ED not finished Flashcards
erectile dysfunction may be a side effect of which drugs? (5)
- ADs
- Antihypertensives
- Cytotoxic drugs
- Recreational drugs (incl alcohol)
- Antipsychotics
5 risk factors for ED
- sedentary lifestyle
- obesity
- smoking
- hypercholesterolaemia
- metabolic syndrome
which of the following is NOT a risk factor for erectile dysfunction
- smoking
- alcohol and recreational drug use
- being underweight
- hypercholesterolaemia
- metabolic syndrome
being underweight
true or false - ED increases risk of CVD
true
If a man has unexplained ED, what should you do?
ED increases risk of CVD
if unexplained ED, evaluate pt for presence of CV RF and address any unidentified risk
4 lifestyle changes in pt with ED
- smoking cessation
- reduce alcohol
- regular exercise
- reduce BMI if obese/overweight
recommended approach in management of ED
combination of drug treatment and lifestyle changes e.g. smoking cessation, regular exercise, reduce BMI, reduce alcohol
this drug class is 1st line for ED, regardless of cause
phosphodiesterase type 5 inhibitor
MOA for PPD type 5 inhibitor for ED
increases blood flow to penis
true or false - mechanism of action of PPD type 5 inhibitors is that they increase blood flow to penis. this will initiate an erection
FALSE
MOA part is true however they DO NOT stimulate an erection; sexual stimulation is required
true or false - there is some short acting and some long acting PPD type 5 inhibitors. Choice depends on frequency of intercourse and response to treatment
True
The following are short acting PPD type 5 inhibitors and are suitable for occasional use as required (3)
avanafil
sildenafil
vardenafil
the following (1) is a longer acting PPD type 5 inhibitor and can be used as required, but also can be given as a regular lower daily dose to allow for spontaneous (rather than schedules) sexual activity, or in those who have frequent sex
tadalafil
true or false - tadalafil can be given as a regular low daily dose to allow for spontaneous sex, rather than scheduled. it is long acting
true
tadalafil - long or short acting
long
how many doses of a PPD type 5 inhibitor should a patient have at the max dose (WITH sexual stimulation) before being classified as a non-responder?
6 doses
What to do with a patient who fails to respond to the max dose of 2 different PPD type 5 inhibitors (at least 6 doses at max dose)?
refer to specialist
1st line for all ED regardless of cause is PPD type 5 inhibitors. What is 2nd line and when can it be given
under careful medical supervision only
intracavernosal, intraurethral or topical application of alprostadil (PG E1)
true or false - intracavernosal or intraurethral preparations of alprostadil can be used to aid DIAGNOSIS
true
what is priapism
prolonged erection
discuss priapism associated with alprostadil
- seek medical help if prolonged erection lasting 4 or more hours
- apply ice pack to upper inner thigh (alternating between R and L every 2 mins for up to 10 mins) can result in reflex opening of venous valves
- if it has lasted for more than 6 hours, urgent treatment must be given; cannot be delayed
what type of drug is alprostadil
prostaglandin analogue
name the different steps in managing priapsim that has lasted >6 hours
(4 steps)
ALIS
- penile aspiration
- lavage if above unsuccessful
- intracavernosal injection of sympathomimetic with action on alpha adrenergic receptors can be given with continuous monitoring of BP and pulse (all unlicensed - adrenaline, phenylephrine etc) ((if necessary, the injections can be followed by further aspiration)
- if this is still unsuccessful, urgent referral for surgical management.
cialis is brand name for which drug
tadalafil
how long can cialis be effective for
tadalafil - long acting
can be effective for up to 36h
when should you take cialis
at least 30 mins before hoping to get an erection
avoid this whilst taking cialis as it affects how well it functions
alcohol
how many tabs of cialis can you take in 24h
max 1
never combine with other ED meds
cialis strengths available
10mg
20mg
cialis daily: 2.5mg, 5mg
what is cialis daily, who is it a good option for, and how to take, and when should you notice the effect
lower strength (2.5mg,5mg) taken daily
- good option if sex at least 2x/week
- take at same time everyday
- max one tablet daily, do not combine with other ED meds
- should notice effect within 3-5 days
common SE cialis
headache
flushing
lightheaded
stuffy nose
indigestion
pounding heartbeat
True or false - a potentially serious, but uncommon side effect of cialis is chest pain
true
what to do if chest pain with cialis
uncommon SE but can be potentially serious
if chest pain occurs, get in a semi-sitting position and try to relax by breathing deeply
- if still present >15mins, call 999
important counselling with any DDP 4 inhibitors, including OTC - do not take with ..
grapefruit juice
2 drug condraindications for DDPT5I (1 recreational)
- poppers
- nitrate based med e.g. isosorbide or GTN - could result in fatal drop in BP
Do not take cialis if …
○ Allergy
○ Taking any form of nitrate - cialis increases the effects of these meds
○ Serious heart disease or recent heart attack within last 90 days
○ Stroke within last 6 months
○ Low BP or uncontrolled high BP
○ Ever had loss of vision due to NAION (aka stroke of the eye)
○ Taking riociguat (used to treat pulmonary arterial hypertension and chronnci TE pulmonary hypertension) - cialis increases the effect of these
A patient has PHx stroke, 5 years ago. Can they take cialis?
Yes
Only contraindicated if recent stroke or serious heart disease or recent MI within 90 days
Counselling point for PDD type 5 inhibitors - can make you
drowsy
caution machinery driving etc
who can OTC viagra/cialis be sold to - age
18 and over only
instructions on when to take viagra
one tablet 1h before sex, swallow whole with water
how long does viagra take to work
- Works within 30-60mins, can take it up to 4h before sex
if taken after a meal high in this ….. it can take longer for viagra to work
fat
avoid this juice with silfenafil/viagra
grapefruit
when should avanafil be taken
15-30 min before sex
max dose avanafil with concurrent use of moderate inhibitors of CYP3A4
Max 100mg once every 48h with concurrent use of moderate inhibitors of CYP3A4
contraindications to avanfil
○ Systolic BP <90
○ BP >170/100
○ Hereditary retinal disorders
○ Hx NAION (aka stroke of eye)
○ Life threatening arrhythmia in previous 6 months
○ Mild to severe HF
○ Not advised to have sex/vasodilation
○ Recent Hx MI
○ Recent Hx stroke
Recent unstable angina
can you take avanafil if on an alpha blocker
Alfuzosin, doxazosin, terazosin causes significant hypotensive effects when given with avanafil, stabilise on first drug then add second drug at llowest recommended dose
can you take avanafil with potent inducers/inhibtiors
○ clarithromycin, itraconazole, ketoconazole, voriconazole, ritonavir predicted to increase exposure to avanafil, avoid
Carbamazepine, fosphenytoin, phenobarbital, phenytoin, primidone, rifampicin, predicte to decrease exposure to avanafil, avoid
why should grapefruit juice be avoided
Caution or avoid grapefruit predicted to increase exposure
Patient would like to be commenced on a PPD5 inhibitor. Their current medication list is as follows. October 2024 new rx for: Omeprazole 20, ramipril 5, clopidogrel 75, aspirin 75, atorvastatin 80, bisoprolol 2.5. Which one would you give?
CI in recent MI, stroke, or unstable angina. From his medication, seems as if he has recently had MI because of the 4 drugs for secondary prevention: BB, statin, DAT, ACE
Avoid all PPD5 inhibitors if systolic BP
below 90
onset of PPd4 inhibtors may be delayed if
taken with food
when to take avanafil, sildenafil, tadalfil and vardenafil before sex
avanafil: 15-30mins
sildenafil: 1 hour
tadalafil: 30 mins
vardenafil: 25-60 mins
common SE
vasodilation
flushing
headache
nasal congestion
hypotension
drowsiness
GI discomfort
When to take before sex
A tiger vanished suddently
A = 15-30
T - 30
V and S = 60
