ED, BPH Flashcards
Sildenafil
Tadalafil
Vardenafil
Avanafil
PDE-5 inhibitors
True or false: PDE-5 inhibitors don’t CREATE erections, they FACILITATE erections
TRUE
Longest lasting PDE5 inhibitor
Tadalafil 18-36 hours
PDE-5’s with FASTEST onset (15 minutes)
Tadalafil & Avanafil
PDE-5 with slowest onset
Vardenafil (1 hour)
AEs of PDE-5 inhibitors
headache, facial flushing, nasal congestion, dyspepsia, myalgia, bac pain, hypotension, dizziness, hearing impairment, priaprism
RARE - ischemic optic neuropathy
Which 2 PDE-5 inhibitors can cause blurred vision, inability to distinguish between blue and green?
Vardenafil
sildenafil
What is the biggest contraindication with PDE-5 inhibitors?
CARDIOVASCULAR RISK
Which cardiovascular drug to be cautious of when prescribing a PDE-5 inhibitor, and what guidelines do you give regarding the interaction?
Nitrates + PDE-5.
Do not take within 24 hours of each other (48 hours w/ tadalafil)
Which ED drug works by stimulating adenyl cyclase, causing increased cAMP and increased blood flow, allowing erection?
Alprostadil
Alprostadil is used for what disorder?
Erectile dysfunction (2nd line treatment)
How is alprostadil administered?
IV - FAST onset
True or False: Testosterone supplementation can be started as long as the serum Testosterone levels are high
FALSE! must be LOW to consider this
What are the contraindications of using Testosterone supplementation?
prostate cancer
erythrocytosis
uncontrolled HF
sleep apnea
What is the ratio of epithelial to stromal tissue in the prostate?
1:5 (more stromal tissue)
Of the BPH medications, which is preferred over the other and why?
Alpha antagonists preferred over 5-alpha reductase
-faster, and improve symptoms regardless of prostate size
Do 5-alpha reductase medications work fast or slow?
slow - delayed onset up to 6 months to reach full efficacy
Terazosin Doxazosin Alfuzosin Tamsulosin Silodosin (prazosin)
Alpha adrenergic antagonists (BPH)
Alfuzosin and Silodosin are contraindicated in what type of impairment?
hepatic
use others w/ caution
Which alpha adrenergics are NONUROSELECTIVE?
Terazosin and Doxazosin
Which alpha adrenergics are UROSELECTIVE?
Alfuzosin, Tamsulosin, Silodosin
What does uroselective mean?
targets alpha 1A and 1D receptors, which dominate the prostate, urethra, bladder
NONUROSELECTIVE alpha adrenergics have an increased risk of what complication?
CV effects - binds peripheral receptors, causing hypotension
True or false: since alpha adrenergic antagonists lower BP, they are safe for hypertension monotherapy
FALSE!
higher risk of heart failure this way
What are some other adverse effects of alpha adrenergics?
ejaculation disorders, rhinitis and malaise, floppy iris/small pupil syndrome
Finasteride
Dutasteride
5-alpha reductase inhibitors
This class of BPH medication shrinks prostate after 6 months of use
5-alpha reductase inhibitors
Whereas alpha adrenergics are used for symptom relief, what are 5-alphas used for?
prevention of BPH complications and progression.
Contraindication of 5-alpha reductase inhibitors?
PREGNANCY - may cause feminization of male fetus
Which adverse effect of 5-alpha reductase inhibitors is false: decreased libido ED ejaculation disorder decreased testosterone
Decreased testosterone (should be INCREASED)
when is combo therapy 5-alpha reductase + alpha antagonists used?
when monotherapy is unsuccessful OR if patient at high risk of complications.
25% of ED is caused by what?
medications
CONTRAINDICATIONS for testosterone supplementation
High serum Testosterone, prostate cancer, sleep apnea, uncontrolled HF
alpha antagonists work best if prostate is ______, while 5-alpha’s work best if prostate is _____
small; large
what is first dose syncope?
syncope with first dose of Terazosin/Doxazosin (BPH meds) - start with lower dose and titrate up
