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Pharmacology-Exam #1 (Summer) > ED > Flashcards

ED Flashcards

1
Q

List the anticholinergics agents that can cause ED

A
  1. Antihistamines
  2. Antiparkinsonian
  3. TCA’s
  4. Phenothiazine
  5. SSRI’s
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2
Q

List the Dopamine Antagonist that can cause ED. MOA?

A

Metoclopramide, Phenothiazines

Increase PRL, which inhibits testicular testosterone production

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3
Q

List the Estrogens, antiandrogens that can cause ED. MOA?

A
  1. LH-RH
  2. Digoxin
  3. Spironolactone
  4. Ketoconazole
  5. Cimetidine

Suppress tesosterone-mediated stimulation of libido

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4
Q

List the CNS depressants that can cause ED. MOA?

A
  1. Barbiturates
  2. Narcotics
  3. Benzodiazepines
  4. Short-term use of large doses of alcohol
  5. Anticonvulsants

Suppress perception of psychogenic stimuli

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5
Q

List the agents thats decrease penile blood flow/reduce arteriolar flow to corpora cavernosa

A
  1. Diuretics
  2. Peripheral β-adrenergic antagonists
  3. Central sympatholytics: Methyldopa, Clonidine
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6
Q

Who are vacuum erection devices most effective for? Why?

A

Couple in a stable relationship

Slow onset & not discrete

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7
Q

Yohimbine MOA

A

May reduce peripheral alpha adrenergic tone permitting cholinergic tone= Vasodilate

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8
Q

Yohimbine ADE’s

A
  1. Anxiety
  2. Insomnia
  3. Tachycardia (increases NE)
  4. HTN (increases NE)
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9
Q

What are the 3 main concepts of PDE-I?

A
  1. Effective regardless of the ED etiology
  2. Fail in 30-40% of pt’s
  3. CI in pt’s taking Nitrates
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10
Q

PDE-5-I MOA

A

Decreases catabolism of cGMP to the inactive form

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11
Q

Where is PDE type 5 enzyme found in the body?

A
  1. Genital tissue
  2. Peripheral vascular tissue
  3. Tracheal smooth muscle
  4. Platelets
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12
Q

Where is PDE type 6 enzyme found in the body?

A

Rods and cones of the eye

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13
Q

What SE is PDE type 6 enzyme associated with?

A

Blurred vision

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14
Q

Define Cyanopsia

A

Seeing everything tinted blue

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15
Q

What PDE-I is Cyanopsia MC in?

A

Sildenafil (Viagra)

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16
Q

Where is PDE type 11 enzyme found in the body?

A

Striated muscle

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17
Q

What SE is PDE type 11 enzyme associated with? What PDE-I is this MC in?

A

Myalgia and muscle pain

Tadalafil

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18
Q

List the PDE-5’s that food decreases absorption by 1 hour

A
  1. Sildenafil (Viagra)

2. Vardenafil (Levitra)

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19
Q

List the PDE-5’s that may be taken with food/food does not affect drug absorption

A
  1. Tadalafil (Cialis)

2. Avanafil (Stendral)

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20
Q

List the PDE-5 that should be taken WITHOUT any food or liquid

A

Vardenafil (STAXYN)

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21
Q

List the PDE-5’s that may cause orthostatic hypotension when taken with large amounts of ethanol?

A
  1. Tadalafil (Cialis)

2. Avanafil (Stendral)

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22
Q

What PDE-5 is CI in sever hepatic disease?

A

Tadalafil

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23
Q

When should you decrease the Sildenafil dose?

A

With the use of any potent Cytochrome P450 3A4 inhibitors

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24
Q

List the MOST POTENT Cytochrome P450 3A4 inhibitors

A
  1. Ketoconazole
  2. Ritonavir

Others: Erythromycin, Clarithromycin, Cimetidine, itraconazole

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25
Q

What PDE-5-I is the only PDE-I that does NOT inhibit enzyme 6 (a PDE-6-I) ?

A

Tadalafil

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26
Q

What PDE-5-I is the only PDE-I that is NOT an active metabolite?

A

Tadalafil

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27
Q

How long does it take for Tadalafil to reach peak plasma level?

A

2 hrs

28
Q

What is the time of onset of Tadalafil? Duration?

A

Onset=45 minutes

Duration=24-36 hrs

29
Q

MC PDE-5-I ADE’s

A
  1. HA
  2. Dizziness
  3. Facial Flushing
  4. Dyspepsia
  5. Nasal congestion
30
Q

What is a MAJOR ADE of PDE-5-1? Sx’s of this ADE?

A

Nonarteritic anterior ischemic optic neuropathy (NAION):

  • Sudden, unilateral, painless blindness
  • D/t decreased blood flow to optic nerve
  • May be irreversible
31
Q

What patients are at risk for NAION?

A
  1. Glaucoma
  2. Macular degeneration
  3. Diabetic retinopathy
  4. HTN
  5. Undergone eye surgery/eye trauma
  6. 50+
  7. Smokers
32
Q

What ADE is unique to Tadalafil?

A

Low back pain

33
Q

What ADE is unique to Vardenafil?

A

QT Prolongation

34
Q

What is a rare, but urologic emergency PDE-5-I ADE?

A

Priapism

35
Q

What PDE-5-I’s is priapism MC in? Why?

A

Sildenafil and Vardenafil

Shorter plasma half-lives

36
Q

How can you help prevent priapism?

A

Avoid EXCESSIVE DOSES

37
Q

Conservative Priapism treatment measures

A
  1. Ice packs
  2. Walk up stairs (artery steal phenomenon)
  3. External perineal compression
  4. Oral pseudoephedrine, 60-120 mg
38
Q

If these conservative measures fail, next step in treating priapism?

A

Needle aspiration of corpus cavernous with intracavernous injection:

  1. Phenylephrine/Epinheprhine(alpha agonists)
  2. Methylene blue
39
Q

PDE-5-I drug interaction

A

Organic Nitrates: Severe Hypotension

40
Q

List the Low CV Risk’s

A
  1. Asx CV dz w/ <3 RF’s
  2. Well-controlled HTN
  3. Mild CHF (Class I or II)
  4. Mild valvular heart dz
  5. MI > 8 wks
41
Q

Management approach in pt’s with Low CV risks?

A

Patients can be stated on PDE-I’s

42
Q

List the Intermediate CV Risk’s

A
  1. > or equal to 3 RF’s for CVD
  2. Moderate CHF (Class III)
  3. Mild/Moderate, STABLE angina
  4. MI or Stroke in the past 2-8 wks
  5. H/o CVA, TIA, or PAD
43
Q

Management approach in pt’s with Intermediate CV risks?

A

Complete CV work-up and stress test to determine tolerance to increased myocardial energy consumption (during sex)

44
Q

List the High CV Risk’s

A
  1. Unstable/refractor angina
  2. Uncontrolled HTN
  3. Severe CHF (Class IV)
  4. Moderate/Severe valvular dz
  5. MI or Storke w/in past 2 wks
  6. High-risk cardiac arrhythmia
  7. Obstructive hypertrophic cardiomyopathy
45
Q

Management approach in pt’s with high CV risks?

A

PDE-I CI

46
Q

Sx’s of late-onset hypogonadism? (decreased testosterone levels starting at age 40)

A
  1. Gynecomastia*
  2. Decreased libido
  3. ED
  4. Small testes
  5. Decreased muscle mass
47
Q

What may the patient develop if late-onset hypogonadism is left untreated?

A
  1. Anemia

2. Osteoporosis

48
Q

Who is testosterone replacement NOT recommended in?

A
  1. Men with NORMAL testosterone levels
  2. Asx hypogonadism
  3. Isolated ED
49
Q

Testosterone MOA

A
  1. Corrects sx’s of hypogonadism
  2. Directly stimulate androgen receptors in CNS (responsible for sex drive)
  3. Stimulate NO synthase
50
Q

Why is Methyltestosterone

and Fluoxymesterone NOT recommended?

A

Heptatotoxicity

51
Q

What do you want to make sure you do with the administration/dosing with testosterone buccal system? Why?

A

Time the dose so that buccal system is removed q AM and PM toothbrushing d/t:

  1. Gum irritation
  2. Bitter taste
52
Q

What is IM Testosterone Cypionate CI?

A

Severe Hepatic or Renal impairment

53
Q

IM Testosterone Cypionate and Enanthate ADE’s

A
  1. Mood swings
  2. Gynecomastia
  3. Polycythemia
  4. Hyperlipidemia
54
Q

What testosterone treatment produces normal circadian pattern of testosterone levels?

A
  1. Patch- IF placed at night

2. Gel

55
Q

Testosterone gel ADE

A

May be transferred to others who rub against the treats skin

56
Q

Testosterone Transdermal solution (Axiron) application instructions

A
  1. Limit application to AXILLA

2. Apply deodorant prior to application of Axiron

57
Q

Time of onset in Testosterone SQ implant pellet?

A

Delayed= 3-4 months

58
Q

Testosterone SQ implant pellet ADE

A

Pellet may be extruded accidentally, losing drug effect

59
Q

Oral Alkylated androgen ADE

A

Hepatotoxicity

60
Q

What testosterone treatment produces normal pattern of serum androgen metabolites

A
  1. Patch

2. Gel

61
Q

Aloprostadil (Caverject and Edex intracavernosal) MOA

A

Smooth muscle relaxation of arterial blood vessels and sinusoidal tissues in corpora= Enhanced blood flow

62
Q

Onset of Alporstadil? Duration of erection?

A 
Onset= 5-15 minutes= RAPID
Duration= No more than 1 hr
63
Q

What do you combine with intraurethral alprostadil (MUSE) to improve the treatment response?

A

Penile contsriction band

64
Q

What should you advise your patient to do before administrating intraurethral alprostadil (MUSE)?

A

Empty bladder, voiding completely

65
Q

What is the MOST INVASIVE treatment option in ED?

A

Penile Prosthesis

Pharmacology-Exam #1 (Summer) (6 decks)

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