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Spring 15 - Pharm Unit III > ED > Flashcards

ED Flashcards

1
Q

ED

A

failure to achieve or maintain a penile erection suitable for sex

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2
Q

Which 4 systems are necessary for a normal erection?

A
  • vascular system
  • nervous system
  • hormonal system
  • perception of psychogenic stimuli
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3
Q

What factors are associated with ED?

A
  • chronic medical conditions: HTN, DM, CVD/PVD, neuro disorders, endocrine, psych, dyslipidemia, renal/liver dz
  • surgical procedures
  • lifestyle: smoking, age, excessive EtOH, obesity
  • trauma
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4
Q

What medication classes are associated with ED?

A
  • antihypertensives
  • lipid medications
  • antidepressants (TCA, MAOI, SSRI/SNRI)
  • histamine agonists
  • antipsychotics
  • anticonvulsants (CBZ, PHT)
  • antiandrogens and hormones
  • recreational drugs (EtOH, cocaine, MJ, opiates_
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5
Q

General Approach to ED Treatment

A
  • identify and reverse underlying causes
  • assess for ability to safely have sex (cardiac dz)
  • consider partner issues
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6
Q

Non-pharm Tx for ED

A
  • lifestyle modifications where appropriate
  • psychotherapy
  • vacuum erection device
  • surgical tx (penile prosthesis)
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7
Q

PDE 5 Inhibitor MOA

A

-inhibit PDE5 which breaks down cGMP –> smooth muscle relaxation –> erection

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8
Q

What must be present for PDE 5 inhibitors to work?

A

only effective in the presence of sexual stimulation

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9
Q

Which ED drug has the fastest onset?

A

avanafil (Stendra) 15 minutes

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10
Q

Which ED drug has the longest duration?

A

tadalafil (Cialis) up to 36 hours

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11
Q

How are ED drugs dosed?

A
  • 30-60 minutes prior to sexual activity

- no more than once daily

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12
Q

AEs of ED Meds

A
  • HA, facial flushing
  • dyspepsia
  • nasal congestion
  • dizziness, abnormal vision
  • rare prolonged erection (>4) or priapism (>6)
  • decrease in BP 1 hr after dose
  • nonarteritic anterior ischemic optic neuropathy warning
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13
Q

CIs and Precautions for ED Meds

A
  • CI concurrent nitrate use
  • caution with concurrent alpha blocker use (increased risk of HoTN)
  • pts with high CV risk
  • precaution in conditions that predispose to priapism (sickle cell anemia, multiple myeloma, leukemia)
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14
Q

Which CV patients would be considered low CV risk for PDE 5 inhibitors?

A
  • asymptomatic CV dz
  • well controlled HTN
  • mild, stable angina
  • mild CHF
  • mild valvular heart dz
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15
Q

Can low risk pts take PDE 5 inhibitors?

A

yes, can start PDE 5 inhibitor

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16
Q

Which CV patients would be considered intermediate CV risk for PDE 5 inhibitors?

A
  • > 3 risk factors for CV dz
  • moderate stable angina
  • moderate CHF
  • recent MI or stroke w/in 6 weeks
17
Q

Can intermediate risk pts take PDE 5 inhibitors?

A
  • pt needs complete cardiovascular work up

- this determines tolerance to increased myocardial energy consumption assoc w/ sex

18
Q

Which CV patients would be considered high CV risk for PDE 5 inhibitors?

A
  • unstable or symptomatic angina
  • uncontrolled HTN
  • severe CHF
  • recent MI or stroke w/in 2 weeks
  • moderate or severe valvular heart dz
  • high risk cardiac arrhythmias
19
Q

Can high risk pts take PDE 5 inhibitors?

A
  • PDE5 inhibitor is contraindicated

- sex should be deferred

20
Q

When can NTG be given in relation to ED meds?

A
  • no NTG with sildenafil or vardanafil for at least 24 hours

- no NTG for 48 hours with tadalafil

21
Q

Alprostadil (PGE1) MOA and Route

A
  • smooth muscle relaxation of arterial vessels to corpora

- intracavernosal or intraurethral injection

22
Q

Alprostadil AEs

A
  • local pain
  • syncope, dizziness
  • priapism
  • fibrotic reaction at intracavernosal injection site)
23
Q

CIs to Alprostadil

A
  • hx of priapism
  • sickle cell anemia
  • concurrent anticoagulants
  • bleeding disorders
  • sex inadvisable or contraindicated
24
Q

Alprostadil Drug Interactions

A

-risk of HoTN and syncope may be increased with antihypertensive agents

25
Q

Testosterone MOA

A

-supplementation only effective in pts w/ documented low serum testosterone levels

26
Q

AEs of Testosterone

A
  • gynecomastia
  • dyslipidemia
  • polycythemia
  • acne
  • weight gain
  • HTN, edema, HF exacerbation
27
Q

CIs for Testosterone

A
  • prostate cancer
  • breast cancer
  • caution with BPH

Spring 15 - Pharm Unit III (12 decks)

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