Erectile Dysfunciton, Prostate, Testosterone Flashcards
ED Treatment, risk factors
- HTN
- Hyperlipidemia
- Diabetes
- Smoking
- Alcohol
ED Treatment, 1st Line
PDE5-I (Phosphodiesterase-5 Inhibitors)
Viagra (Sildenafil)
Levitra (Vardenafil)
Cialis (Tadalafil)
ED Treatment, 2nd Line
Alprostadil (Synthetic PGE-1)
suppository, intracavernosal injection
PDE5-Inhibitors
Phosphodiesterase-5 Inhibitors
- Acts like Nitric Oxide
- Increase smooth muscle relaxation & blood flow
- Doesn’t work for 30-40% of patients (try 6-8 doses)
PDE5 - I ADRs
- Hypotension/Dizziness except not w Cialis/Tadalafil!
- Headache
- Flushing
- Nasal congestion
- Dyspepsia
- Visual disturbances not w Cialis/Tadalafil
- Priapsism & Back Pain - *ONLY w Cialis / Tadalafil *
PDE5-I Interactions
Nitrates, CI, need 24-48 hr separation
HTN meds - need to lower dose,
*esp alpha blockers (doxazosin, prazosin, terazosin)
Levitra / Vardenafil CI w Antiarrythmics, LONG Q-T
Viagra (Sildenafil)
Phosphodiesterase-5 Inhibitor
Administration -> 1 HOUR PRIOR, NO FATTY FOO
Peak effect -> 30 to 60min
Duration of effect -> 4hr
Daily dose -> 25-100mg, MAX 1
LEAST EXPENSIVE - $10 for 30 pills, 20mg each
Levitra (Vardenafil)
Phosphodiesterase-5 Inhibitor
Administration -> 1 HOUR PRIOR, NO FATTY FOO
Peak effect -> 70 to 90min
Duration of effect -> 4hr
Daily dose -> 5-20mg, MAX 1
Cialis (Tadalafil)
how is this one different?
Phosphodiesterase-5 Inhibitor
Administration -> prior OR daily dose - FAT FOO OK
Peak effect -> 2hr
Duration of effect -> 24 -36hr
Daily dose -> 5-20mg MAX I
- No visual disturbances or Hypotension*
- More prone to Priapsism and Back Pain**
Also indicated for BPH
Which PDE5-I is also indicated for BPH
Cialis (Tadalafil)
Which PDE5-I has the fastest peak effect?
Viagra / Sildenafil
30-60 min
Which PDE5-I lasts the longest?
Cialis (Tadalafil)
24-36 hrs
Which PDE5-I is the least expensive?
Genergic Viagra (Sildenafil)
Which PDE5-I can be taken with fatty foods without decreasing efficacy?
Cialis (Tadalafil)
Which PDE5-I doesn’t cause Hypotenstion?
Cialis (Tadalafil)
Which PDE5-I doesn’t cause visual disturbances?
Cialis (Tadalafil)
Which PDE5-I is most likely to cause priapsism?
Cialis (Tadalafil) - 24-36 hr effect
HTN drug of choice in sexually active men w ED
ARB (valsartan, losartan, all the sartan’s)
- *unless CI due to aortic stenosis, renal artery stenosis etc
- *or if compelling indication for another drug
Absolute Indication for Intervention w BPH
- Renal complications (due to BPH)
- Bladder stones
- Urinary Retention
- Chronic UTIs
BPH treatment, classes
Selective and Nonselective Alpha-Antagonists (Zosins)
5-Alpha Reductase Inhibitors (Fina/Dutasteride)
**Combo Alpha Ant + 5 Alpha** Recommended
PDE5-Inhibitors (Cialis)
Nonselective Alpha Antagonists
ZOSINS
Terazosin
Doxazosin
Prazosin
MOA: blocks NE effects on vascular smooth muscle. Relaxes urethra sphincter, prostate tissue to ^ urine flow
**Nonselectives, work on vascular, CNS receptors as well»_space;> ADRs
Ortho Hypotension, Dizziness, Syncope
Selective Alpha Antagonists
ZOSINS
Tamsulosin (Flomax)
Alfuzosin — * ^ with 3A4’s *
Silodosin — * ^ with 3A4’s *
Selective for prostate receptors. No effect on BP
Good for combo to HTN meds
Effective within days - week
Tamsulosin (Flomax)
Selective Alpha Agonist
- Take any time, on empty stomach
- Ok w renal, caution for pts w liver failure
ADRs
- Tired, weak
- ED
Alfuzosin
- ^ with 3A4’s *
Selective Alpha Agonist
- Take after small meal
- Ok w renal
- CI in mod-sev liver failure **
ADRs
- Tired, weak, dizzy
- Headache
- ED
- ^ with 3A4’s *
(Fluconzal, Diltiazem
