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LUTS/BPH Manifestations Quiz
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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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