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PHA 551 > ED > Flashcards

ED Flashcards

1
Q

What are the risk factors for erectile dysfunction?

A 
HTN (diuretics)
HLD 
DM
metabolic syndrome
smoking
chronic ethanol abuse
psychological etiologies
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2
Q

Which medications can cause erectile dysfunction?

A

anticholinergics

dopamine antagonists (inc PRL –> inhibited T production)

estrogens, antiandrogens (suppress T mediated stimulation of libido)

CNS depressants (suppress perception of psychogenic stimuli)

agents that dec penile blood flow (reduce arteriolar flow to corpora)

  • diuretics
  • peripheral beta adrenergic antagonists
  • central sympatholytic

opiates (high dose)

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3
Q

What are the different treatment options of erectile dysfunction?

A

vacuum erection devices (least invasive)

oral PDEi (1st line)

intracavernosal injections/intraurethral inserts (poor adherence)

surgical insertion of penile prosthesis

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4
Q

What are disadvantages of vacuum erection devices?

A

slow onset of action (30min)

not discreet

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5
Q

Yohimbine: MOA

A

vasodilation

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6
Q

Yohimbine: ADEs

A

anxiety
insomnia
tachycardia
HTN

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7
Q

Trazodone

A

antagonizes adrenergic receptors

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8
Q

PDE Inhibitors: agents

A

Sildenafil
Tadalafil
Vardenafil
Avanafil

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9
Q

When are PDE inhibitors contraindicated?

A

in patients taking any dosage formulation of NITRATE

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10
Q

PDE Inhibitors: MOA

A

need sexual stimulation to work

dec catabolism of cGMP

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11
Q

Where is PDE isoenzyme type 5 found?

A

genital tissue

ALSO:
peripheral vascular tissue
tracheal smooth muscle
platelets

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12
Q

Where is PDE isoenzyme type 6 found?

A

rods and cones of eye

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13
Q

What ADEs are associated w/ inhibition of PDE isoenzyme type 6?

A

blurred vision
cyanopsia

MC w/ sildenafil

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14
Q

Where is PDE isoenzyme type 11 found?

A

striated muscle

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15
Q

What ADEs are associated w/ inhibition of PDE isoenzyme type 11?

A

myalgia
muscle pain

MC w/ tadalafil

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16
Q

What ADEs are associated w/ inhibition of PDE isoenzyme type 5?

A 
flushing
headache
dyspepsia 
nasal congestion
dizziness
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17
Q

Food decreases absorption by 1 hour for which agents?

A

sildenafil

vardenafil

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18
Q

Which agents, when combined with ethanol, may cause orthostatic hypotension?

A

tadalafil

avanafil

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19
Q

Which agents may be taken with food?

A

tadalafil

avanafil

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20
Q

Which agent is not recommended for patients with severe renal impairment?

A

avanafil

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21
Q

Which agent is not recommended for patients with severe hepatic impairment?

A

tadalafil
avanafil

*vardenafil - not evaluated

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22
Q

Which agent does NOT inhibit PDE 6?

A

tadalafil

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23
Q

Which agent inhibits PDE 11?

A

tadalafil

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24
Q

Sildenafil: drug interaction

A

dec dose w/ potent P450 3A4 inhibitor

cimetidine
erythromycin
clarithromycin
ketoconazole
itraconazole
ritonavir
saquinavir
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25
Q

Tadalafil: drug interaction

A

reduce dose w/ most potent P450 3A4 inhibitors

ketoconazole
ritonavir

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26
Q

What is nonarteritic anterior ischemic optic neuropathy (NAION)?

A

dec blood flow to optic nerve –> sudden, unilateral, painless blindness

PDEi ADE

27
Q

Which patients are at risk for NAION?

A 
glaucoma, macular degeneration, diabetic retinopathy
HTN
eye surgery/eye trauma
age 50+
smokers
28
Q

What is an ADE unique to tadalafil?

A

low back pain

29
Q

What is an ADE unique to vardenafil?

A

QT prolongation

30
Q

What is a rare ADE associated with PDE inhibitors (particularly with excessive doses of sildenafil, vardenafil)

A

priapism

31
Q

Which population of men have an increased risk of priapism?

A

hx of sickle cell anemia, leukemia, multiple myeloma

32
Q

Priapism: treatment

A

ice packs
walk up stairs (arterial steal phenomenon)
external perineal compression
oral pseudoephedrine
aspiration
injection of alpha adrenergic agents
instilled phenylephrine, epinephrine, methylene blue

33
Q

What is the result of the drug interaction between PDEi and nitrates?

A

severe hypotension

BECAUSE:

  • nitrates produce hypotension
  • nitrates are nitric oxide donors (inc levels of cGMP)
34
Q

When is testosterone replacement indicated?

A

primary, secondary or mixed hypogonadism

confirmed by:

  • dec libido
  • low serum concentration of testosterone
35
Q

Hypogonadism Labs:

  • what are we looking at
  • when do we measure
A

testosterone
LH (distinguishes primary (inc) from secondary (dec))

measured in the early morning (~8am)

36
Q

Contraindications for testosterone replacement

A
  • normal serum T levels
  • asymptomatic w/ hypogonadism
  • isolated ED as the only sign of hypogonadism
37
Q

At what level do we consider initiating exogenous testosterone therapy?

A

serum levels <300

38
Q

Oral Testosterone Supplements: agents

A

methyltestosterone

fluoxymesterone

39
Q

Why are oral testosterone supplements not recommended?

A

extensive first pass

hepatotoxicity

40
Q

Testosterone Buccal System: special instructions

A

remove before every morning/evening toothbrushing

avoids first pass

41
Q

Parenteral Testosterone Supplements: agents

A

testosterone cypionate
testosterone enanthate
testosterone undecanoate

42
Q

When is testosterone cypionate contraindicated?

A

severe hepatic or renal impairment

43
Q

What is an ADE of testosterone cypionate and testosterone enanthate?

A

supraphysiologic serum concentrations of testosterone –> MOOD SWINGS

44
Q

When applied at bedtime, which testosterone supplement can produce testosterone in the usual circadian pattern?

A

Transdermal patch

45
Q

Special Instructions for Transdermal Testosterone Supplementation

A

cover application site to avoid transfer to others

apply to site recommended by label (different for each one)

women and children should avoid contact

46
Q

Which testosterone supplement can also be used in menopausal women?

A

subcutaneous implant pellet

47
Q

When is the clinical onset of the testosterone subcutaneous implant pellet?

A

3-4 mo after initial dose

48
Q

transdermal nonscrotal skin patch: ADEs

A

dermatitis

49
Q

oral alkylated androgens: ADEs

A

HEPATOTOXICITY
hyperlipidemia
sodium retention

50
Q

transdermal gel: ADEs

A

inadvertent transmission to others

51
Q

Intramuscular testosterone cypionate or enanthate: ADEs

A

mood swings
gynecomastia
polycythemia
hyperlipidemia

52
Q

Testosterone subcutaneous implant: ADEs

A

can be extruded accidentally

53
Q

Buccal System: ADEs

A

gum irritation

bitter taste

54
Q

Which testosterone replacement regiment does NOT achieve serum testosterone concentrations in normal range?

A

oral testosterone

55
Q

Papaverine: ADEs

A

priapism
corporal fibrosis
hypotension
hepatotoxicity

56
Q

Phentolamine: ADE

A

hypotension

57
Q

Phentolamine: MOA

A

competitive nonselective alpha adrenergic blocking agent

58
Q

Papaverine: MOA

A

nonspecific PDEi5

59
Q

Alprostadil: class, MOA

A

prostaglandin E1

inc cAMP production –> smooth muscle relaxation –> inc blood flow and filling of the corpora

60
Q

What is the relationship between Alprostadil and Nitric Oxide?
Which patients benefit from this relationship?

A

alprostadil acts through a nitric oxide independent mechanism

useful for:

  • DM pts
  • post radical prostatectomy
  • PDE failure
61
Q

Alprostadil: intracavernosal
time to effect
duration
drug interactions

A

acts rapidly

duration directly related to dose - duration of erection is no more than 1 hr

can be used w/ VED and PDEi

62
Q

What is the recommended maximum dose per day of intraurethral alprostadil?

A

no more than 2 doses per day

63
Q

Alprostadil: intraurethral

-patient instructions

A

before administration: empty bladder before administration, voiding completely

PHA 551 (9 decks)

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