LUTS/BPH Manifestations Quiz
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Questions and Answers

Which subtype of alpha-1 receptors predominates in the human prostate?

  • α2
  • α1B
  • α1A (correct)
  • α1D

    • What is the primary effect of adrenergic stimulation of α1A receptors in the bladder neck?

  • Decrease bladder neck closure
  • Decrease urine flow
  • Increase bladder neck closure (correct)
  • Increase bladder hypertrophy

    • In patients with bladder outlet obstruction, which subtype of alpha-1 receptors increases with bladder hypertrophy?

  • α1A
  • α1D (correct)
  • α1B
  • α2

    • Which drug class can interact with PDE5 inhibitors and result in significant blood pressure lowering?

    <p>Alpha-blockers</p> Signup and view all the answers

    What is a common side effect associated with the use of Tamsulosin?

    <p>Retrograde ejaculation</p> Signup and view all the answers

    What is the mechanism of action of uro-selective alpha-1A-adrenergic antagonists like tamsulosin and silodosin in the treatment of lower urinary tract symptoms in BPH?

    <p>Blockade of alpha-1A-adrenoceptors leading to smooth muscle relaxation</p> Signup and view all the answers

    Which of the following statements is true regarding the selectivity of Tamsulosin?

    <p>Moderate selectivity for alpha-1B-adrenoceptors over alpha-1A-adrenoceptors</p> Signup and view all the answers

    What is the impact of Silodosin's selectivity for alpha-1A-adrenoceptors over alpha-1B-adrenoceptors?

    <p>Increased efficacy in treating BPH symptoms</p> Signup and view all the answers

    Which of the following is a common side effect associated with Tamsulosin use?

    <p>Retrograde ejaculation</p> Signup and view all the answers

    When initiating Terazosin and Doxazosin therapy, what precaution is important due to their mechanism of action?

    <p>Start with a low dose at bedtime to reduce first-dose phenomenon risk</p> Signup and view all the answers

    Which of the following best describes the typical voiding symptoms associated with LUTS/BPH?

    <p>Slow urinary stream, straining to void, and terminal dribbling</p> Signup and view all the answers

    What is the main reason storage symptoms are often more bothersome than voiding symptoms in LUTS/BPH?

    <p>Storage symptoms affect daily activities more significantly</p> Signup and view all the answers

    Which of the following is true about the histology of the prostate gland?

    <p>The supporting stroma includes autonomic nerve cells and inflammatory cells</p> Signup and view all the answers

    What is the underlying cause of BPH according to the text?

    <p>Inflammation and sex hormones influencing stromal and secretory epithelial cells proliferation</p> Signup and view all the answers

    Which side effect is commonly associated with Tamsulosin use?

    <p>Orthostatic hypotension</p> Signup and view all the answers

    Which side effect is less common with 'uroselective' alpha-adrenergic receptor antagonists?

    <p>Postural hypotension</p> Signup and view all the answers

    Which alpha-adrenergic receptor antagonist is associated with improved ejaculation?

    <p>Tamsulosin</p> Signup and view all the answers

    Which PDE 5 inhibitor could potentiate the hypotensive effects of Terazosin and Doxazosin?

    <p>Vardenafil</p> Signup and view all the answers

    When initiating treatment with Terazosin or Doxazosin, what adverse effect should be considered due to potential drug interactions?

    <p>Postural hypotension</p> Signup and view all the answers

    Which is a common side effect of Tamsulosin use?

    <p>Impaired ejaculation</p> Signup and view all the answers

    How does penile fibrosis affect the penis?

    <p>Decreases the number of corporal smooth muscle cells</p> Signup and view all the answers

    What is the consequence of untreated Clinical BPH?

    <p>Acute urinary retention</p> Signup and view all the answers

    Which component of BPH involves the compression of the urethra due to hyperplastic prostatic tissue?

    <p>Static component</p> Signup and view all the answers

    What is a common side effect associated with Tamsulosin?

    <p>Ejaculation disorder</p> Signup and view all the answers

    How do PDE-5 inhibitors interact with other drugs commonly used for erectile dysfunction?

    <p>They may potentiate the hypotensive effects when taken concurrently with nitrates</p> Signup and view all the answers

    What is the main impact of PDE5 inhibition on smooth muscle relaxation in the urinary tract?

    <p>Activating Protein Kinase G</p> Signup and view all the answers

    How does Tamsulosin affect ejaculation in patients with BPH?

    <p>Causes retrograde ejaculation</p> Signup and view all the answers

    Which drug class commonly interacts with PDE5 inhibitors and can lead to significant blood pressure lowering?

    <p>Calcium channel blockers</p> Signup and view all the answers

    What is the primary mechanism of action for initiating Terazosin and Doxazosin in patients with BPH?

    <p>Activation of alpha-1 adrenergic receptors</p> Signup and view all the answers

    What is a common side effect associated with the use of Tamsulosin in BPH patients?

    <p>Dizziness upon standing</p> Signup and view all the answers

    Which enzyme converts testosterone into DHT?

    <p>5-Alpha Reductase</p> Signup and view all the answers

    In which of the following conditions does DHT play a causative role?

    <p>Benign Prostatic Hyperplasia</p> Signup and view all the answers

    Which form of 5-Alpha Reductase is primarily active in reproductive tissues and the hair follicle?

    <p>Type II</p> Signup and view all the answers

    Which enzyme is responsible for converting testosterone into DHT by reducing a double bond in the 'A-ring' of testosterone?

    <p>5-Alpha Reductase</p> Signup and view all the answers

    What is the primary role of DHT in musculoskeletal development?

    <p>Prostate enlargement</p> Signup and view all the answers

    Which enzyme is NOT involved in the conversion of testosterone into DHT?

    <p>Aromatase</p> Signup and view all the answers

    Where is the Type I form of 5-Alpha Reductase mostly active?

    <p>Liver, bone, and non-genital skin</p> Signup and view all the answers

    What is the primary biological function of DHT?

    <p>Facial hair growth stimulation.</p> Signup and view all the answers

    WHat is the Brand for Silenafil

    <p>Viagra</p> Signup and view all the answers

    What is the Brand name for Tadalafil

    <p>Cialis</p> Signup and view all the answers

    What is the brand name for avanafil

    <p>Spedra</p> Signup and view all the answers

    What is the brand name for Vardenadil

    <p>Levitra</p> Signup and view all the answers

    Which PDE5 has the longest half life

    <p>Cialis</p> Signup and view all the answers

    Which of this PDE5 can be taken once a day?

    <p>Cialis</p> Signup and view all the answers

    Viagra has the shortest half life out of all the PDE5

    <p>True</p> Signup and view all the answers

    Which PDE5 can be taken with food without any effect?

    <p>Cialis</p> Signup and view all the answers

    Acetylcholine acts at the muscarinic receptors on the vascular endothelial cells to increase the production of nitric oxide

    <p>True</p> Signup and view all the answers

    What is the role of Protein Kinase G (PKG) in the relaxation of penile vascular smooth muscle?

    <p>Inhibiting membrane depolarization</p> Signup and view all the answers

    Which action of Protein Kinase G (PKG) contributes to muscle relaxation?

    <p>Detaching myosin from actin</p> Signup and view all the answers

    What is the consequence of PKG opening K+ channels on vascular smooth muscle cells?

    <p>Hyperpolarization of smooth muscle cells</p> Signup and view all the answers

    How does PKG's action on K+ channels affect Ca++ levels in the smooth muscle cell?

    <p>Promotes sequestration of Ca++ in the endoplasmic reticulum</p> Signup and view all the answers

    What effect does PKG have on the interaction between myosin and actin in smooth muscle cells?

    <p>Prevents myosin detachment from actin</p> Signup and view all the answers

    What is the primary effect of Protein Kinase G (PKG) opening K+ channels on the plasma membrane of vascular smooth muscle cells?

    <p>Promotes hyperpolarization of smooth muscle cells</p> Signup and view all the answers

    How does Protein Kinase G (PKG) action impact the attachment between myosin and actin in smooth muscle cells?

    <p>Detaches myosin head from actin</p> Signup and view all the answers

    What is the consequence of hyperpolarizing the smooth muscle cell by opening K+ channels?

    <p>Prevents membrane depolarization</p> Signup and view all the answers

    What effect does Protein Kinase G (PKG) have on the sequestration of Ca++ in the endoplasmic reticulum of vascular smooth muscle cells?

    <p>Increases sequestration of Ca++</p> Signup and view all the answers

    How does activation of myosin light chain phosphatase by Protein Kinase G (PKG) affect smooth muscle contraction?

    <p>Prevents smooth muscle contraction</p> Signup and view all the answers

    How do PDE5 inhibitors facilitate smooth muscle relaxation?

    <p>By activating myosin phosphatase through increased cGMP levels</p> Signup and view all the answers

    What is the role of myosin phosphatase in smooth muscle relaxation?

    <p>Removing phosphate groups from myosin</p> Signup and view all the answers

    What is the mechanism of action of PDE5 inhibitors in promoting muscle relaxation?

    <p>Blocking PDE5 activity to prevent cGMP breakdown</p> Signup and view all the answers

    How does the activation of myosin phosphatase counteract contractile force in smooth muscle cells?

    <p>By removing phosphate groups from myosin</p> Signup and view all the answers

    What effect does increased cGMP levels have on myosin phosphatase activity?

    <p>Activates myosin phosphatase activity</p> Signup and view all the answers

    Which protein is involved in smooth muscle contraction and is targeted by myosin phosphatase?

    <p>Myosin</p> Signup and view all the answers

    How do PDE5 inhibitors affect the downstream activation of PKG in the smooth muscle cell?

    <p>By increasing cGMP levels</p> Signup and view all the answers

    What is the primary function of activating myosin phosphatase in smooth muscle cells?

    <p>To facilitate smooth muscle relaxation</p> Signup and view all the answers

    How do PDE5 inhibitors affect smooth muscle relaxation?

    <p>By preventing the degradation of cGMP</p> Signup and view all the answers

    What is the primary role of phosphodiesterase 5 (PDE5) in the body?

    <p>Activating cGMP breakdown</p> Signup and view all the answers

    What happens when cGMP levels are increased in smooth muscle cells?

    <p>Enhanced PKG phosphorylation</p> Signup and view all the answers

    How does inhibiting PDE5 affect cGMP levels in cells?

    <p>Decreases cGMP breakdown</p> Signup and view all the answers

    What is the significance of cGMP degradation in cellular processes?

    <p>Controls cellular response to second messengers</p> Signup and view all the answers

    Which enzyme is responsible for breaking down cGMP in the body?

    <p>Phosphodiesterase 5 (PDE5)</p> Signup and view all the answers

    What downstream effect does increased cGMP levels have on smooth muscle relaxation?

    <p>Enhanced PKG phosphorylation</p> Signup and view all the answers

    Which of the following is a contraindication for using PDE5 inhibitors?

    <p>Regular use of organic nitrates</p> Signup and view all the answers

    What is a potential risk associated with the longer half-life of tadalafil in terms of drug interactions?

    <p>Increased risk for drug interactions</p> Signup and view all the answers

    How does prolonged usage of PDE5 inhibitors affect the risk of priapism?

    <p>Increases the risk of priapism</p> Signup and view all the answers

    Which factor contributes to the potential dangerous hypotension when PDE5 inhibitors are co-administered with alpha-adrenergic receptor antagonists?

    <p>Additive effect on blood pressure lowering</p> Signup and view all the answers

    What is the potential consequence of not treating priapism caused by PDE5 inhibitors?

    <p>Structural damage to the penis</p> Signup and view all the answers

    What is the recommended minimum time to leave for absorption after taking sildenafil or valdenafil?

    <p>60 minutes</p> Signup and view all the answers

    How long should men using tadalafil (Cialis® as needed) wait for absorption after intake?

    <p>2 hours</p> Signup and view all the answers

    What is the primary role of cGMP in smooth muscle relaxation?

    <p>Activate myosin phosphatase</p> Signup and view all the answers

    How does activation of myosin light chain phosphatase by Protein Kinase G (PKG) affect smooth muscle contraction?

    <p>Induces smooth muscle relaxation</p> Signup and view all the answers

    Which enzyme is responsible for breaking down cGMP in the body?

    <p>Phosphodiesterase 5 (PDE5)</p> Signup and view all the answers

    Which type of cells are NOT part of the supporting stroma of the prostate?

    <p>Epithelial cells</p> Signup and view all the answers

    Among the components of the prostate's supporting stroma, which one is primarily responsible for muscle contraction?

    <p>Smooth muscle cells</p> Signup and view all the answers

    Which cell type in the prostate's supporting stroma is likely to be involved in immune responses and inflammation?

    <p>Inflammatory cells</p> Signup and view all the answers

    Which component of the prostate's stroma plays a key role in maintaining blood vessel integrity?

    <p>Autonomic nerve cells</p> Signup and view all the answers

    Among the listed supporting stroma components, which one is NOT directly involved in facilitating nutrient exchange in the prostate tissue?

    <p>Smooth muscle cells</p> Signup and view all the answers

    What is the primary reason for Tamsulosin's minimal interaction with alpha-1b receptors?

    <p>Selective binding to alpha-1a receptors</p> Signup and view all the answers

    Which uroselective alpha-blocker is associated with an enhanced safety profile due to its specific targeting of alpha-1 receptors?

    <p>Silodosin</p> Signup and view all the answers

    What distinguishes Silodosin from other alpha-blockers in terms of receptor selectivity?

    <p>Preference for alpha-1A-adrenoceptors</p> Signup and view all the answers

    Which characteristic makes Doxazosin and Terazosin unique among the uroselective alpha-blockers?

    <p>Potential for drug interactions</p> Signup and view all the answers

    Which factor contributes to Alfuzosin's effectiveness in managing BPH symptoms?

    <p>Selective binding to prostate and bladder neck receptors</p> Signup and view all the answers

    What makes Tamsulosin favorable in terms of side effect prevention compared to non-uroselective alpha-blockers?

    <p>Reduction in the risk of specific side effects</p> Signup and view all the answers

    Which alpha-blocker has the slowest absorption rate among the mentioned drugs?

    <p>Alfuzosin</p> Signup and view all the answers

    Which alpha-blocker is known for its association with a low incidence of ejaculatory dysfunction?

    <p>Silodosin</p> Signup and view all the answers

    Which alpha-blocker is often prescribed off-label for the treatment of urinary hesitancy and urgency incontinence?

    <p>Terazosin</p> Signup and view all the answers

    Among the mentioned alpha-blockers, which one offers sustained-release formulations eliminating the need for frequent dose titration?

    <p>Alfuzosin</p> Signup and view all the answers

    Which alpha-blocker interacts with both alpha-1a and alpha-1b receptors, providing broader coverage but less preferred in BPH due to postural hypotension?

    <p>Doxazosin</p> Signup and view all the answers

    Which alpha-blocker exhibits a shorter half-life of approximately 8 hours, necessitating twice daily dosing?

    <p>Silodosin</p> Signup and view all the answers

    Study Notes

    Alpha-1 Receptors and Bladder Function

    • Alpha-1 receptors are located in the bladder neck, prostate, and urethra
    • Alpha-1A receptors are more common in women than men
    • Alpha-1 receptors are rare in the detrusor muscle

    Subtypes of Alpha-1 Receptors

    • Alpha-1A receptors: prevail in the bladder neck, lead to an increase in bladder neck closure upon adrenergic stimulation
    • Alpha-1B receptors: less common in the bladder neck, but increase with bladder hypertrophy
    • Alpha-1D receptors: predominate in the spinal cord and afferent nerves, blockade decreases LUTS symptoms

    Receptor Sites in the Urinary Tract

    • Bladder neck (internal urethral sphincter): alpha-1A receptors
    • Prostate: alpha-1A receptors (predominate in prostate stromal smooth muscle)

    Pharmacologic Treatment Options for BPH

    • Alpha-1 receptor antagonists: target alpha-1A receptors, leading to smooth muscle relaxation and improvement in urine flow
    • Uro-selective alpha-1 adrenergic antagonists: exhibit selectivity for alpha-1A receptors, reducing side effects

    Treatment of BPH

    • Alpha-1 receptor antagonists: block alpha-1A receptors, leading to smooth muscle relaxation and improvement in urine flow
    • Tamsulosin: exhibits a modest degree of selectivity for alpha-1A receptors, shows 162/1 selectivity for alpha-1A receptors vs. alpha-1B receptors
    • Silodosin: shows 162/1 selectivity for alpha-1A receptors vs. alpha-1B receptors

    Lower Urinary Tract Symptoms (LUTS) Associated with BPH

    • Storage symptoms: urinary frequency, urgency, nocturia, and incontinence
    • Voiding symptoms: slow urinary stream, straining to void, urinary intermittency, and hesitancy

    Anatomy of the Prostate Gland

    • The prostate has four distinct regions: anterior fibromuscular zone, and glandular peripheral, central, and transitional zones
    • The prostate has two basic compartments: glandular (secretory) epithelium and supporting stroma

    Benign Prostatic Hyperplasia (BPH)

    • Occurs when both stromal and secretory epithelial cells of the prostate (mainly in the transitional zone surrounding the urethra) proliferate
    • Can slow the flow of urine even if the overall size of the gland is nearly normal

    Consequences of Untreated Clinical BPH

    • Acute urinary retention
    • Urinary tract infection
    • Bladder calculi
    • Renal impairment
    • Bladder damage
    • Hematuria

    PDE5 Inhibitors

    • Inhibit the breakdown of cGMP, leading to smooth muscle relaxation
    • Phosphodiesterase type 5 (PDE5) inhibitors: sildenafil, tadalafil, and vardenafil
    • Locations of PDE5 enzyme: detrusor smooth muscle layers, bladder neck, prostatic stromal smooth muscle cell layers, and vascular smooth muscle layers

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    Test your knowledge on the typical manifestations of Lower Urinary Tract Symptoms (LUTS) and Benign Prostatic Hyperplasia (BPH) including storage and voiding symptoms. Explore topics such as glandular epithelial cells, stroma histology of the prostate gland, and anatomy of the prostate.

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