Chapter 50: Sexual Dysfunction

Question 1

Which meds are used to treat hypoactive sexual desire disorder (HSDD) & which patients can use it

Answer 1

Filbanserin (Addyi)
Bremelanotide (injection)

PREmenopausal women only

Question 2

Filbanserin can cause which SE

Answer 2

fainting, hypotension, syncope

Question 3

Filbanserin CI

Answer 3

alcohol (REMS required)
3A4 inhibitors

Question 4

Bremelanotide CI

Answer 4

uncontrolled HTN or known CVD

Question 5

Bremelanotide administration

Answer 5

SC injection

Question 6

ED is common in people with which medical conditions

Answer 6

HTN, atherosclerosis, diabetes

Question 7

Key drugs that can cause ED

Answer 7

• Alcohol
• Antidepressants (esp SSRIs and SNRIs)
• BB, clonidine, thiazides
• FGAs (e.g., chlorpromazine), prolactin-raising SGAs (e.g., risperidone, paliperidone)
• Finasteride, dutasteride, and silodosin (mostly retrograde ejactulation)

Question 8

Antidepressant that does not cause sexual side effects

Answer 8

bupropion

Question 9

Natural products that can be used for ED

Answer 9

yohimbe, L-arginine, ginseng

Ginseng can increase risk of bleeding

Question 10

Which ED med is also used for BPH

Answer 10

Tadalafil

Question 11

Which ED meds are also used for PAH

Answer 11

sildenafil and tadalafil

Question 12

PED5 inhibitors MOA

Answer 12

sexual stimulation → release of NO → increases cGMP → smooth muscle relaxation → blood flows in → erection
PDE5i block PDE-5 from degrading cGMP

Question 13

T/F: PDE5 inhibitors can also increase libido

Answer 13

FALSE - sexual desire must be present for these drugs to work

Question 14

Sildenafil brand name

Answer 14

Viagra

Revatio for PAH

Question 15

Tadalafil brand name

Answer 15

Cialis

Adcirca for PAH

Question 16

PDE5 inhibitor MOA

Answer 16

block PDE5 from degrading cGMP to prolong smooth muscle relaxation

these do NOT increase libido

Question 17

Sildenafil starting dose and when should it be taken

Answer 17

50 mg

~1 hour before sexual activity

Question 18

Vardenafil starting dose and when should it be taken

Answer 18

10 mg

~1 hour before sexual activity

Question 19

Tadalafil starting dose and when should it be taken

Answer 19

10 mg

at least 30 min before sexual activity

Question 20

Tadalafil on demand dosing

Answer 20

5-20 mg daily PRN

Question 21

Avanafil starting dose and when should it be taken

Answer 21

100 mg

15-30 min before sexual activity

Question 22

PDE5i CI

Answer 22

do not use with nitrates or riociguat

Question 23

PDE5i warnings

Answer 23

impaired color discrimination, hearing loss, vision loss, hypotension, priapism

Question 24

Seek emergency medical help with PDE5i if erection lasts > __ hrs

Answer 24

4

Question 25

PDE5i SE

Answer 25

HA, flushing, dizziness, dyspepsia, back pain (mostly with tadalafil)

Question 26

Which PDE5 inhibitors can have decreased efficacy if taken with high-fat or large meal

Answer 26

Sildenafil and vardenafil

Question 27

PDE5i doses should be decreased by 50% if:

Answer 27

≥ 65 years old
Using alpha blocker
Using 3A4 inhibitor
Severe renal or liver disease

Question 28

Alprostadil MOA

Answer 28

prostaglandin E1, vasodilator

Question 29

Alprostadil formulations

Answer 29

injected into the penis or a pellet is inserted through the urethra

Question 30

Alprostadil SE

Answer 30

penile pain, priapism

Question 31

alprostadil pellets storage information

Answer 31

refrigerate

Question 32

Filbanserin MOA

Answer 32

agonist at 5-HT1A and antagonist at 5-HT2A receptors