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1. Pharm II > Erectile Dysfuncion > Flashcards

Erectile Dysfuncion Flashcards

1
Q

What can indicate androgen deficiency?

A

Loss of libido

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2
Q

Loss of erections may result from..

A

arterial, venous, neuro, hormonal, psycho causes

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3
Q

What are RFs for ED?

A
  • HTN
  • HLD
  • DM
  • Metabolic syndrome
  • Smoking
  • Etoh abuse
  • Psycho etiologies
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4
Q

What meds can cause ED?

A
  • Anticholinergic (paroxetine, sertraline, fluvoxamine, & fluoxetine more commonly)
  • Dopamine antagonists: increase prolactin levels, inhibiting testosterone production
  • Estrogens, antiandrogens
  • CNS depressants
  • Agents that decrease penile BF
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5
Q

How is tx initiated?

A

W/ least invasive forms 1st

  • Vacuum erection devices
  • oral phosphodiesterase inhibitors (1st line)
  • intracavernous injections or intraurethral inserts
  • penile prosthesis
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6
Q

Goal of tx

A
  • improve quantity/quality of erections suitable for intercourse
  • considered satisfactory by pt & partner
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7
Q

What type of tx has a slow onset of action & is not discreet?

A

Vacuum erection devices

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8
Q

Vacuum erection devices are most effective for….

A

a couple in a stable relationship

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9
Q

Which type of med is considered convenient & effective regardless of the etiology of ED?

A

Phosphodiesterase inhibitors

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10
Q

What is the failure rate among phosphodiesterase inhibitors?

A

30-40%

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11
Q

Phosphodiesterase inhibitors are contraindicated in….

A
  1. Nitrate users
    - Can cause severe hypotension
  2. Those w/ high cardiovascular risk
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12
Q

Reversible inhibitors of phosphodiesterase isoenzyme type 5 - MOA & location

A
  • Decreases catabolism of cGMP

- Found in genital tissue

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13
Q

Type 5 is also found in…

A
  • peripheral vascular tissue
  • tracheal SM
  • platelets
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14
Q

Phosphodiesterase isoenzyme type 6 is localized to…

A

the rods & cones of the eye

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15
Q

Inhibition of isoenzyme type 6 ADEs

A
  • blurred vision

- cyanopsia (MC w/ sildenafil)

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16
Q

Where is phosphodiesterase isoenzyme type 11 localized?

A

striated muscle

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17
Q

Inhibition of isoenzyme type 11 ADEs

A

myalgia & muscle pain (MC w/ tadalafil)

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18
Q

What decreases the absorption of sildenafil & vardenafil by 1 hour?

A

Food!

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19
Q

How should staxyn be taken?

A
  • W/out liquid or food

- On the tongue to dissolve

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20
Q

Can you combine tadalafil or avanafil w/ Etoh?

A

No!

Can cause orthostatic hypotension

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21
Q

Is tadalafil affected by food?

A

No, does not affect rate or absorption

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22
Q

Can avanafil be taken w/ food?

A

Yes!

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23
Q

Which drug is not recommended in pts w/ hepatic impairment?

A

Tadalafil

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24
Q

When should sildenafil doses be decreased?

A

When any potent cytochrome P450 3A4 inhibitor is used

  • Cimetidine
  • Erythromycin, Clarithromycin
  • Ketoconazole, itraconazole
  • Ritonavir, saquinavir
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25
Q

When should tadalafil doses be reduced?

A

When the MOST POTENT cytochrome P450 3A4 inhibitors are used

  • Ketoconazole
  • Ritonavir
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26
Q

What are the most common ADEs of isoenzyme type 5?

A
  • HA
  • Facial flushing
  • Dyspepsia
  • Congestion
  • Dizziness
27
Q

Describe nonarteritic anterior ischemia optic neuropathy (NAION)

A
  • Unilateral, painless blindness (may be irreversible)

- Decreased BF to optic nerve

28
Q

NAION RFs? (5 categories)

A
  • Glaucoma, macular degeneration, diabetic retinopathy
  • HTN
  • Hx of eye surgery or trauma
  • Age > 50
  • Smoking
29
Q

What ADE is unique to tadalafil? Why?

A

Low back pain

- May be linked to inhibition of type 11 phosphodiesterase

30
Q

What ADE is unique to vardenafil?

A

QT prolongation

31
Q

Priapism is most commonly seen in what 2 meds?

A

Sildenafil & vardenafil (have shorter half-lives)

32
Q

What is priapism associated w/?

A

Excessive doses of phosphodiesterase inhibitors

33
Q

How do you treat priapism?

A
  • Oral pseudoephedrine, 60-120 mg orally
  • Aspiration of the corpus cavernosum & intracavernous injection of alpha-adrenergic agents or methylene blue
  • Phenylephrine, epinephrine, or methylene blue may be instilled into the corpus cavernosa
34
Q

What causes the drug interaction btwn phosphodiesterase inhibitors & nitrates? (2 major factors)

A
  • Nitrates alone can produce hypotension

- Nitrates increase levels of cGMP

35
Q

How do you manage a pt w/ ED & a low cardiovascular risk?

A

Start on phosphodiesterase inhibitor

36
Q

How do you manage a pt w/ ED & an intermediate cardiovascular risk?

A

Pt should undergo complete cardio workup & treadmill stress test to determine tolerance to increased myocardial energy consumption

37
Q

Describe low cardiovascular risk (5)

A
  • < 3 RFs
  • Well-controlled HTN
  • Mild CHF
  • Mild valvular disease
  • MI > 8 wks ago
38
Q

Describe intermediate cardiovascular risk (5)

A
  • ≥ 3 RFs
  • Mild or mod stable angina
  • MI or stroke within 2-8wks
  • Mod CHF
  • Hx of stroke, TIA, or PAD
39
Q

Describe high cardiovascular risk (7)

A
  • Unstable/refractory angina
  • Uncontrolled HTN
  • Severe CHF
  • MI or stroke within 2wks
  • Mod or severe valvular disease
  • High risk arrhythmias
  • Obstructive hypertrophic CM
40
Q

What is the MOA of testosterone tx?

A
  • Directly stimulates androgen receptors

- May stimulate nitric oxide synthase

41
Q

What are 2 examples of oral testosterone supplements? Are they recommended?

A
  1. Methyltestosterone
  2. Fluoxymesterone

*Not recommended due to hepatotoxicity!

42
Q

How should you time the dose of the testosterone buccal system?

A

Remove every morning & evening while brushing teeth

43
Q

What are 3 examples of parenteral testosterone supplements?

A
  1. Cypionate IM injection
  2. Enathate IM injection
  3. Undecanoate IM injection
44
Q

Who is cypionate IM injection contraindicated in?

A

Pts w/ severe hepatic or renal impairment

45
Q

Supraphysiologic serum concentrations of cypionate has been linked to…

A

mood swings

46
Q

What occurs when testosterone transdermal patch is administered at bedtime?

A

Serum concentrations of testosterone in the usual circadian pattern are produced

47
Q

What 4 locations are recommended for the transdermal patch?

A
  1. Upper arm
  2. Back
  3. Abdomen
  4. Thigh
48
Q

When using the transdermal patch, you should avoid..

A

Swimming, showering, or washing site for 3 hrs

49
Q

How should you apply testosterone gel?

A
  • Cover application site to avoid inadvertent transfer to others
  • Wash hands w/ soap & water after administration
50
Q

What 3 locations are recommended to apply testosterone gel (Androgel 1%)?

A
  1. shoulders
  2. upper arms
  3. abdomen
51
Q

When using testosterone gel, children & women should avoid…

A

contact w/ unclothed or unwashed application sites

52
Q

What 2 locations should you apply Androgel 1.6%?

A

Shoulders & upper arms

53
Q

Where should you apply testosterone transdermal spray?

A

front & inner thighs

54
Q

How & where should you apply testosterone transdermal solution?

A
  • 1st apply antiperspirant or deodorant

- Then apply to axilla

55
Q

Who is required to administer testosterone subcutaneous implant pellets?

A

Trained health professional

56
Q

Subcutaneous implant pellets: How long is the onset?

A

Delayed for 3-4 months after initial dose

57
Q

What are 3 ADEs of oral testosterone & alkylated androgens

A
  1. HLD
  2. Na retention
  3. Hepatotoxicity*
58
Q

What is an ADE of transdermal patches?

A

Dermatitis

59
Q

What are 4 ADEs of IM cypionate or enanthate?

A
  1. Mood swings
  2. Gynecomastia
  3. Polycythemia
  4. HLD
60
Q

What is an ADE of subcutaneous implants?

A

Extruded accidentally

61
Q

What are 2 ADEs of the buccal system?

A
  1. Gum irritation

2. Bitter taste

62
Q

What is the MOA of Alprostadil–Prostaglandin E1?

A

SM relaxation of arterial vessels & sinusoidal tissues in the corpora –> enhanced blood flow & blood filling of the corpora

63
Q

Alprostadil–Prostaglandin E1: What is the duration of erection?

A

No more than 1 hr

64
Q

What is the most invasive tx option for ED?

A

Penile prothesis

1. Pharm II (11 decks)

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