Application 2 BPH Blank Student

1. 77-year-old white man presents with a 2-month history of nocturia, dribbling, and decreased urine stream. His American Urological Association symptom score is 6 of 35, his prostate is slightly enlarged, and his prostate-specific antigen concentration is within normal limits. He has not tried to treat his symptoms. He takes amlodipine 5 mg daily for hypertension (HTN) and oral diphenhydramine 50 mg at bedtime for insomnia. Which therapy plan is most appropriate for this patient? A. Initiate dutasteride 0.5 mg/day. B. Initiate tamsulosin 0.8 mg/day. C. Change amlodipine to terazosin. D. Discontinue diphenhydramine. 2. The MD decides to put the patient on tamsulosin for BPH. Which of the following is true regarding tamsulosin? A. B. C. D. Alpha-1 agonist; third generation Alpha-2 blocker; second generation Alpha-1 blocker; third generation 5-α Reductase Inhibitor; second generation 3: What would be an appropriate starting dose for tamsulosin? A. B. C. D. 1 mg/day; titrate slowly to 4 mg/d 0.1 mg/day; titrate slowly to 0.4 mg/d 4 mg/day flat dose 0.4 mg/d; maximum dose of 0.8 mg/d 4: Which of the following is correct counselling point for tamsulosin? A. Take tamsulosin 30 min after same meal every day to reduce risk of low blood pressure B. Take tamsulosin on empty stomach in the morning to allow better absorption C. Take tamsulosin 60 min before meal to help reduce upset stomach D. Tamsulosin helps with ejaculation problems so it should help with your erectile dysfunction as well E. First dose of tamsulosin should be taken in the morning as it can cause difficulty sleeping 5: When would be an appropriate time for the patient to be reassessed for his BPH symptoms after he was started on tamsulosin? A. B. C. D. In one year In six months In three months In one month 6: Which of the current medications that the patient is using may contribute to worsening in BPH symptoms? (choose 2) A. Chlorthalidone B. Omeprazole C. Sildenafil D. Benadryl 7. For which one of the following conditions in a patient with BPH should an anticholinergic agent be avoided? A. Urinary flow rate of 20 mL/s B. Essential hypertension C. Prostate gland of 30 g D. A history of diabetes mellitus E. A postvoid residual urine volume of 250 to 300 mL or more 8. GH is 55 year old male presenting to clinic with symptoms of urinary hesitancy, dribbling and feeling of incomplete emptying of bladder. After the physician doing a physical exam, his assessment is benign prostatic hyperplasia. The patients symptoms are very bothersome to him and would like to start a treatment that can give him relief relatively quickly. PSA= 1.1 ng/dl; Prostate volume= 18 ml. What would be the best next step? A. Start Flomax 0.4mg daily b. Behavioral modification alone c. Start Proscar 5mg daily d. Start Proscar 1mg + Flomax 0.8mg daily 9. PS is a 70 year old man who comes to pick up his refill for Flomax. He also tells you he is scheduled for cataract surgery next week. Which of the following statements is true regarding Intra-operative Floppy Iris Syndrome? a. Flomax is associated with Floppy Iris Syndrome, therefore, you should counsel the patient to let his surgeon know that he is taking Flomax b. Floppy Iris Syndrome occurs mostly in female patients therefore the risk of floppy iris syndrome is low in this patient c. Discontinuing Flomax before cataract surgery will result in reduced risk of Floppy Iris Syndrome during the cataract surgery 10. You received the following prescription: Cialis 5mg PO PRN for BPH”. Which of the following is the most appropriate response? a) Change the dose b) Change the route c) Change the frequency d) Approve the prescription as is