Drugs for Fertility Flashcards
Which medication is most appropriate for treating erectile dysfunction in patients who also have antidepressant-induced erectile dysfunction?
A. Alprostadil
B. Sildenafil
C. Clomipramine
D. Flibanserin
B. Sildenafil: Correct. PDE5 inhibitors like sildenafil are the drugs of choice for erectile dysfunction, including cases induced by antidepressants.
A. Alprostadil: Incorrect. Alprostadil is typically used when PDE5 inhibitors are ineffective or contraindicated, not as the first-line treatment for erectile dysfunction.
C. Clomipramine: Incorrect. Clomipramine is used for premature ejaculation, not erectile dysfunction.
D. Flibanserin: Incorrect. Flibanserin is approved for female sexual interest/arousal disorder, not male erectile dysfunction.
Which of the following is a common adverse effect of PDE5 inhibitors?
A. Priapism
B. Nasal congestion
C. Permanent vision loss
D. Chest pain
B. Nasal congestion: Correct. Nasal congestion is a common adverse effect of PDE5 inhibitors, along with headache flushing, and dyspepsia. These occur because PDE5 inhibitors enhance blood flow, which can also lead to increased vascular congestion in mucosal tissues.
A. Priapism: Incorrect. Priapism is a rare but serious adverse effect, not a common one.
C. Permanent vision loss: Incorrect. While rare, permanent vision loss is a potential adverse effect, but it is not common.
D. Chest pain: Incorrect. Chest pain may occur but is a rare and serious adverse effect requiring emergency care.
In female sexual interest/arousal disorder (FSIAD), which therapy is approved for low sexual desire in premenopausal patients?
A. Testosterone supplementation
B. Flibanserin
C. Sildenafil
D. Vaginal DHEA
**B. Flibanserin: Correct. Flibanserin is a serotonin agonist/antagonist approved for low sexual desire in premenopausal women. Its action on serotonin and dopamine pathways is thought to balance neurotransmitters associated with sexual desire. However, its use is limited due to modest efficacy, a daily dosing requirement, and risks of adverse effects like syncope when combined with alcohol.
**
A. Testosterone supplementation: Incorrect. Testosterone is not approved for women and lacks robust safety data for use in FSIAD.
C. Sildenafil: Incorrect. Sildenafil has not been found useful for female sexual dysfunction.
D. Vaginal DHEA: Incorrect. Vaginal DHEA is used to improve genital sensitivity and dyspareunia but is not specifically approved for FSIAD.
What is the most appropriate pharmacologic intervention for genitourinary syndrome of menopause (GSM)?
A. Systemic testosterone
B. Intravaginal estrogen
C. Sodium cromoglycate
D. PDE5 inhibitors
B. Intravaginal estrogen: Correct. Intravaginal estrogen is effective in restoring vaginal health, increasing blood flow, and managing symptoms of GSM.
A. Systemic testosterone: Incorrect. Testosterone supplementation is not approved for GSM.
C. Sodium cromoglycate: Incorrect. Sodium cromoglycate is used for provoked vestibulodynia, not GSM.
Vestibulodynia - is chronic or recurrent pain localized at the area surrounding the vaginal opening.
D. PDE5 inhibitors: Incorrect. PDE5 inhibitors are not indicated for GSM.
Which antidepressant is considered “sexually neutral” and less likely to cause sexual dysfunction?
A. Citalopram
B. Venlafaxine
C. Mirtazapine
D. Paroxetine
C. Mirtazapine: Correct. Mirtazapine is considered “sexually neutral” and less likely to cause sexual dysfunction.
Mirtazapine is classified as a tetracyclic antidepressant (TeCA) and is primarily used to treat major depressive disorder (MDD)
A. Citalopram: Incorrect. Citalopram, like most SSRIs, is associated with sexual dysfunction.
B. Venlafaxine: Incorrect. Venlafaxine, an SNRI, also has a higher risk of causing sexual dysfunction.
D. Paroxetine: Incorrect. Paroxetine is associated with a high risk of sexual dysfunction.
Mechanism of action of Mirtazapine:
Mechanism of Action
Antagonist at α2-adrenergic receptors: Inhibits the α2-autoreceptors and heteroreceptors, enhancing the release of norepinephrine and serotonin. This disinhibition increases neurotransmitter availability, improving mood.
Serotonin receptor modulation:
Blocks 5-HT2A, 5-HT2C, and 5-HT3 receptors, promoting the activity of the 5-HT1A receptor, which has mood-enhancing effects.
The blockade of 5-HT3 reduces nausea and gastrointestinal side effects often seen with selective serotonin reuptake inhibitors (SSRIs).
Histamine H1 receptor antagonist: Causes sedative effects, making it useful for individuals with insomnia associated with depression.
Minimal activity on serotonin or norepinephrine reuptake: Unlike SSRIs or SNRIs, mirtazapine does not inhibit reuptake but enhances neurotransmitter levels through receptor modulation.
Indications
Major depressive disorder (MDD): Particularly in patients with insomnia or poor appetite due to its sedative and appetite-stimulating effects.
Off-label uses: Anxiety disorders, post-traumatic stress disorder (PTSD), and as an adjunct in other psychiatric conditions.
Adverse Effects
Sedation: Due to strong H1 receptor antagonism.
Weight gain: Caused by increased appetite through histamine and serotonin receptor modulation.
Dry mouth, dizziness, and constipation: Common side effects.
Unique Features
Unlike SSRIs and SNRIs, mirtazapine is less likely to cause sexual dysfunction and gastrointestinal issues.
Its sedative properties make it a dual-purpose medication for depression with insomnia.
In summary, mirtazapine is a tetracyclic antidepressant with a unique receptor-targeting profile, offering therapeutic benefits for depression with a side effect profile that may suit certain patient populations better than other antidepressants.
Which of the following is true regarding the use of PDE5 inhibitors in erectile dysfunction?
A. Absorption of sildenafil is delayed by high-fat meals.
B. Tadalafil has the shortest duration of action.
C. PDE5 inhibitors are safe to combine with nitrates.
D. Sildenafil is ineffective for premature ejaculation.
A. Absorption of sildenafil is delayed by high-fat meals: Correct. High-fat meals can delay sildenafil absorption.
B. Tadalafil has the shortest duration of action: Incorrect. Tadalafil has the longest duration of action, lasting up to 36 hours.
C. PDE5 inhibitors are safe to combine with nitrates: Incorrect. PDE5 inhibitors are contraindicated with nitrates due to the risk of severe hypotension.
D. Sildenafil is ineffective for premature ejaculation: Incorrect. Sildenafil may be beneficial for premature ejaculation, sometimes exceeding the benefits of antidepressants.
