Erectile Dysfunction Flashcards

1
Q

What other factors may cause ED?

A

Low testosterone (hormone imbalances)

Stress and depression (psychological issues)

Neurological illness

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2
Q

List common drugs that cause ED

A

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

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3
Q

What’s the primary pharmacologic therapy for ED?

A

Phosphodiesterase 5 (PDE-5) inhibitors

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4
Q

Are all PDE-5 inhibitors used in ED?

A

No!

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

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5
Q

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

A

Sexual stimulation

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6
Q

MOA of PDE-5 inhibitors?

A

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

Note: they don’t increase desire

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7
Q

List agents used as PDE-5 inhibitors in ED

A

Sildenafil (Viagra)

Vardenafil (Levitra, Staxyn ODT)

Tadalafil (Cialis)

Avanafil (Stendra)

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8
Q

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

A

Viagra

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9
Q

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

A

Levitra

Staxyn ODT

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10
Q

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

A

Cialis

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11
Q

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

A

25, 50, 100mg

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12
Q

How should Sildenafil (Viagra) be taken?

A

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

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13
Q

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

A

25mg

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14
Q

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

A

2.5, 5, 10, 20mg (Levitra)

10mg only (Staxyn ODT)

Note: 10mg Staxyn ODT = 10mg Levitra

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15
Q

Staring dose of Vardenafil (Levitra, Staxyn ODT)?

A

10mg taken ~ 1hr b4 intercourse

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16
Q

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

17
Q

Staring dose of Tadalafil (Cialis)?

A

10mg taken ~ 1hrs b4 intercourse

OR

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

18
Q

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

19
Q

SEs of PDE-5 inhibitors?

A

Headache

Flushing

Dyspepsia

Color

Erythema

20
Q

Are all PDE-5 inhibitors CYP 3A4 inducers?

A

No!

They’re CYP 3A4 SUBSTRATES

(T4 use lower dose with inhibitors)

21
Q

Whats the best way to take PDE-5 inhibitors?

A

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

22
Q

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

A

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

23
Q

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

A

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

24
Q

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

A

Intracavernosal alprostadil (Caverject)

Transurethral alprostadil (MUSE)

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

25
What's erectile dysfunction (ED)?
ED is reduced blood flow to the penis, which is commonly caused by diseases, including DM, metabolic syndrome, obesity, HTN, HD and nerve damage