ED And BPH

Question 1

drug of choice for ED

Answer 1

PDE 5 inhibitor

Question 2

PDE 5 inhi can also be used for

Answer 2

pul hypertension

Question 3

mechanism of penile erection

Answer 3

sexual stimulation…NO release…activation of guanyl cyclase of arteries……GTP to cGMP…..relaxation of smooth muscles by dec intracellular Ca…(PDE 5 responsible for cGMP degradation)

Question 4

at recommended doses PDE5 inb have no effect in the abscence of sexual stimulation.

Answer 4

yes

Question 5

PDE5 imh differ in duration of action and the effect of food on absorption.JUSTIFY

Answer 5

yes

sildenafil/verdinafil: 1hr before sexual activity- effect till 4 hrs.
affected by high fatty meal

tadalafil:once daily dosing.
not affected by food

avanafil: quickiest onset of action..30 min before
not affected by food

a/s/v:t1/2 almost 4-5 hrs
t: 18 hrs

Question 6

SE of PDE5 inh

Answer 6

MC:headache,flushing, dyspepsia, nasal congestion

PDE6 inh(in retina): dist in colour vision(not with tadalafil)

PDE11 inh(in skeletal muscles): back pain and myalgia

priapism(prolonged painful erection)

sudden hearing loss: due to prrssure changes because of sinus vadodilation

should not be used for more than once daily

Question 7

prostangalndin used in ED

Answer 7

alprostadil PGE1

intraurethral suppossitary or inj

Question 8

SE of alprostadil

Answer 8

systemic rare
headache/flushing
priapism
due to injection

Question 9

drug interaction of PDE5

Answer 9

c/i:nitrates

caution with alpha1 antagonist

potentiate hypotensive action

Question 10

all PDE5 inh metabolized by CYP

Answer 10

yea

Question 11

alpha 1 adrenergic antagonist used in BPH

Answer 11

tamsulosin, silodosin : a1A(prostate)
less hypotsn

trazosin, alfusozin ,doxaxosin (all Z): a1A and a1B(prostate and vasculature)
more hypotsn

Question 12

SE of adrenergic drugs

Answer 12

nasal conjestion
headache
drowsiness
hypotsn
sexual dysfxn(blocking of receptors in ejaculatory duct ,blocks s.m. contn)

to lesser extent than phentolamine/phenoxybenzamine

FLOPPY IRIS SYNDROME-tamsulosin
iris billows in response to intraoperativesurgery

Question 13

5 a reductase inh use

Answer 13

BPH

alopecia

Question 14

tadalafil uses

Answer 14

ED

pulmonary htn(sildenafil also)

BPH (only one approved)

Question 15

SE of 5 a reductase inh

Answer 15

sexual side effects::::
dec libido
ED
oligozoospermia
gynaecomastia
dec ejaculate

Question 16

both a1 adrenergic antagonist and 5a reductase inh cause sexual SE

Answer 16

yes

Question 17

time taken for affect to come in BPH

Answer 17

2-4 wks:::::::::adrenergic antagonist

6-12mths::::::reductase inh