ED Flashcards

1
Q

Treatment goals of male sexual dysfunction

A
  1. Imrprove libido
  2. Acquire and sustain erection
  3. Treat premature ejactulations
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2
Q

Main class of drugs for ED

A

Phosphodiesterase-5 inhibitors

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3
Q

Dose of sildenafil and dosing instructions

A

50 - 100 mg, 30 mins before sex
- Duration of action: 4h

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4
Q

Dosing of vardenafil and tadalafil and their dosing instructions

A

10 - 20 mg one hour before sex

Vardenafil duration of action: 4h
Tadalafil duration of action: 36h (very long)

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5
Q

Monitoring for PDE-5 inhibitors?

A
  1. Blood pressure
  2. Pulmonary edema (due to decreased BP, may cause fluid accumulation)
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6
Q

Significant drug interactions with PDE-5 inhibitors and management

A
  1. Nitrates: severe hypotension. Space 48h apart
  2. Antihypertensive: may lead to hypotension
  3. CYP3A4 modulators (increase or decrease concentrations of PDE-5 inhibitors)
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7
Q

Administration counselling points for PDE-5 inhibitors?

A
  • Take on empty stomach
  • Avoid high-fat meals as it may decrease absorption
  • Take xx hours before sexual intercourse
  • Stimulation is still needed for erection
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8
Q

Which PDE-5 inhbitors require renal, hepatic, or both dosing adjustments?

A
  1. Sildenafil: Both (CrCL < 30, half initial dose)
  2. Vardenafil: only if moderate hepatic impairment
  3. Tadalafil: Both (need to adjust starting CrCL ≤50, avoid use in CrCL < 30)
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9
Q

Side effects of PDE-5 inhibitors?

A
  1. Hypotension
  2. Visual disturbances (except avanafil)
  3. Flushing, headache, dyspepsia, etc.
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10
Q

Mechanism of action of alprostadil

A

Prostaglandin E1 agent, directly effect vascular smooth muscle and stimulate corporeal veno-occlusive mechanism

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11
Q

Route of administration and dosing of alprostadil

A

Intracavernous route. Initial 2.5 mcg
- If no response: increase to 7.5 mcg, then 5-10 mcg increaments
- If partial response: Increase to 5 mcg, then 5-10 mcg increaments

Intraurethral route: Initial 125-250 mcg, increase or decrease stepwise until erection achieved

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12
Q

Dose limits of alprostadil

A

Maximum 3x/w, spaced at least 24h between dose

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13
Q

Therapeutic monitoring of alprostadil

A

Ensure erections are firm and lasts for <1h

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