welcome back to the real life pharmacology podcast on today's episode I'm going to cover five Alpha reductase Inhibitors five Alpha reductase Inhibitors are commonly used in BPH that's benign prostatic hypertrophy sometimes called benign prostatic hyperplasia as well and with the symptoms of of BPH uh that can result from the enlargement of the prostate and really can impact our patients as far as urinary function it can exacerbate uh frequency so patients with BPH males with BPH can feel like they have to go to the bathroom all the time uh they can have incomplete bladder emptying and urinary retention the flow of that urine uh coming coming out can be lower and reduced compared to patients uh without issues with BPH and can ultimately lead to uh incontinence as well so how do the five Alpha reductase Inhibitors work uh testosterone and particularly dihydrotestosterone which is a more potent form uh impacts the prostate by causing it to grow and become larger that growth excessive overgrowth of the prostate can kind of block off that uh urine passageway out of the body and that leads to kind of the uh blockage of urine flow out of the body and can lead to some of those symptoms that I mentioned earlier how 5 reductase Inhibitors work is they prevent the conversion of testosterone to dihydrotestosterone which again is the more uh potent form has has stronger activity in the body ultimately what that does is by blocking that conversion it can reduce the growth of the prostate and actually begin to shrink the size of the prostate and therefore alleviating symptoms now one thing that you abs absolutely have to teach patients and I've seen patients come to me and ask this um finasteride uh dutasteride so that's Avodart is dutasteride finasteride is is prar uh most common five Al reductase Inhibitors there it takes a long time to shrink the prostate so what that means is if you've got a patient that starts on it they're on it for a week and they don't don't notice any change in symptoms they don't think the medication is helping uh they're probably right because it takes a really really long time to shrink that prostate we're talking weeks probably more likely months uh before a patient is going to start feeling any potential or identifying any potential relief from their symptoms so um you know 3 to 6 months is probably uh inadequate trial so you need to sure patients are actually taking the medication uh for that amount of time and and not just um stopping it because they don't feel anything within a week or two another important thing to remember with 5el reductase Inhibitors is side effects often times they're they're pretty well tolerated but for sure the most common side effect I've heard uh is sexual dysfunction and impotence okay so definitely remember that adverse effect uh if you think about you know what testosterone does in the body or or dihydrotestosterone does uh it definitely can um give patients a sense of um feeling more energy and and feeling you know strong you know thinking about what testosterone is often used for in the the abuse setting um in professional sports and things like that um it can help with energy and and helping um build strength and muscle so blocking that process kind of blocking that activity um could lead to weakness fatigue and things of that nature I did also want to mention the brand Nam propia uh which is finasteride at a at a 1 mgram dose this is the medication uh classically used for uh hair loss so higher levels or um of dihydro testosterone can potentially lead to male pattern baldness so you may see patients using finasteride to help uh with hair growth and reducing baldness another very very important thing to remember is that this medication takes a really really long time to work for baldness okay so even longer than it takes for BPH um it may be up to uh kind of a year before we we start seeing uh decent results in kind of reversing uh male pattern baldness so definitely kind of a unique uh clinical Quirk with that propa that finasteride uh but a good one to to remember and one that might come up uh on an exam there we're going to take a quick break here and um get get a word from our sponsor and right after that we'll talk about two really important things you need to think about um in the management of BPH and also with the use of five Alpha reductase Inhibitors medad 101.com is a premier website that provides excellent pharmacology education whether you're a nurse pharmacist physician or other Healthcare practitioner we've got a growing list of resources available there check out metad 101.com store again Meed 101.com SL store welcome back to the episode on 5 Al for reductase Inhibitors I wanted to talk about two specific things that um I have come across that are are kind of a little bit interesting so the one you definitely have to remember that finasteride uh prar dutasteride they are a pregnancy risk factor of X which we've kind of steered away from um pregnancy risk factor categorizations but with that said absolutely incredibly important to be extremely careful uh in females who are pregnant now I've worked in healthc care for quite a while long-term care clinic setting all sorts of of different settings and I work with a lot of nurses and many nurses are of childbearing age and that's the kind of angle that I I want you to think about in administering a drug a medication like finasteride if you've got anybody that's a caregiver for any type of elderly male patient at all crushing broken tablets extremely extremely careful with these medications um because because they have uh the potential to cause significant birth defects okay so remember females that are caregivers that might be crushing that may be administering these tablets very very important to be careful on that I've definitely run into that and have had to uh educate uh female nursing staff uh who are pregnant about that as well so you may not think of these medications being used in in females and yeah they they typically aren't um but definitely remember that uh caregiving type patients um for maybe elderly male patients with BPH may be exposed uh to those tablets in some way shape or form so be very very careful there another uh issue that I I definitely think you should pay attention to is whenever you see somebody on on prar or avidar you've got to remember to look out for drugs that exacerbate BPH symptoms so classic examples here are anti-cholinergic medications uh badril hydroxyzine uh tricyclic anti-depressants which I'll talk about in in future episodes of the podcast but any medication potentially with anti-cholinergic adverse effects can absolutely uh exacerbate or worsen urinary retention and contribute to symptoms of BPH most commonly I probably see uh the anticholinergics like badril or Dien hydramine and many many times I've seen patients use that medication such as in Tylenol PM uh to help with sleep rarely I have seen it used for uh allergy symptoms maybe an elderly patient has just always used benad for their allergies cuz it you know works well that type of thing um but you got to remember in a patient on a 5 elf reductase inhibitor this definitely can uh exacerbate those symptoms to use those uh anti-cholinergic and older generation uh antihistamines that wraps up today's episode be sure to go check us out at real life pharmacology share us on Facebook Twitter Instagram wherever you're at we'd certainly appreciate that hope you enjoyed the free education today and I hope you have a great day