ED Flashcards
ED
failure to achieve or maintain a penile erection suitable for sex
Which 4 systems are necessary for a normal erection?
- vascular system
- nervous system
- hormonal system
- perception of psychogenic stimuli
What factors are associated with ED?
- chronic medical conditions: HTN, DM, CVD/PVD, neuro disorders, endocrine, psych, dyslipidemia, renal/liver dz
- surgical procedures
- lifestyle: smoking, age, excessive EtOH, obesity
- trauma
What medication classes are associated with ED?
- antihypertensives
- lipid medications
- antidepressants (TCA, MAOI, SSRI/SNRI)
- histamine agonists
- antipsychotics
- anticonvulsants (CBZ, PHT)
- antiandrogens and hormones
- recreational drugs (EtOH, cocaine, MJ, opiates_
General Approach to ED Treatment
- identify and reverse underlying causes
- assess for ability to safely have sex (cardiac dz)
- consider partner issues
Non-pharm Tx for ED
- lifestyle modifications where appropriate
- psychotherapy
- vacuum erection device
- surgical tx (penile prosthesis)
PDE 5 Inhibitor MOA
-inhibit PDE5 which breaks down cGMP –> smooth muscle relaxation –> erection
What must be present for PDE 5 inhibitors to work?
only effective in the presence of sexual stimulation
Which ED drug has the fastest onset?
avanafil (Stendra) 15 minutes
Which ED drug has the longest duration?
tadalafil (Cialis) up to 36 hours
How are ED drugs dosed?
- 30-60 minutes prior to sexual activity
- no more than once daily
AEs of ED Meds
- 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
CIs and Precautions for ED Meds
- 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)
Which CV patients would be considered low CV risk for PDE 5 inhibitors?
- asymptomatic CV dz
- well controlled HTN
- mild, stable angina
- mild CHF
- mild valvular heart dz
Can low risk pts take PDE 5 inhibitors?
yes, can start PDE 5 inhibitor
Which CV patients would be considered intermediate CV risk for PDE 5 inhibitors?
- > 3 risk factors for CV dz
- moderate stable angina
- moderate CHF
- recent MI or stroke w/in 6 weeks
Can intermediate risk pts take PDE 5 inhibitors?
- pt needs complete cardiovascular work up
- this determines tolerance to increased myocardial energy consumption assoc w/ sex
Which CV patients would be considered high CV risk for PDE 5 inhibitors?
- 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
Can high risk pts take PDE 5 inhibitors?
- PDE5 inhibitor is contraindicated
- sex should be deferred
When can NTG be given in relation to ED meds?
- no NTG with sildenafil or vardanafil for at least 24 hours
- no NTG for 48 hours with tadalafil
Alprostadil (PGE1) MOA and Route
- smooth muscle relaxation of arterial vessels to corpora
- intracavernosal or intraurethral injection
Alprostadil AEs
- local pain
- syncope, dizziness
- priapism
- fibrotic reaction at intracavernosal injection site)
CIs to Alprostadil
- hx of priapism
- sickle cell anemia
- concurrent anticoagulants
- bleeding disorders
- sex inadvisable or contraindicated
Alprostadil Drug Interactions
-risk of HoTN and syncope may be increased with antihypertensive agents
Testosterone MOA
-supplementation only effective in pts w/ documented low serum testosterone levels
AEs of Testosterone
- gynecomastia
- dyslipidemia
- polycythemia
- acne
- weight gain
- HTN, edema, HF exacerbation
CIs for Testosterone
- prostate cancer
- breast cancer
- caution with BPH
