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Pharm II- Exam 1 > Erectile dysfunction > Flashcards

Erectile dysfunction Flashcards

1
Q

Erectile dysfunction is likely a result of…

A

concurrent medical conditions that impair systems necessary for penile erection

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2
Q

Loss of libido may indicate?

A

androgen deficiency

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3
Q

Loss of erections may result from?

A

arterial/venous, neurogenic, hormonal, or psychogenic causes

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4
Q

What are Risk factors for erectile dysfunction

A 
HTN
Hyperlipidemia
DM
metabolic syndrome
smoking
chronic ethanol abuse
psychological etiologies
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5
Q

Which medications can lead to erectile dysfunction?

A 
anticholinergic agents
dopamine antagonists
estrogens, antiandrogens
cns depressants
agents that decrease penile blood flow
BPH tx (finasteride, dutasteride)
HLD tx (gemfibrozil)
opiods
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6
Q

What are types of sexual dysfunction in men?

A 
increased/decreased libido
erectile dysfunction
delayed ejaculation
retrograde ejactulation
infertility
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7
Q

Role of PNS and SNS in stimulation of the penis?

A

“point and shoot”

Parasympathetic - erection
Sympathetic - ejaculate

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8
Q

specific tx is first initiated with…

A

the least invasive forms of tx

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9
Q

Goal of tx for ED

A

restore the quality of the erection and satisfy the pt/partner

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10
Q

how do Vacuum erection devices work and who are they most effective for?

A

have slow onset of action (30 mins) and are not discreet

couple in a stable relationship

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11
Q

What are oral agents used in ED?

A 
PDE inhibitors: 
Sildenafil (Viagra)
Tadalafil (Cialis)
Vardenafil (Levitra)
Avanafil (Stendra)

Yohimbine (Aphrodyne, Yocon, tree bark) - available OTC
Trazodone (Desyrel)

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12
Q

ADE’s of Yohibine (Aphrodyne, Yocon, Yohimex, tree bark)

A

anxiety, insomnia, tachycardia, hypertension

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13
Q

Which drugs are convenient and effective regardless of the etiology of erectile dysfunction?

A

phosphodiesterase inhibitors

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14
Q

phosphodiesterase inhibitors fail in which % of pts??

A

30-40%

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15
Q

Contraindications for phosphodiesterase inhibitors

A

in pt’s taking any dosage formulation of nitrate

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16
Q

FYI: cGMP is involved in which 2 systems and which drugs work

A

lungs (bronchodilation)
mass cell degradation

anticholinergics (atrovent, ipotroprium)

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17
Q

How does phosphodiesterase isoenzyme Type 5 work and where is it found?

A

decreases catabolism of cGMP

genital tissue
also, peripheral vascular tissue, tracheal smooth muscle, platelets

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18
Q

where is PDE isoenzyme type 6 found? MC side effects and drug assoc. w/?

A

Rods and cones of the eye
blurred vision and cyanopsia (tinted blue)
MC w/ Sildenafil

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19
Q

Where is phosphodiesterase isoenzyme type 11 found and which drug is MC?

A

striated muscle

Tadalafil

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20
Q

PDE isoenzyme type 11 is assoc. with?

A

myalgia and muscle pain

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21
Q

PDE 5 Dosing instructions for Sildenafil (viagra) and vardenafil (levitra)

A

food decreases absorption by 1 hour

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22
Q

PDE 5 Dosing instructions for Tadalafil (cialis)

A

food does not affect rate or extent of drug absorption,

when taken w/ large amount of ethanol may cause orthostatic hypotension

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23
Q

PDE 5 Dosing instructions for Avanafil (stendra)

A

may be taken with food, when taken w/ large amount of ethanol may cause orthostatic hypotension

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24
Q

Which drug is not recommended in ED for a pt with severe hepatic impairment?

A

Tadalafil (cialis)

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25
Q

Eating a fatty meal decreases rate of oral absorption of which 2 PDE inhibitors?

A

Sildenafil (viagra)

vardenafil (levitra/staxyn)

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26
Q

Which drugs interact with Sildenafil, vardenafil, and tadalafil by causing a rise in serum levels unless you reduce the dose?

A

any potent cytochrome P450 34A inhibitor

ie. Cimetidine, erythromycin, clarithromycin, ketoconzaole, itraconazole, ritonavir, and saquinavir

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27
Q

Tadalafil doses are reduced only when the drug is used w/

A

most potent cytochrome P450 3A4 inhibitors

ie. Ketoconazole, Ritonavir

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28
Q

MC ADE’s for PDE 5 inhibitors?

A 
Headache
facial flushing
dyspepsia
nasal congestion
dizziness
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29
Q

What is the most worrisome ADE for PDE Inhibitors?

A

Nonarteritic anterior ischemic optic neuropathy

- sudden, unilateral, painless blindness, which may be irreversible

30
Q

Which pt’s are at risk for Nonarteritic anterior ischemic optic neuropathy

A

glaucoma, macular degeneration, DM retinopathy
HTN
undergone eye surgery or have experienced eye trauma
pts age 50 y/o or greater
smokers

31
Q

Low back pain is unique to which PDE Inhibitor?

A

Tadalafil (cialis)

32
Q

Which ADE is unique to vardenafil?

A

prolongation of the QT interval

33
Q

Which 2 drugs have a shorter plasma half live making it more assoc. w/ priapism?

A

Sildenafil and vardenafil

34
Q

Tx for priapism

A
  1. oral pseudoephedrine 60-120mg orally
  2. aspiration of the corpus cavernosum and intracavernous injection of alpha-andrenergic agents or methylene blue
  3. phenylephrine, epi, or methylene blue may be instilled into the corpus cavernosa
35
Q

Which drugs interact with PDE and what can it cause?

A

organic nitrates

severe hypotension
increase tissue levels of cGMP

also angina tx (CCB, morphine, adrenergic antagonist)

36
Q

Serum testosterone levels decrease starting at what age and rate?

A

40y/o

~10% per decade after

37
Q

Symptoms of decreased testosterone?

A

decreased libido, ED, gynecomastia, small testes, reduced growth of body hair and beard, decreased muscle mass, increased body fat

38
Q

untreated decreased testosterone may cause –>

A

anemia and osteoporosis

39
Q

What time of day should you collect serum testosterone concentrations and what should you order with it?

A

8am

serum luteinizing hormone (LH)

40
Q

T or F: Testosterone replacement regimens directly correct erectile dysfunction?

A

FALSE. improves libido therby correcting 2ndary ED

41
Q

Testosterone replacement regimens should never be administered to..

A

men with normal serum levels
pts asxs w/hypogonadism
pts w /isolated ED as only sign hypogonadism

42
Q

Oral testosterone supplements (Methyltestosterone and fluoxymesterone) are not recommended for use in…

A

pt’s with hepatotoxicity

43
Q

What is important about dosing testosterone buccal system (striant)

A

time the dose so that buccal system is removed before every am and evening toothbrushing

do NOT chew or swallow

44
Q

Testosterone cypionate IM injection (depo-testosterone) Contraindicated in…

A

pts w/severe hepatic or renal impairment

45
Q

Testosterone cypionate IM injection (depo-testosterone) side effects

A

mood swings

46
Q

What pt. education should you give pt on testosterone transdermal patch (androderm)

A

avoid swimming, showering, or washing administration site for 3 hrs after patch application

47
Q

Where should you apply the transdermal testosterone supplement - androgel 1.6%?

A

to shoulders and upper arms

48
Q

Where should you apply the transdermal testosterone spray (fortesta)?

A

front and inner thighs

49
Q

Pt education for Testosterone transdermal solution (axiron)?

A

limit application to axilla

apply antiperspirant or deodorant before axiron

50
Q

Who should administer testosterone subQ implant pellet (testopel)

A

trained health professional

51
Q

Pt education for testosterone subQ implant pellet (testopel)

A

clinical onset is delayed for 3-4 months after initial dose

52
Q

ADE’s of oral testosterone?

A

hyperlipidemia
sodium retention

*NOT a good choice!!

53
Q

ADE’s of oral alkylated androgens?

A

hyperlipidemia
sodium retention
*Hepatoxicity

54
Q

Intramuscular testosterone cypionate or enanthate ADE’s

A

mood swings, gynecomastia, polycythemia, hyperlipidemia

55
Q

What is the only testosterone replacement regimen that does not achieve serum testosterone concentrations in normal range?

A

Oral testosterone

56
Q

Testosterone subcutaneous implant ADE’s

A

pellet can be extruded accidentally (loss of drug effect)

57
Q

Buccal system ADE’s?

A

gum irritation, bitter taste

58
Q

Which testosterone replacement regiment achieves normal range of serum testosterone, circadian pattern, and androgen metabolites?

A

Transdermal gel

59
Q

T or F: Alprostadil intracavernosal injections and intraurethral pellets are effective independent of etiology of erectile dysfunction? How many fail tx?

A

Trueee

1/3 of pt’s

60
Q

Who administers Alprostadil?

A

the pt.

intracavernosal injection and intraurethral pellets

61
Q

What is an example of an intraurethral drug?

A

Alprostadil (MUSE)

62
Q

What are examples of intracavernosal agents?

A

Alprostadil (Caverject and Edex)
Papaverine
Phentolamine

63
Q

MOA of Alprostadil – Prostaglandin E1 (Caverject and Edex intracavernosal?

A

causes smooth muscle relaxation of the arterial blood vessels and sinusoidal tissues in the corpora –> enhanced blood flow to and blood filling of the corpora

64
Q

How long does the erection last with Alprostadil – Prostaglandin E1 (Caverject and Edex intracavernosal?

A

no longer than 1 hour

directly related to the dose

65
Q

What is the efficacy of Alprostadil – Prostaglandin E1 (Caverject and Edex intracavernosal?

A

70-90%

66
Q

T or F: Intraurethral Alprostadil (MUSE) can be combined with VED?

A

trueeee

67
Q

Pt education of Intraurethral Alprostadil (MUSE)

A

administer 5-10 mins before sexual intercourse

empty bladder beforehand, voiding completely

68
Q

what is Penile prothesis?

A

surgical insertion of a prothesis is most invasive tx of ED

69
Q

Which PDE lasts 24-36 hours and inhibits PDE-11?

A

Tadalafil (Cialis)

70
Q

Which PDE does not have an active metabolite?

A

Tadalafil (Cialis)

Pharm II- Exam 1 (6 decks)

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