Drugs & Sexuality Flashcards
What adverse side effects are associated with sildenafil?
hypotension, headache, flushing, indigestion
less commonly- visual disturbance and acute hearing loss
Discuss the significant drug interactions that can occur with sildenafil.
It has a significant interaction with nitrates, causing large drop in BP, syncope, decreased cardiac perfusion and MI. This includes nitroglycerin, nitroprusside, and pentaethrytritol tentranitrate.
Discuss the pharmacokinetics of sildenafil.
It should be taken one hour before sex and it is metabolized by CYP3A4.
Describe the mechanism of action of prostaglandin E.
It causes vasodilation
What adverse effects are associated with prostaglandin E?
hypotension, mild penile pain, and occasional priapism
What is the clinical indication for sildenafil or prostaglandin E?
Erectile dysfunction.
How is prostaglandin E administered?
As an injectable or urethral suppository.
Which hormones and neurotransmitters increase libido?
Testosterone, dopamine, NE, ACh, dopamine
*And potentially estrogen/LH/FSH in females.
What hormones and neurotransmitters decrease libido?
Prolactin, estrogen in males, serotonin, and possibly progesterone
In what other capacities can PDE5 inhibitors like sildenafil be used?
To treat BPH and pulmonary hypertension
What is yohimbine?
It is an alpha-2 agonist/partial agonist that may increase libido and improve ED but its efficacy is not well known and it causes many side effects (nausea, sweating, palpitations, tremor, etc.)
What are the basic targets for pharmacologic libido enhancement?
Testosterone replacement and dopamine agonists
Describe the relationship between the peripheral nervous system and sexual function.
Parasympathetic stimulation leads to arousal and penile engorgement/clitoral erection. Sympathetic stimulation leads to ejaculation and uterine/fallopian tube/vagina contraction. Somatic response contributes to orgasm.
Of the antihypertensives, which classes have minimal effects on sexual performance?
Ca++ channel blockers, ACEIs, ARBs, and direct renin inhibitors.
What sexual side effects are associated with ganglionic blockers?
Total failure of erection and orgasm
What sexual side effects are associated with clonidine and methyldopa?
Decreased libido, impotence, and interference with orgasm (these drugs inhibit NE release via a2 agonism for essential htn)
What sexual side effects are associated with alpha-1 blockers?
Ejaculatory failure (but NOT erection failure) [remember that NE increases libido and is part of sympathetic NS]
What sexual side effects are associated with beta blockers?
5-10% have ED, and they may decrease libido
What sexual side effects are associated with thiazide diuretics?
Impotence, decreased libido, and difficulty ejaculating (I’m guessing it’s similar to spironolactone by losing testosterone in urine)
What sexual side effects are associated with spironolactone?
Decreased libido and impotence. (you’re dumping out testosterone)
Which psychoactive drugs significantly interfere with sexual performance?
antipsychotics, SSRIs, TCAs, and MAOIs (all of these increase serotonin levels which decreases libido)
Which psychoactive drugs have fewer sexual side effects?
Bupropion, mirtazapine, vilazodone, and trazodone. Levodopa actually increases libido b/c it increases DA
What is the most common sexual side effect associated with MAOIs?
Orgasm/ejaculation difficulty
Which recreational drugs increase libido/sensation in low doses?
Alcohol, marijuana (sensation), cocaine/amphetamines, sometimes opioids, LSD, and MMDA
