Erectile Dysfunction

Question 1

PDE 5 Inhibitors

Answer 1

IND: 1st line in ED
MOA: Inhibit PDE5 enzyme from converting cGMP into GMP to allow greater effect of cGMP. Relaxes arterial and trabecular smooth muscle, leading to engorgement in sinusoidal space in corpus cavernosum, increased arterial flow out, venous occlusion, and therefore decreased venous flow.
BOX: n/a
CON: Use with Nitro, nitrates, or riociguat (Adempas Pulmonary HTN)
CAUTION: Use in men with MI, stroke, life threatening arrhythmias, resting hypotension, significant hypertension, heart failure, UNstable angina.
ADR: Hypotension, risk with alpha blockers and nitrates. Priapism; can cause permanent damage, relieved with vasconstrictors or aspiration. Sudden loss of vision or hearing may be permanent.

Question 2

PDE 5 Inhibitors with Coronary Heart Disease

Answer 2

SAFE!
DIdn’t have any harmful effects on blood flow or hemodynamic properties in men who were resting.
During exercise, there were no exacerbations or intolerance
Sexual activity, NOT PDE5I’s is whats dangerous

Question 3

Sildenafil

Answer 3

IND: ED, pulmonary HTN
MOA: PDE5I
BOX: n/a
CON: PDE5I
ADR: Flushing, HA, Dyspepsia, Epistaxis, Visual disturbances. Major substate of CYP
Effects begin about 30 min after ingestion.

Question 4

Tadalafil

Answer 4

IND: ED, BPH, Pulmonary HTN
MOA: PDE5I
BOX: n/a
CON: PDE5I
ADR: Flushing, HA, nausea. Myalgia, limb pain
Effect: 2 hours but lasts for 36. “When the moment is right”. Daily dosing approved. Major CYP substrate

Question 5

Vardenafil

Answer 5

IND: ED
MOA: PDE5I
BOX: n/a
CON: PDE5I
ADR: Flushing/HA. QT Prolongation
Effect: 60min after dosing. Major CYP substrate

Question 6

Avanafil

Answer 6

IND: ED, least used
MOA: PDE5I
BOX: n/a
CON: PDE5I
ADR: HA/flushing
Effect: Fastest onset, 15 min. Major CYP substrate

Question 7

Alprostadil

Answer 7

IND: ED
MOA: Prostaglandin E mimic. Increases arterial influx and decreased venous outflow
BOX: Apnea in neonates
CON: Intracavernous: Sickle cell, MM, Leukemia or men with anatomical deformation of penis. Transurethral: Stricture, chronic urethritis, Balantis, hypospadias/curvature, sex with a pregnant without a condom.
ADR: Penile pain, urethral pain. Dizzy/HA

Question 8

Alprostadil Dosing

Answer 8

Caverject: Limit 3x/week or 1/day
Muse: Erection in 5-10 min, lasts up to 30-60min. 2x/day. Penis pellets