ED Flashcards
analog of PGE1
Stimulation of adenyl cyclase causes increased production of cAMP which causes smooth-muscle relaxation of the arterial blood vessels to
and sinusoidal tissues in the corpora. This results in enhanced blood flow to and blood filling of the corpora
Alprostadil
can cause weight gain, or exacerbate
hypertension, congestive heart failure, and edema
sodium retention a/e of testosterone replacement therapy
caused by inhibition of PDE11 in muscle
back and muscle pain PDE5 inhibitors
Caution is recommended in airplane pilots
PDE5; rely on green and blue
lights for landing planes
decreases intracellular calcium
concentrations to produce smooth-muscle relaxation in cells of the arteries
and cavernosal sinuses. Arterial blood flow to and blood filling of the corpora
are enhanced, and a penile erection results
cAMP
enhances the activity of
guanylate cyclase, which increases the conversion of cyclic guanosine
triphosphate to cGMP
Nitric oxide
enhances the production of nitric oxide by endothelial cells and
nonadrenergic-noncholinergic neurons
acetylcholine
Female sexual partners may experience vaginal burning, itching, or
pain
Intraurethral alprostadil
First line for ED
Sildenafil, tadalafil, vardenafil
How is priapism managed?
In addition, needle aspiration
of sludged blood in the corpora or intracavernosal injection of α-adrenergic agonists (e.g., phenylephrine) can be used
Hypotension
i. Increased sensitivity to light
ii. Blurred vision
iii. Loss of blue-green color discrimination
Back and muscle pain
Priapism
Sudden hearing loss usually on one side involving partial or complete
loss of usual hearing; reversible
Headache, facial flushing, rhinitis (due to vasodilation)
Sildenafil, tadalafil, vardenafil
indicated in symptomatic
patients with primary or secondary hypogonadism
Testosterone replacement
Intracavernosal
Cavernosal plaques or areas of fibrosis at injection sites
Burning discomfort or dull pain near the injection site or during the erection
Priapism
Intraurethral
Urethra injury leading to urethral stricture and difficulty voiding
Urethral pain
Female sexual partners may experience vaginal burning, itching, or pain
Priapism
Alprostadil
intracavernosal - second line for ED
combination therapy - third line for ED
Alprostadil
Nitrates (severe hypotension)
Contraindicated in patients at risk of
ophthalmologic problems
Caution in airplane pilots
Sildenafil, tadalafil, vardenafil
patients with sickle cell disease or
lymphoproliferative disorders are at risk of what adverse effect of ED drugs?
Patients at risk of priapism
PDE5 Inhibitors
decrease catabolism of cGMP
Sildenafil, tadalafil, vardenafil
Priapism is rare especially with (1) and (2) because of their
shorter durations of action
- sildenafil and 2. vardenafil
Contraind.
Prostate cancer
BPH
Testosterone replacement
Rank order of PDE5 inhibitors: Back and muscle pain
Sildenafil = vardenafil > tadalafil
Rank order of PDE5 inhibitors: Hypotension
Sildenafil = vardenafil > tadalafil
Rank order of PDE5 inhibitors: Priapism
Tadalafil > sildenafil = vardenafil
Rank order of PDE5 inhibitors: Visual adverse effects
Sildenafil > vardenafil > tadalafil
resulting from the conversion of testosterone to estrogen
in peripheral tissues
gynecomastia
Severe hypotension can occur when PDE5 inhibitors are used in patients
taking?
nitrates
Sickle cell disease (risk of priapism)
Lymphoproliferative disorders (risk of priapism)
Thrombocytopenia
Anticoagulants
Patients with poor-quality injection technique (patients with psychiatric
disorders, obese patients, patients who are blind, and patients with
severe arthritis)
Alprostadil
Sodium retention Gynecomastia Decreased HDL cholesterol levels Polycythemia Hepatotoxicity (oral) contact dermatitis (topical)
Testosterone replacement
Summarize ED treatment
PDE5 inhibitors or non pharmalogic
intracavernosal alprostadil injection therapy
combination nonpharm with intracavernosal, or intracavernosal with intraurethral
penile prosthesis
The progression of an erect penis to a flaccid state results from the actions
of (1) on (2), which contracts vascular
smooth muscle to decrease arterial inflow to the corpora and contracts
sinusoidal tissue in the corpora
norepinephrine
α1-adrenergic receptors
This correct symptoms of hypogonadism, which include malaise, loss of muscle strength, depressed mood, and decreased libido
stimulates androgen receptors in the CNS and is thought to be responsible for maintaining normal sexual drive
Testosterone replacement
This results from the agent’s
inhibition of phosphodiesterase type 6 in the photoreceptor cells in
the retina
Loss of blue-green color discrimination (PDE5 inhibitors)
how do nitrates cause severe hypotension when taken with pde5 inhibitor?
nitrates supply NO which increases activity of guanylyl cyclase which converts GTP to cGMP; the hypotensive effects of both drugs cause the issue
