Erectile dysfunction Flashcards
Definition of erectile dysfunction?
inability to achieve or maintain an erection for >3 months
What drug has the least likely to cause erectile dysfunction?
furosemide
testosterone-abuse=no
How does an erection happen?
stimulation= release of acetylcholine= more cGMP= nitric acid= relaxation of corpora= fills with blood
General causes of ED?
vascular disease, hormonal disease, neurologic disease, psychogenic, meds
What lifestyle choices increase ED risk?
smoking, obese, sedentary
What is ED an early sign of?
CAD
A condition that is most linked with ED?
Diabetes
What therapy changes are needed if DM and ED?
higher doses of PDE5i
What are some neurological causes of ED?
spine injury, stroke, parkinsons, MS, epilepsy, neuropathies
Hormonal causes of ED?
hypothalmic, thyroid issues, hyperprolactemia
What drugs cause hyperprolactemia?
cimetidine, ranitidine, methyldopa
What general drugs cause ED?
anticholinergic, suppress mental, reduce blood flow to penis
Nonpharm for ED?
stop smoking
no alcohol
improve diet/exercise
psychotherapy
How do PDE5i work?
stops PD innactivating cGMP= more nitrates
Which PDE5 is more efficacious?
all the same
IN regards to future doses what can we say about efficacy?
improved success with more doses
How long should trial of PDE5 be?
6-8 times
WHich PDE5 takes the longest to work?
tadalifil
Which PDE% lasts the longest?
tadalifil
Which PDE5 has less absorption with high fat meal?
vardenafil
Which PDE5 has less Tmax with high fat meal?
sildenafil
WHich PDE5 does not need renal adjustment?
vardenafil
What CYP metabolizes PDE5?
3A4, 2C9(sildenafil/vardenafil)
Contraindication with PDE5?
nitrates
How long to wait to use nitrospray if used sildenafil, tadalfil?
sildenafil- 24 hours
tadalafil- 48 hours
interactions with PDE5?
ketoconazole, erythromycin, grapefruit
What conditions should you avoid PDE5?
recent stroke/MI, unstable angina, bad HF,
S/e of PDE5?
headache, fatigue, flushing, dizzy,
WHich PDE5 causes more colour vision changes?
Sildenafil
WHich PDE5 causes more back pain?
tadalafil
WHich PDE5 causes more hypotension changes?
sildenafil
Serious s/e of PDE5?
unilateral hearing loss
NAION-eye issues
priapism, chest pain
WHat to do if no effect on PDE5?
when was it taken (enough time)
with food?
increase dose or switch
How does alprostadil work?
increases production of cGMP
How is alprostadil administered?
injection
intraurethral insert
How long does alprostadil?
10 min onset lasts for 1 hour
Max use of alprostadil?
3x/week
Special administration instruction for intraurethral?
empty bladder first
s/e of alprostadil?
penile fibrosis
urethral pain
dizzy
headache
Issues with alprostadil?
priaprism is more common
How does papaverine work?
stops PD and increase cGMP
Onset and duration of papaverine?
10 min
1 hour
max use of papaverine?
3 x a week or 2 times in succession
Issue with papaverine?
bad s/e of fibrosis, hypotension, hepatotoxicity
How does phentolamine work?
alpha blocker to increase cholinergic= better filling
Issue with phentolamine?
no monotherapy only combo
S/e of penis pump?
numb, cold, blue
Are PDE5 helpful for female sex dysfunction?
no maybe if caused by SSRI
What is flibanserin for?
hypoactive sexual desire disorder
s/e of flibanserin?
dizzy, nausea, bad fainting and hypotension
Is flibanserin worth it?
1 extra sexual satisfying event per month
