ED (Erectile Dysfunction) Flashcards
Name all Alprostadil formulation?
Intracavernosal Injection
Transurethreal System
Name all Phosphodiesterase Type-5 Inhibitors (PDE5)?
Avanafil (Stendra)
Sildenafil (Viagra)
Tadalafil (Cialis)
Vardenafil (Levitra)
Name Intracavernosal Injections availably?
Caverject or Edex
Name Transurethral System availably?
MUSE
Whats the contraindications do PDE5 (Phosphodiesterase Type-5 inhibitors?
Use of any organic nitrates, nitroglycerin, (sublingual, or capsules) IMDUR, isosorbidie dinatrate ir monotitrate. Any nitrate prouct have a absolute contradiction.
Relative : Alpha 1 -blockers (Severe Hypotenstion)
What are the non-pharmalogical treatment options for erectile dysfunction?
- Vacuum erection devices
- Penile Prosthetic implants
- Venous and arterial surgery
Non FDA - Approved drug therapies for erectile dysfunction?
- Trazodone -Proerectogenic MOA unclear
- Yohimbine -Central α-2 antagonist
- Papaverine -Opium alaloid that inhibits phosphodiesterase
- Phentolamine - nonselective α-2 antagonist
What are the first line agents used for ED (Erectile Dysfunction)?
Phosphodiesterase Type-5 Inhibitors (PDE5)
What is the mechanism of action for Phosphodiesterase Type-5 inhibitors?
They enhance the effect of nitric oxide through the inhibition of PDE 5. They do not directly cause penile erection but affect the mans response to stimulation. They do not work without stimulation.
What is the brand name of Avanafil?
Stendra
What is the brand name of Sildenafil?
Viagra
What is the brand name of Tadalafil?
Cialis
What is the brand name of Vardenafil?
Levitra or Staxyn
What are the four systems necessary for penile erection?
- Vascular 2.Neurologic 3.Hormonal 4.Psychogenic
Name causes of Physical/Organic Erectile dysfunction?
(Vascular) What are the details?
Vascular disease: Compromised blood flow to coups cavernous.
PAD (Peripheral artery disease),
PVD (Peripheral vascular disease),
HTN,
Atherosclerosis
Name causes of Physical/Organic Erectile dysfunction?
(Neurological) What are the details?
Neurological disease: impaired nerve conduction
Stroke,
Spinal Cord Injury,
Diabetes
Name causes Physical/Organic Erectile dysfunction?
(Hormonal) What are the details?
Hormonal: Hypogonadism leads to decrease testosterone.
Secondary ED
Name causes of Physical/Organic Erectile dysfunction?
(Anatomical) What are the details?
Pelvic trama and Peyronie’s disease
Phosphodiesterase 5-Type Inhibitory (PDE5) patient education?
- No effect in absence of stimulation
- s/s hypotension
- Does not stop STDs
- Do not take with nitrates
Phosphodiesterase 5-Type Inhibitor (PDE5) Drug interactions?
CYP3A4 inhibitors
Grapefruit juice
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Dosing and population dosing for Sildenafil (Viagra®)?
Sildenafil (Viagra®) dosing
a. 50 mg po as needed 1 hour before sexual activity
b. 25 – 100 mg/day; no more than once daily
c. Start 25 mg po in certain populations:(↓ below)
- Age > 65
- Hepatic impairment
- CrCl < 30 ml/min
- CYP 3A4 inhibitors
- Stable α-blocker use
AE: (PDE 6) Abnormal Vision
Duration ~ 4-5 hours
Dosing and population dosing for Tadalafil (Cialis®)?
Tadalafil (Cialis®)
a. 10 mg po as needed 1 hour before sexual activity
b. 20 mg maximum
c. Start 5 mg in certain populations:
- Moderate renal disease
- Mild to moderate hepatic disease
- Potent CYP 3A4 inhibitors
- Stable α-blocker use
**AE: Myalgia (PDE 11)
Duration ~ 36 hours**
Dosing and population dosing for Vardenafil (Levitra®)?
Vardenafil (Levitra®)
a. 10 mg po as needed 1 hour before sexual activity
b. 20 mg maximum
c. Start 2.5 to 5 mg in certain populations:
i. Age > 65
i. Mild to moderate hepatic disease
iii. Potent CYP 3A4 inhibitors
iv. Stable α-blocker dose
Adverse reactions: Abnormal vision (PDE 6)
(Staxyn®) :Orally disintegrating tablet DOES NOT have a faster onset of action compared to regular oral formulations
Duration ~ 4-5 hours
DI: QT prologation?
Dosing and population dosing for Avanafil (Stendra®)?
Avanafil (Stendra®)
a. 100 mg po as needed 30 minutes before sexual activity
b. 50 – 200 mg/day; no more than once daily
c. Start 50 mg in certain populations:
- i. Moderate CYP 3A4 inhibitors
- ii. Stable α-blocker dose
- *d. Do not use in CrCl < 30 ml/min or ESRD/HD
e. Do not use in severe hepatic impairment**
Duration ~ 4-5 hours
AE: Abnormal vision (PDE 6)
CI: Nitrates and Alpha1- Blockers (Absolute)
Which Phosphodiesterase 5-Type Inhibitor has the longest duration? The Weekender.
Tadalafil (Cialis®) Duration ~ 36 hours
Which Phosphodiesterase 5-Type Inhibitor is used for BPH?
Tadalafil (Cialis®) 2.5-5mg PO daily BPH
Drug Induced ED: Antihypertensive
Examples: beta blockers (higher dose = more decrease in blood flow) clonidine, methyladopa
(Safer Options) Drug Induced ED: Antihypertensive
Safe Alternatives: ACEI, ARB, CCB, α- blockers (terazosin/doxazosin)
Drug Induced ED: Thiazide Diurectics
Examples: Hydrochlorithiazide and chlortalidone
(Safer Options)Drug Induced ED: Thiazide Diurectics
Safer options: Loop diuretics (Furosemide, Torsemide, Bumetanide, Etacrynic acid, Co-amilofruse)
Drug Induced ED: Anticholinergics (Urinary Retention)
Examples:
TCAs
Antihistamines (older ones like Benadryl)
Parkinson meds
Many cough and cold products have them
(Safer Options) Drug Induced ED: Anticholinergics (Urinary Retention)
Safe options: Non-sedating antihistamines (allegra, claritin)
Drug Induced ED: Antidepressants
(Antidepressants many have anticholinergic effects and sexual dysfunction )
Examples:SSRIS TCAs MAOis
Drug Induced ED: Antipsychotics
Examples:Typical Ones: Haldol, Pyridizine
(Safer Options)Drug Induced ED: Antipsychotics
Atypical agents (quetiapine, olanzapine)
Drug Induced ED: Antiandrogens
(meds with antiandrogen properties have effects on testosterone and cause secondary ED
Examples:
Digoxin, (decreases testosterone) spironolactone (increases the clearance of testeosterone), cimetidine
**all these meds, affect testosterone one way or another **
Drug Induced ED: CNS depressants
Examples:
Chronic Use of Opiates Benzos
Alcholol (decrese Testosterone)
Drug Induced ED: Dopamine antagonists
Example: Metoclopramide (increases prolactin which blocks the production of testosterone which then decreases libido
Drug Induced ED: Recreational Drugs
Examples: Amphetamines, barbiturates, cocaine, heroin, MJ