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Pharm II Exam 2 > Drugs & Sexuality > Flashcards

Drugs & Sexuality Flashcards

1
Q

What adverse side effects are associated with sildenafil?

A

hypotension, headache, flushing, indigestion

less commonly- visual disturbance and acute hearing loss

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2
Q

Discuss the significant drug interactions that can occur with sildenafil.

A

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.

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3
Q

Discuss the pharmacokinetics of sildenafil.

A

It should be taken one hour before sex and it is metabolized by CYP3A4.

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4
Q

Describe the mechanism of action of prostaglandin E.

A

It causes vasodilation

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5
Q

What adverse effects are associated with prostaglandin E?

A

hypotension, mild penile pain, and occasional priapism

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6
Q

What is the clinical indication for sildenafil or prostaglandin E?

A

Erectile dysfunction.

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7
Q

How is prostaglandin E administered?

A

As an injectable or urethral suppository.

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8
Q

Which hormones and neurotransmitters increase libido?

A

Testosterone, dopamine, NE, ACh, dopamine

*And potentially estrogen/LH/FSH in females.

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9
Q

What hormones and neurotransmitters decrease libido?

A

Prolactin, estrogen in males, serotonin, and possibly progesterone

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10
Q

In what other capacities can PDE5 inhibitors like sildenafil be used?

A

To treat BPH and pulmonary hypertension

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11
Q

What is yohimbine?

A

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.)

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12
Q

What are the basic targets for pharmacologic libido enhancement?

A

Testosterone replacement and dopamine agonists

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13
Q

Describe the relationship between the peripheral nervous system and sexual function.

A

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.

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14
Q

Of the antihypertensives, which classes have minimal effects on sexual performance?

A

Ca++ channel blockers, ACEIs, ARBs, and direct renin inhibitors.

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15
Q

What sexual side effects are associated with ganglionic blockers?

A

Total failure of erection and orgasm

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16
Q

What sexual side effects are associated with clonidine and methyldopa?

A

Decreased libido, impotence, and interference with orgasm (these drugs inhibit NE release via a2 agonism for essential htn)

17
Q

What sexual side effects are associated with alpha-1 blockers?

A

Ejaculatory failure (but NOT erection failure) [remember that NE increases libido and is part of sympathetic NS]

18
Q

What sexual side effects are associated with beta blockers?

A

5-10% have ED, and they may decrease libido

19
Q

What sexual side effects are associated with thiazide diuretics?

A

Impotence, decreased libido, and difficulty ejaculating (I’m guessing it’s similar to spironolactone by losing testosterone in urine)

20
Q

What sexual side effects are associated with spironolactone?

A

Decreased libido and impotence. (you’re dumping out testosterone)

21
Q

Which psychoactive drugs significantly interfere with sexual performance?

A

antipsychotics, SSRIs, TCAs, and MAOIs (all of these increase serotonin levels which decreases libido)

22
Q

Which psychoactive drugs have fewer sexual side effects?

A

Bupropion, mirtazapine, vilazodone, and trazodone. Levodopa actually increases libido b/c it increases DA

23
Q

What is the most common sexual side effect associated with MAOIs?

A

Orgasm/ejaculation difficulty

24
Q

Which recreational drugs increase libido/sensation in low doses?

A

Alcohol, marijuana (sensation), cocaine/amphetamines, sometimes opioids, LSD, and MMDA

25
Q

Which recreational drug can inhibit sensation regardless of dose?

A

PCP

26
Q

Chronic use of which recreational drugs leads to loss of libido and ejaculatory failure?

A

Cocaine/amphetamines and opioids

27
Q

How does chronic marijuana use impact sexual performance?

A

It decreases spermatogenesis causing infertility problems, decreases testosterone, and leads to anovulation in women

28
Q

Describe the mechanism of action of Sildenafil.

A

It is a PDE5 inhibitor. PDE5 degrades cGMP, so by inhibiting this the cGMP (activated by NO release) remains available for vasodilation and thus, erection.

Pharm II Exam 2 (3 decks)

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