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Pharmacology II > Erectile Dysfunction > Flashcards

Erectile Dysfunction Flashcards

1
Q

Medication Causes of ED

A
  • Diuretics
  • Opiates
  • Dopamine antagonists
  • Finasteride
  • Gemfibrozil
  • Spironolactone
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2
Q

What is the least invasive treatment for ED

A

Vacuum erection device

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3
Q

What is often the first line treatment for ED

A

oral phosphodiesterase inhibitor

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4
Q

Goal of treatment of ED must consider what?

A

satisfaction of both the patient and the partner

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5
Q

Vacuum erection Devices (VED) who is this most appropriate for?

A

Since these are not discreet and can take 30 minutes to work, this is best for couple in a stable relationship

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6
Q

Yohimbine (oral tree bark supplement)

A
  • reduces peripheral alpha adrenergic tone

- so, permits cholinergic tone

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7
Q

When are PDEs contraindicated

A

if patient is taking nitrate

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8
Q

What is a side effect of PDE isoenzyme type 6?

A

cyanopsia (seeing with blue tint)

**most common with sildenafil (Viagra)

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9
Q

What is the side effect associated with PDE Isoenzyme type 11?

A

myalgia and muscle pain

**most common with tadalafil (Cialis)

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10
Q

What is the difference in regards to food and absorption with sildenafil and Tadalafil?

A

Sildenafil has decreased absorption with food

Tadalafil (Cialis) absorption is not affected by food

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11
Q

Which PDE is not recommended in severe hepatic impairment?

A

Tadalafil (Cialis)

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12
Q

Which PDE doesn’t have an active metabolite?

A

Tadalafil (Cialis)

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13
Q

Discuss differences in PDE inhibitors and the cytochrome P450 3A4 system

A

Sidenafil should be decreased with any potent inhibitor

Tadalafil should be reduced only with the MOST potent (ex. ketozonazole, ritonavir)

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14
Q

What are the 2 most common adverse effects of PDE?

A

headache
facial flushing
dyspepsia*
nasal congestion*

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15
Q

What is the most concerning ADE for PDEs?

A

Nonarteritic anterior ischemic optic neuropathy

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

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16
Q

Who is at risk for NAION - nonarteritic anterior ischemic optic neuropathy?

A
  • smokers*

- 50+

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17
Q

What is the most concerning ADE for Vardenafil (Levitra)

A

QT prolongation

18
Q

What most often is the cause for priapism?

A

excessive dosing

19
Q

Priaprism Treatment

A
  1. Ice packs on perineum and penis
  2. Walk up stairs
  3. Oral pseudophedrine (alpha-agonist effect)
  4. Aspiration of corpus cavernosum
  5. injection of alpha-adrenergic agent (phenylephrine, epinephrine, or methylene blue into the corpus cavernosa)
20
Q

Third Princeton consensus conference for cardiovascular risk stratification: Low risk

A
  • asymptomatic cardiovascular disease with <3 risk factors
  • Well controlled HTN
  • Mild CHF
  • Mild valvular disease
  • MI >8 weeks ago
21
Q

Can a low risk patient be started on a phosphodiesterase inhibitor?

A

yes

22
Q

Third Princeton consensus conference for cardiovascular risk stratification: Intermediate risk

A
  • > 3 CV risk factors
  • Mild/Moderate stable angina
  • Recent stroke in past 2-8 weeks
  • Moderate CHF
  • History of stroke, TIA, or PAD
23
Q

Can an intermediate risk patient be started on phosphodiesterase inhibitor?

A

complete CV workup with treadmill stress test to see if they are healthy enough for sexual activity (then, reclassify as low or high risk)

24
Q

Third Princeton consensus conference for cardiovascular risk stratification: High risk

A
  • Unstable angina
  • Uncontrolled HTN
  • Severe CHF
  • Recent MI in past 2 weeks
  • Moderate to severe valvular disease
  • High-risk for arrhythmias
  • obstructive hypertrophic cardiomyopathy
25
Q

Who is testosterone indicated for?

A
  • Decreased libido**

- Confirmed low serum testosterone

26
Q

Best time to measure testosterone?

A

early morning (8am)

27
Q

What other lab value needs to be assessed with testosterone?

A

lutenizing hormone (LH) to distinguish primary versus secondary hypogonadism

28
Q

Testosterone contraindications

A
  1. If normal serum testosterone
  2. asymptomatic with hypogonadism
  3. isolated erectile dysfunction
29
Q

Why are (oral testosterones) methyltestosterone and Fluoxymesterone not recommended?

A
  • extensive first pass hepatic catabolism

- associated with hepatotoxicity**

30
Q

What is important to consider about buccal testosterone supplements?

A

remove before every morning and evening toothbrushing

31
Q

What is important to remember about IM testosterone?

A

ADEs:

  • Mood swings*
  • Gynecomastia (excess testosterone is converted to estradiol)
  • Polycythemia
  • Hyperlipidemia
32
Q

Where should transdermal testosterone supplements be placed?

A
  • upper arm
  • Back
  • Abdomen
  • thigh
33
Q

How long should you avoid swimming, showering, or washing administration site after placing transdermal testosterone?

A

3 hours after application

34
Q

Where is the testosterone transdermal spray placed?

A

front and inner thighs

35
Q

Where should Testosterone transdermal solution (Axiron) be applied?

A
  • Axilla

- Apply testosterone AFTER deodorant is in place

36
Q

How long does it take the subcutaneous implant pellet form of testosterone to work?

A

Takes 3-4 months to work

must be given by trained health professional

37
Q

Which testosterone formulations put serum testosterone in normal range, produce normal circadian pattern of serum testosterone and produce normal pattern of serum concentrations of androgen metabolites?

A
  1. Transdermal patch

2. Transdermal gel

38
Q

Which testosterone formulations only give normal serum testosterone concentrations but not normal cicadian pattern and normal androgen metabolites?

A
  1. IM
  2. Subcutaneous implant
  3. Buccal system
39
Q

What is the name of the intracavernosal injections?

A

Alprostadil (Caverject)

40
Q

What is the name of the intraurethral medication for ED?

A

Alprostadil (MUSE)

41
Q

What does Alprostadil (Prostaglandin E1) stimulate?

A

adenylcyclase which leads to increased production of cAMP–>smooth muscle relaxation of the arterial blood vessels and sinusoidal tissues (enhanced blood flow)

42
Q

Why does MUSE (intraurethral alprostadil) have minimal systemic absorption?

A

most is removed by first pass through the lungs!

Pharmacology II (31 decks)

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