Erectile Dysfunction Flashcards
What other factors may cause ED?
Low testosterone (hormone imbalances)
Stress and depression (psychological issues)
Neurological illness
List common drugs that cause ED
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
What’s the primary pharmacologic therapy for ED?
Phosphodiesterase 5 (PDE-5) inhibitors
Are all PDE-5 inhibitors used in ED?
No!
Some are used in BPH, and pulmonary arterial. The brand names are different depending on use
What’s REQUIRED for PDE-5 inhibitors to work?
Sexual stimulation
MOA of PDE-5 inhibitors?
They increase blood flow to the penis following sexual stimulation (which is req)
Note: they don’t increase desire
List agents used as PDE-5 inhibitors in ED
Sildenafil (Viagra)
Vardenafil (Levitra, Staxyn ODT)
Tadalafil (Cialis)
Avanafil (Stendra)
What’s the brand name of sildenafil? (PDE-5 inhibitor)
Viagra
What’s the brand name of Vardenafil? (PDE-5 inhibitor)
Levitra
Staxyn ODT
What’s the brand name of Tadalafil? (PDE-5 inhibitor)
Cialis
What’s the usual strengths of Sildenafil (Viagra)?
25, 50, 100mg
How should Sildenafil (Viagra) be taken?
50mg, ~ 1 hr (0.5 - 4 hrs) B4 intercourse
What’s the starting dose of Sildenafil (Viagra)in elderly pts (age > 65yrs)?
25mg
What strengths do Vardenafil (Levitra, Staxyn ODT) come in?
2.5, 5, 10, 20mg (Levitra)
10mg only (Staxyn ODT)
Note: 10mg Staxyn ODT = 10mg Levitra
Staring dose of Vardenafil (Levitra, Staxyn ODT)?
10mg taken ~ 1hr b4 intercourse
Staring dose of Vardenafil (Levitra) in elderly pts (age > 65yrs)?
5mg
Staring dose of Tadalafil (Cialis)?
10mg taken ~ 1hrs b4 intercourse
OR
2.5mg-5mg daily (for men that use cialis > 2 times a wk)
Staring dose of Tadalafil (Cialis) in men that use it more than 2 x a week?
2.5 - 5mg
SEs of PDE-5 inhibitors?
Headache
Flushing
Dyspepsia
Color
Erythema
Are all PDE-5 inhibitors CYP 3A4 inducers?
No!
They’re CYP 3A4 SUBSTRATES
(T4 use lower dose with inhibitors)
Whats the best way to take PDE-5 inhibitors?
Best when taken on an empty stomach, avoid with fatty food (Tadalafil is with or without food)
What other meds are PDE-5 inhibitors absolutely C/I with?
Nitrate meds (any NTG-containing drug, e.g. Nitrostat, Nitrolingual, Isosorbide dinitrate-hydralazine (BiDil)
What other class of meds are used with caution with PDE-5 inh?
Selective and non-selective alpha-antagonist - may enhance hypotensive effect
If pts can’t use PDE-5 inhibitors, what alternatives agents are available?
Intracavernosal alprostadil (Caverject)
Transurethral alprostadil (MUSE)
Tri-Mix gel (papaverine, phentolamine and alprostadil) - compounded, not FDA approved