Erectile Dysfunction

Question 1

What other factors may cause ED?

Answer 1

Low testosterone (hormone imbalances)

Stress and depression (psychological issues)

Neurological illness

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

Question 25

What’s erectile dysfunction (ED)?

Answer 25

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