Erectile Dysfunction

Question 1

Sildenafil, Vardenafil, Tadalafil , Avanafil

-afil

Answer 1

Erectile Dysfunction
-Phosphodiesteras-5 inhibitors (PDE-5)
-oral
-first-line drug
MOA
-Inhibits enzyme phosphodiesterase 5, allowing cGMP to accumulate within penis.
- cGMP mediates smooth muscle relaxation by activating myosin light chain phosphatase which dephosphorylates the myosin light chain. This results in the relaxation of the smooth muscle cells and vasodilation.
-NO→guanylate cyclase→GTP→cGMP
Adverse effects
-headache and flushing (most common)
-Priapism (persistent erection of the penis)
-Vision and Hearing Loss
-Sildenafil (causes blue vision) (*chromatopsia)
Contraindication
-Cardiovascular problems
Drug interaction
-Alpha blockers, alcohol, or other antihypertensives may lead to hypotension.
-Nitrates

Question 2

Alprostadil

Answer 2

Erectile Dysfunction
-synthetic form of prostaglandin E1
-injection to urethra
-second-line drug
MOA
-binds with specific receptors on smooth muscle cells and activates intracellular adenylyl cyclase to produce cAMP, which in turn induces tissue relaxation and vasodilation.

Question 3

Penile prosthesis

Answer 3

Erectile Dysfunction

-only for men who cannot use or who have not responded to first and second line therapies

Question 4

Testosterone Replacement therapy

Answer 4

Erectile Dysfunction

-for men w/ documented hypogonadism ( Grade 2B)

Question 5

SSRI’s (first line) Clomipramine (2nd line)

Answer 5

Erectile Dysfunction

-for men w/ premature ejaculation