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
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
