NURS 5432 module 4 (Men's Health and STDs)
Questions & Answers
What drugs should you avoid in a BPH patient
(Ans- anticholinergics... it can increase risk of urinary retention
Which drug classes are used to treat BPH and what do they do?
(Ans-
alpha-1-antagonists: affects contraction around bladder neck and
urethra
5-a-reductase inhibitors: decrease size of prostate
alpha 1 blockers
(Ans-
used for BPH
· 1st line for moderate to severe bothersome symptoms
· Will affect the contraction of the smooth muscle around urethra and
bladder neck
· Takes 2-4 weeks to work
· Can affect BP.. lowers BP... consider orthostatic hypotension as a
potential AE
o Doxazosin—1-8mg PO daily
,o Tamsulosin—0.4-0.8mg PO daily
o Alfuzosin—10mg PO daily
o Terazosin—1mg PO daily... max of 20mg... This one is not as
recommended
5-a-reductase inhibitors
(Ans-
· Blocks conversion of testosterone to dihydrotestosterone, which will
help decrease the size of the prostate
· Most beneficial for men who have a prostate bigger than 40ml
· Needs 6 months to work
o Finasteride—5mg PO daily
o Dutasteride—0.5mg PO daily
· Only use if they have enlarged prostate
· These drugs will decrease risk of acute urinary retention, prosate
cancer
· Used in patients with refractory hematuria after all other causes are
ruled out
· AE
o Decreased libido and ED
,acute prostatitis
(Ans- ·
Inflammatory infection of the prostate that usually has systemic
symptoms (fever, malaise, chills) along with urinary symptoms that
mimic a UTI.
acute prostatitis etiology
(Ans-
o Usually gram-negative bacteria (e. coli)
o Non-bacterial prostatitis most likely from chlamydia, mycoplasma,
Gardnerella
o It is a translocation of bacteria up the urethra... infected urine backs
up into the prostatic parenchyma.
acute prostatitis PE
(Ans-
o Edematous prostate that may be warm, boggy, tender or painful
o Abrupt onset
o Low back pain
, acute prostatitis diagnosis
(Ans-
o UA with culture and sensitivity to find causative agent
o PSA will be increased due to the acute infection, do not screen for
prostate cancer until 4 weeks after treatment
Only need ultrasound if you suspect an abscess
acute prostatitis treatment for the Lower urinary symptoms
(Ans- alpha 1 blockers (zosins)
acute prostatitis treatment (outpatient treatment)
(Ans-
Fluoroquinolones are first line treatment
levofloxacin 500-750mg PO daily 2-4 weeks OR
Ciprofloxacin 500mg PO BID for 2-4 weeks AND
alpha-1 blocker (zosin)
alternative is TMP/SMZ 180/800 BID for 2-4 weeks.. but E. coli is very
resistant to this.. so be careful
Questions & Answers
What drugs should you avoid in a BPH patient
(Ans- anticholinergics... it can increase risk of urinary retention
Which drug classes are used to treat BPH and what do they do?
(Ans-
alpha-1-antagonists: affects contraction around bladder neck and
urethra
5-a-reductase inhibitors: decrease size of prostate
alpha 1 blockers
(Ans-
used for BPH
· 1st line for moderate to severe bothersome symptoms
· Will affect the contraction of the smooth muscle around urethra and
bladder neck
· Takes 2-4 weeks to work
· Can affect BP.. lowers BP... consider orthostatic hypotension as a
potential AE
o Doxazosin—1-8mg PO daily
,o Tamsulosin—0.4-0.8mg PO daily
o Alfuzosin—10mg PO daily
o Terazosin—1mg PO daily... max of 20mg... This one is not as
recommended
5-a-reductase inhibitors
(Ans-
· Blocks conversion of testosterone to dihydrotestosterone, which will
help decrease the size of the prostate
· Most beneficial for men who have a prostate bigger than 40ml
· Needs 6 months to work
o Finasteride—5mg PO daily
o Dutasteride—0.5mg PO daily
· Only use if they have enlarged prostate
· These drugs will decrease risk of acute urinary retention, prosate
cancer
· Used in patients with refractory hematuria after all other causes are
ruled out
· AE
o Decreased libido and ED
,acute prostatitis
(Ans- ·
Inflammatory infection of the prostate that usually has systemic
symptoms (fever, malaise, chills) along with urinary symptoms that
mimic a UTI.
acute prostatitis etiology
(Ans-
o Usually gram-negative bacteria (e. coli)
o Non-bacterial prostatitis most likely from chlamydia, mycoplasma,
Gardnerella
o It is a translocation of bacteria up the urethra... infected urine backs
up into the prostatic parenchyma.
acute prostatitis PE
(Ans-
o Edematous prostate that may be warm, boggy, tender or painful
o Abrupt onset
o Low back pain
, acute prostatitis diagnosis
(Ans-
o UA with culture and sensitivity to find causative agent
o PSA will be increased due to the acute infection, do not screen for
prostate cancer until 4 weeks after treatment
Only need ultrasound if you suspect an abscess
acute prostatitis treatment for the Lower urinary symptoms
(Ans- alpha 1 blockers (zosins)
acute prostatitis treatment (outpatient treatment)
(Ans-
Fluoroquinolones are first line treatment
levofloxacin 500-750mg PO daily 2-4 weeks OR
Ciprofloxacin 500mg PO BID for 2-4 weeks AND
alpha-1 blocker (zosin)
alternative is TMP/SMZ 180/800 BID for 2-4 weeks.. but E. coli is very
resistant to this.. so be careful
