Erectile dysfunction (ED), low T Flashcards
medication classes associated with ED
- antihypertensives
- CNS depressants
- lipid meds
- antidepressants/ antipsychotics
- anticonvulsants
-GI agents (h2RAs, PPI)
-antiadrogens & hormones (5a-reductase inhibitors, steroids)
-recreational drugs (ethanol, etc)
factors associated with ED
-HTN
-DM
-BPH
-coronary & peripheral vasc
-neurologic disorders (MS, Parkinson)
-endocrine (hypogonadism, pituitary)
-psychiatric disorders
-dyslipidemia
-RF
-liver disease
-penile disease
lifestyle:
smoking, excessive alcohol consumption, obesity, overall poor health and reduced physical activity
dy
before initiating treatment
-physical exam
-thorough medical, social, med hx w/ emphasis on cardiac disease
-labs
labs
-fasting glucose or HbA1c
-PSA
-FLP (fasting lipid panel)
-testosterone
non-pharm interventions
lifestyle modifications:
-reduce fat & cholesterol in diet
-decrease/limit alcohol consumption
-eliminate tobacco use & substance abuse
-wt loss if needed
-regular exercises
1st line treatment
oral PDE5 inhibitors w/ vacuum erection devices (VEDs)
choice therapy should be individualized
oral drugs
Sildenafil (Viagra)
Tadalafil (Cialis)
Vardenafil (Levitra)
Avanafil (Stendra)
Testosterone undecanoate (Jatenzo_
intracavernosal
into penis
alprostadil (Caverjet) 1st inj at docto’s office; wait until erection subsides
routes of drug administration
oral
intracavernosal
intraurethral
IM
topical
buccal
sub implantable pellet
PDE5-is
drug choice (all agents are equal)
educate: onset, duration, impact of high fat meals, need for sexual stimulation, single trial is inadequate
most 4-5h, tadalafil 36h
headache, flushing; ***serious cardiac events possible
contraindicated for nitrate, alpha-blockers
examples of drugs from PDE5-i
avanafil
sildenafil
tandalafil (LATS assoc BPH)
vardenafil
PDE5-i abbr
phosphodiesterase type 5 inhibitors
if one agent from PDE5i doesn’t work, try
another agent from the same class
prolonged cGMP activity
smooth muscle relaxation is induced, leading to an erection
MOA: PDE5i
increases cGMP (vasodilator secondary messenger that up regulates the response to nitric oxide by activating protein kinase G. This decreases intracellular calcium levels, resulting in smooth muscle relaxation, enhanced arterial flow to the corpora cavernosa, and enhanced blood filling of cavernosal sinuses)
