Erectile Dysfunction

Question 0

What other factors may cause ED?

Answer 0

Low testosterone (hormone imbalances)

Stress and depression (psychological issues)

Neurological illness

Question 1

What’s erectile dysfunction (ED)?

Answer 1

ED is reduced blood flow to the penis, which is commonly caused by diseases, including DM, metabolic syndrome, obesity, HTN, HD and nerve damage

Question 2

List common drugs that cause ED

Answer 2

HTN meds - esp, BB, Clonidine, Methyldopa

Antipsychotics - Haloperidol, Chlorpromazine, Fluphenazine and
Thioridazine

Antidepressants - esp, SSRIs and SNRIs

Atomoxetine

BPH meds - Finasteride ,Dutasteride (possible persistent sexual
dysfxn after d/c) and Silodosin

Chemotherapeutic agents - Leuprolide (Lupron)

Cimetidine - which blocks Androgenic hormones

Opioids, chronic use, including methadone

Nicotine

Question 3

What’s the primary pharmacologic therapy for ED?

Answer 3

Phosphodiesterase 5 (PDE-5) inhibitors

Question 4

Are all PDE-5 inhibitors used in ED?

Answer 4

No!

Some are used in BPH, and pulmonary arterial. The brand names are different depending on use

Question 5

What’s REQUIRED for PDE-5 inhibitors to work?

Answer 5

Sexual stimulation

Question 6

MOA of PDE-5 inhibitors?

Answer 6

They increase blood flow to the penis following sexual stimulation (which is req)

Note: they don’t increase desire

Question 7

List agents used as PDE-5 inhibitors in ED

Answer 7

Sildenafil (Viagra)

Vardenafil (Levitra, Staxyn ODT)

Tadalafil (Cialis)

Avanafil (Stendra)

Question 8

What’s the brand name of sildenafil? (PDE-5 inhibitor)

Answer 8

Viagra

Question 9

What’s the brand name of Vardenafil? (PDE-5 inhibitor)

Answer 9

Levitra

Staxyn ODT

Question 10

What’s the brand name of Tadalafil? (PDE-5 inhibitor)

Answer 10

Cialis

Question 11

What’s the usual strengths of Sildenafil (Viagra)?

Answer 11

25, 50, 100mg

Question 12

How should Sildenafil (Viagra) be taken?

Answer 12

50mg, ~ 1 hr (0.5 - 4 hrs) B4 intercourse

Question 13

What’s the starting dose of Sildenafil (Viagra)in elderly pts (age > 65yrs)?

Answer 13

25mg

Question 14

What strengths do Vardenafil (Levitra, Staxyn ODT) come in?

Answer 14

2.5, 5, 10, 20mg (Levitra)

10mg only (Staxyn ODT)

Note: 10mg Staxyn ODT = 10mg Levitra

Question 15

Staring dose of Vardenafil (Levitra, Staxyn ODT)?

Answer 15

10mg taken ~ 1hr b4 intercourse

Question 16

Staring dose of Vardenafil (Levitra) in elderly pts (age > 65yrs)?

Answer 16

5mg

Question 17

Staring dose of Tadalafil (Cialis)?

Answer 17

10mg taken ~ 1hrs b4 intercourse

OR

2.5mg-5mg daily (for men that use cialis > 2 times a wk)

Question 18

Staring dose of Tadalafil (Cialis) in men that use it more than 2 x a week?

Answer 18

2.5 - 5mg

Question 19

SEs of PDE-5 inhibitors?

Answer 19

Headache

Flushing

Dyspepsia

Color

Erythema

Question 20

Are all PDE-5 inhibitors CYP 3A4 inducers?

Answer 20

No!

They’re CYP 3A4 SUBSTRATES

(T4 use lower dose with inhibitors)

Question 21

Whats the best way to take PDE-5 inhibitors?

Answer 21

Best when taken on an empty stomach, avoid with fatty food (Tadalafil is with or without food)

Question 22

What other meds are PDE-5 inhibitors absolutely C/I with?

Answer 22

Nitrate meds (any NTG-containing drug, e.g. Nitrostat, Nitrolingual, Isosorbide dinitrate-hydralazine (BiDil)

Question 23

What other class of meds are used with caution with PDE-5 inh?

Answer 23

Selective and non-selective alpha-antagonist - may enhance hypotensive effect

Question 24

If pts can’t use PDE-5 inhibitors, what alternatives agents are available?

Answer 24

Intracavernosal alprostadil (Caverject)

Transurethral alprostadil (MUSE)

Tri-Mix gel (papaverine, phentolamine and alprostadil) - compounded, not FDA approved