Erectile Dysfunction Flashcards
Trimix
Phentolamine +papaverine + prostaglandin e1
Phentolamine: blocks alpha adrenergic receptors which can cause constriction
Papaverine :causes vasorelaxation either directly or thru inhibition of phosphodiesterase
Pge1- increasing cAMP
The combo allows pharm synergy
PGE1
Injectable
Alprosadil
Response rate excellent
Can still be effective even if oral meds fail
Ae: injection site pain , fibrotic episodes are rare
Phosphodiesterase 5 inhibitors
5 PDE in penile tissue PDE-5 most prominent
MOA: inhibition of PDE-5 which potentiates the relaxant effects necessary for erection intimated by no release. Prevents the degradation of cGMP-> potent intake the relaxation if corporeal arterial and sinusoidal smooth muscle
DONT use in pts with are cent history of stroke, MI, low blood pressure, unstable angina,severe cardiac failure, severe liver impairment and or end stage kidney disease
Sildenafil
PDE 5 inhibitor
Pk and pd
- work so new our after oral ingestion
- high fat meals decreases absorption rate
- duration 4-5 hrs
-degraded in liver by cytochrome P-450 3A4 and 2C9 ( liver problems, on p450 inhibitors or over 65 will havering reader levels )
70% will get erection somewhat lower in diabetics
Ae :headache, flushing, dyspepsia, nasal congestion, blue aura, priapism if used with other ed therapies.
Life threatening hypotension possible with pt on alpa blockers and no donors
Vardenafil
PDE 5 inhibitors
Same as slidenafil
Tadalafil
PDE 5 inhibitor
Half life 18hrs
Duration of effect 36 hours
Plasma concentration in effected by food
Same problems with p450
Same efficiency as the other drugs but longer duration
Less cardiac problems since it’s. Greatly selective against PDE 5 and leaves PDE 3A alone and also leaves alone PDE6 in the retina
Apomorphine
Centrally acting agent
Sublingual formulation that works in 20 minutes
D1/d2 agonist at there velour. The hypothalamus
Half as effective as PDE inhibitors
Ae: nausea, headache, yawning and dizziness
