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BPH P&T > ED (Erectile Dysfunction) > Flashcards

ED (Erectile Dysfunction) Flashcards

1
Q

Name all Alprostadil formulation?

A

Intracavernosal Injection

Transurethreal System

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2
Q

Name all Phosphodiesterase Type-5 Inhibitors (PDE5)?

A

Avanafil (Stendra)

Sildenafil (Viagra)

Tadalafil (Cialis)

Vardenafil (Levitra)

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3
Q

Name Intracavernosal Injections availably?

A

Caverject or Edex

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4
Q

Name Transurethral System availably?

A

MUSE

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5
Q

Whats the contraindications do PDE5 (Phosphodiesterase Type-5 inhibitors?

A

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)

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6
Q

What are the non-pharmalogical treatment options for erectile dysfunction?

A
  1. Vacuum erection devices
  2. Penile Prosthetic implants
  3. Venous and arterial surgery
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7
Q

Non FDA - Approved drug therapies for erectile dysfunction?

A
  1. Trazodone -Proerectogenic MOA unclear
  2. Yohimbine -Central α-2 antagonist
  3. Papaverine -Opium alaloid that inhibits phosphodiesterase
  4. Phentolamine - nonselective α-2 antagonist
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8
Q

What are the first line agents used for ED (Erectile Dysfunction)?

A

Phosphodiesterase Type-5 Inhibitors (PDE5)

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9
Q

What is the mechanism of action for Phosphodiesterase Type-5 inhibitors?

A

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.

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10
Q

What is the brand name of Avanafil?

A

Stendra

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11
Q

What is the brand name of Sildenafil?

A

Viagra

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12
Q

What is the brand name of Tadalafil?

A

Cialis

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13
Q

What is the brand name of Vardenafil?

A

Levitra or Staxyn

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14
Q

What are the four systems necessary for penile erection?

A
  1. Vascular 2.Neurologic 3.Hormonal 4.Psychogenic
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15
Q

Name causes of Physical/Organic Erectile dysfunction?

(Vascular) What are the details?

A

Vascular disease: Compromised blood flow to coups cavernous.

PAD (Peripheral artery disease),
PVD (Peripheral vascular disease),
HTN,
Atherosclerosis

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16
Q

Name causes of Physical/Organic Erectile dysfunction?

(Neurological) What are the details?

A

Neurological disease: impaired nerve conduction

Stroke,
Spinal Cord Injury,
Diabetes

17
Q

Name causes Physical/Organic Erectile dysfunction?

(Hormonal) What are the details?

A

Hormonal: Hypogonadism leads to decrease testosterone.

Secondary ED

18
Q

Name causes of Physical/Organic Erectile dysfunction?

(Anatomical) What are the details?

A

Pelvic trama and Peyronie’s disease

19
Q

Phosphodiesterase 5-Type Inhibitory (PDE5) patient education?

A
  1. No effect in absence of stimulation
  2. s/s hypotension
  3. Does not stop STDs
  4. Do not take with nitrates
20
Q

Phosphodiesterase 5-Type Inhibitor (PDE5) Drug interactions?

A

CYP3A4 inhibitors

Grapefruit juice

21
Q

Dosing and population dosing for Sildenafil (Viagra®)?

A

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

22
Q

Dosing and population dosing for Tadalafil (Cialis®)?

A

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**

23
Q

Dosing and population dosing for Vardenafil (Levitra®)?

A

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?

24
Q

Dosing and population dosing for Avanafil (Stendra®)?

A

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)

25
Q

Which Phosphodiesterase 5-Type Inhibitor has the longest duration? The Weekender.

A

Tadalafil (Cialis®) Duration ~ 36 hours

26
Q

Which Phosphodiesterase 5-Type Inhibitor is used for BPH?

A

Tadalafil (Cialis®) 2.5-5mg PO daily BPH

27
Q

Drug Induced ED: Antihypertensive

A

Examples: beta blockers (higher dose = more decrease in blood flow) clonidine, methyladopa

28
Q

(Safer Options) Drug Induced ED: Antihypertensive

A

Safe Alternatives: ACEI, ARB, CCB, α- blockers (terazosin/doxazosin)

29
Q

Drug Induced ED: Thiazide Diurectics

A

Examples: Hydrochlorithiazide and chlortalidone

30
Q

(Safer Options)Drug Induced ED: Thiazide Diurectics ​

A

Safer options: Loop diuretics (Furosemide, Torsemide, Bumetanide, Etacrynic acid, Co-amilofruse)

31
Q

Drug Induced ED: Anticholinergics (Urinary Retention)

A

Examples:

TCAs
Antihistamines (older ones like Benadryl)
Parkinson meds
Many cough and cold products have them

32
Q

(Safer Options) Drug Induced ED: Anticholinergics (Urinary Retention)

A

Safe options: Non-sedating antihistamines (allegra, claritin)

33
Q

Drug Induced ED: Antidepressants

(Antidepressants many have anticholinergic effects and sexual dysfunction )

A

Examples:SSRIS TCAs MAOis

34
Q

Drug Induced ED: Antipsychotics ​

A

Examples:Typical Ones: Haldol, Pyridizine

35
Q

(Safer Options)Drug Induced ED: Antipsychotics ​

A

Atypical agents (quetiapine, olanzapine)

36
Q

Drug Induced ED: Antiandrogens ​

(meds with antiandrogen properties have effects on testosterone and cause secondary ED

A

Examples:

Digoxin, (decreases testosterone) spironolactone (increases the clearance of testeosterone), cimetidine

**all these meds, affect testosterone one way or another **

37
Q

Drug Induced ED: CNS depressants ​

A

Examples:

Chronic Use of Opiates Benzos

Alcholol (decrese Testosterone)

38
Q

Drug Induced ED: Dopamine antagonists ​

A

Example: Metoclopramide (increases prolactin which blocks the production of testosterone which then decreases libido

39
Q

Drug Induced ED: Recreational Drugs

A

Examples: Amphetamines, barbiturates, cocaine, heroin, MJ

BPH P&T (8 decks)

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