolactone

 B

Ketoconazole

 C

Finasteride

 D

Flutamide

Q. 8

An old man has enlarged prostate. Which of the following may be use to suppress his prostatic growth –

 A

Spironolactone

 B

Ketoconazole

 C

Finasteride

 D

Flutamide

Ans. C

Explanation:

Ans. is ‘c’ i.e., Finasteride

o 5-α reductase inhibitors (finasteride) are used in BPH.


Q. 9

The following statements regarding finasteride are true except

 A

It is used in the medical treatment of Benign prostatic hypertrophy

 B

Impotence is well documented after its use

 C

It blocks the conversion of dihydrotestosterone to testosterone

 D

It is a 5-oc reductase inhibitor

Q. 9

The following statements regarding finasteride are true except

 A

It is used in the medical treatment of Benign prostatic hypertrophy

 B

Impotence is well documented after its use

 C

It blocks the conversion of dihydrotestosterone to testosterone

 D

It is a 5-oc reductase inhibitor

Ans. C

Explanation:

Ans. is ‘c’ i.e. It blocks the conversion of dihydrotestosterone to testosterone 

  • Finasteride is a 5 a-reductase inhibitor which blocks the conversion of testosterone to its more active form dihydrotestosterone
  • Uses
  • BPH – decreases the size of large prostate (> 40 cm3) and can retard disease progression.
  • Male pattern baldness – in patients of male pattern baldness, it promotes hair growth and prevents further hair loss.

Side effects

a)       Impotence: is a well documented although infrequent side effect.

b)       Decreased libido

c)       Decreased volume of ejaculate

d)       Skin rashes

e)       Swelling of lips

Quiz In Between


Q. 10

Which is the earliest symptom of benign hypertrophy of prostate –

 A

Frequency

 B

Haematuria

 C

Incontinence

 D

Strangury

Q. 10

Which is the earliest symptom of benign hypertrophy of prostate –

 A

Frequency

 B

Haematuria

 C

Incontinence

 D

Strangury

Ans. A

Explanation:

Ans. is ‘a’ i.e., Frequency 


Q. 11

An old man is having benign prostatic hypertrophy. Drug useful in such a patient would be:

March 2012

 A

Cyproterone acetate

 B

Danazol

 C

Bicalutamide

 D

Finasteride

Q. 11

An old man is having benign prostatic hypertrophy. Drug useful in such a patient would be:

March 2012

 A

Cyproterone acetate

 B

Danazol

 C

Bicalutamide

 D

Finasteride

Ans. D

Explanation:

Ans: D i.e. Finasteride

Drugs and uses

  • Cyproterone has been clinically tested in precocious puberty in boys, inappropriate sexual behaviour in men, acne and virilisation in women, but is not marketed.
  • Danazol is useful in endometriosis, menorrhagia, fibrocystic breast disease and hereditary angioneurotic edema.
  • Bicalutamide (more potent and longer acting congener of flutamide) is suitable for once daily administration in metastatic carcinoma of prostrate.
  • Treatmentt with finasteride has resulted in decreased prostate size and increased peak urinary flow rate in nearly 50% patients with symptomatic benign hypertrophy of the prostrate (BHP). It is the only drug which can retard disease progression.

Quiz In Between



Benign Hypertrophy of Prostate (BHP)

BENIGN HYPERTROPHY OF PROSTATE (BHP)


 

BENIGN HYPERTROPHY OF PROSTATE (BHP)

  • Causes urinary obstruction.
  • Static component of obstruction – Occurs due to increased prostate size.
  • Dynamic component – Occurs due to increased tone of bladder neck/prostate smooth muscle.

Management:

I) Drugs used:

1. Selective α1-Blockers:

MOA:

  • α-adrenoceptor activation in bladder trigone, prostate & prostatic urethra, increases smooth muscle tone.
  • α-adrenoceptor blockade (particularly α-1 receptor) causes,  
    • Smooth muscle relaxation in neck of urinary bladder & prostatic urethra.
    • Reduces dynamic obstruction.
    • Increases urinary flow rate.
    • Cause complete bladder emptying in BHP patients.

Uses:

  • Relieves dynamic obstruction in BHP.
  • Provides rapid symptomatic relief in BHP.

Advantages:

  • Relieves voiding symptoms (hesitancy, narrowing of stream, dribbling & increased residual urine) effectively.
  • Also relieves irritative symptoms (urgency, frequency & nocturia).
  • Afford faster (within 2 weeks) & greater symptomatic relief (than finasteride).
  • Does not affect prostate size.

Disadvantage:

  • Effects last only till drug is given.
  • Benefit declines after few years of continued therapy, due to disease progression.
  • Taken concurrently with finasteride for long-term relief.

Drugs:

  • Prazosin, terazosin, silodosin, doxazosin & alfuzosin – DOC for benign hyperplasia of prostate (BHP).
  • Case-specific management:
    • DOC for BHP cases with hypertension – Prazosin/Doxazosin.
    • DOC for BHP cases without hypertension –Tamsulosin
  • Prazosin:
    • MOA – Blocks α1 receptors in bladder trigone & prostatic smooth muscle –> Improves urine flow & reduces residual urine in bladder.
  • Tamsulosin & Silodosin:
    • Selective inhibitor of α1A receptor (α1 subtype) present in prostate.
  • Advantage:
    • Doesn’t affect receptors in blood vessels – Hence, reduced propensity to cause postural hypotension.
    • Thus preferred for BHP treatment.

2. 5-α reductase inhibitors:

  • 5-α reductase – Enzyme converting DHT to testosterone.
  • Important drugs: 
    • Finasteride & dutasteride.
  • MOA:
    • Testosterone mediates important mechanisms like growth of prostate, male pattern baldness and hirsutism in females, via DHT.
    • By blocking 5-α reductase enzyme, conversion of dihydrotestosterone to testosterone is blocked –> reduced DHT production –> Prostate gland growth is influenced.
    • Hence, BHP treated by arresting growth/reducing prostate size.

Individual drugs:

  • Finasteride:
  • MOA:
    • Antagonist of 5α-reductase, mainly type II.
    • Inhibits conversion of testosterone to dihydrotestosterone & reduces prostate volume.
  • Uses:
    • Moderately effective in reducing prostate size in men with benign prostatic hyperplasia.
    • Used for relieving static component of urinary obstruction in BHP.
    • By reducing serum & prostatic concentrations of dihydrotestosterone –> prostatic volume decrease & urine flow rate increases
    • Delayed action; hence, takes >3 months to exert its beneficial effect.
  • Dose: 5 mg OD, review after 6 months.
  • Adverse effect:
    • Decreased libido
    • Erectile dysfunction
    • Ejaculation disorder – Decreased ejaculates volume.
    • Increased risk of hypospadias.
  • Disadvantage: 
    • Drug withdrawal causes re-growth of prostate.
    • On continued therapy, benefit is maintained for 3 years or more.  

Exam Important

BENIGN HYPERTROPHY OF PROSTATE (BHP)

  • Drugs used for treating BHP include Selective α1-blockers & 5-α reductase inhibitors.
  • α-adrenoceptor blockade results in smooth muscle relaxation in neck of urinary bladder & prostatic urethra, reduces dynamic obstruction, increases urinary flow rate & causes complete bladder emptying in BHP patients.
  • Selective α1-blockers relieves dynamic obstruction & provides rapid symptomatic relief in BHP.
  • Selective α1-blockers afford faster (within 2 weeks) & greater symptomatic relief (than finasteride).
  • Selective α1-blockers relieves voiding symptoms (hesitancy, narrowing of stream, dribbling & increased residual urine) effectively.
  • Selective α1-blockers does not affect prostate size.
  • Selective α1-blockers includes prazosin, terazosin, silodosin, doxazosin & alfuzosin. 
  • Selective α1-blockers are DOC for BHP.
  • DOC for BHP cases with hypertension is Prazosin/Doxazosin.
  • DOC for BHP cases without hypertension –Tamsulosin.
  • Prazosin blocks α1 receptors in bladder trigone & prostatic smooth muscle –> Improves urine flow & reduces residual urine in bladder.
  • Tamsulosin & Silodosin acts by selectively inhibiting α1A receptor (α1 subtype) present in prostate.
  • Tamsulosin & Silodosin has reduced propensity to cause postural hypotension, hence preferred for treating BHP.
  • 5-α reductase inhibitors like Finasteride & dutasteride.
  • 5-α reductase enzyme converts DHT to testosterone.
  • 5-α reductase inhibitors block 5-α reductase enzyme, conversion of dihydrotestosterone to testosterone is blocked –> reduced DHT production –> Prostate gland growth is controlled.
  • 5-α reductase inhibitors treats BHP by arresting growth/reducing prostate size.
  • 5-α reductase inhibitors are used for relieving static component of urinary obstruction in BHP.
  • Finasteride is 5α-reductase antagonistmainly type II.
  • Finasteride inhibits conversion of testosterone to dihydrotestosterone & reduces prostate volume.
  • Finasteride reduces serum & prostatic concentrations of dihydrotestosterone –> prostatic volume decrease & urine flow rate increases, hence useful for BHP treatment.
  • Finasteride exhibits delayed action; hence, takes >3 months to exert its beneficial effect.

 

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