Exam 4 - Sexxx Flashcards by Kristian Melby | Brainscape

Q

Sex Pharm

Limitations

A

1) taboo
2) animal studies hormonal > brain
2) male focus

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Q

Factors Affecting

Sexual Activity

A

1) Physical/Mental Health
2) Hormone status, mood circumstance
3) Psych conditioning, expectations
4) Drug use

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Q

Libido

A

Sex drive (hypothalamus, limbic/reward
system)

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Q

Performance

A

Male: erection, ejactulation
Female: lubrication, organsm

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Q

Hormones & NTsthat increase

libido include:

A

1) testosterone (male/female)
2) dopamine
3) estrogen? (females)
4) LH/FSH?

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Q

Hormones & NTs that

decrease libido:

A

1) prolactin (male/female)
2) estrogen (male)
3) serotonin
4) progesterone?

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Q

How do DA receptor agonists

& antagonist effect libido?

A

DA agonists ^^ libido

DA antagonist vv libido

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Q

How do alpha 2 blockers effect

libido?

A

^ libido by ^ NEpi in synapse

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Q

How do beta blockers & alpha

2 agonists effect libido?

A

decrease libido

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Q

How do nicotinic agonists

effect libido?

A

may ^ libido by enhancing DA

release

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Q

How do muscarinic antagonists

affect libido?

A

decrease libido

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Q

How does serotonin (5-HT)

effect libido?

A

decrease libido

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Q

Male Sexual Response:

parasympathetic

A

1) penile engorgement & erection

2) closure of bladder neck

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Q

Female Sexual Response:

parasympathetic

A

1) clitoral erection

2) lubrication

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Q

Male Sexual Response:

sympathetic

A

1) seminal emission
2) ejactualtion
2) detumescence (de-erection)

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Q

Female Sexual Response:

sympathetic

A

1) contraction of uterus, vagina,

fallopian tubes

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Q

Male Sexual Response:

somatic

A

erection and orgasm contribution

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Q

Female Sexual Response:

somatic

A

contribution to orgasm

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Q

Typical mechanisms for drug

related decreased libido:

A

1) increased prolatin secretion
2) anti-androgenic effect
3) block DA, NE, orAch
4) sedation
5) enhance 5-HT

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Q

Typical mechanisms for drug

interference w erection:

A

1) peripheral anti-muscarinic action

2) decreased blood flow

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Q

Typical mechanisms for drug

interference of orgasm:

A

1) alpha 1 blockade
2) local anethetic
3) sedative effects

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Q

Anti-HTNs with high incidence

of sexual dysfunction:

A

1) ganglionic blockers
2) Clonidine & methyldopa
3) alpha 1 blockers
4) beta blockers

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Q

Ganglionic blockers cause:

A

complete failure of erection and orgasm

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Q

Clonidine & methyldopa cause:

A

decreased libido and impotence via

sympatholytic effects

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Q

Alpha 1 blockers cause:

A

^incidence of ejaculatory failure

no erection effect

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Q

Beta blockers cause:

A

5 - 10% incidence of ED

lower libido reported

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Q

Spironolactone causes:

A

decreased libido and frequent

impotence

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Q

MOA of spironolactone

sexual dysfunction:

A

1) blocks DHT from receptor
2) inhibits 5 alpha reductase (testosterone)
3) ^prolactin

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Q

Thiazide diuretic induced

sexual dysfunction:

A

1) 5 - 30% incidence
2) impotence
3) vv libido
4) difficult ejaculation
* MOA uncertain

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Q

Anti-HTNs with fewer side

effects include:

A

1) Ca channel blockers
2) ACE inhibitors
3) ARBS
4) direct renin inhibitors

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Q

Antipsychotics vv libido by:

A

1) DA block
2) CNS anticholinergic effect
3) CNS sedative effect

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Q

Antipsychotics cause ED by:

A

peripheral anticholinergic effects

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Q

Antipsychotics cause problems

with orgasm by:

A

alpha 1 blockade

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Q

Do “atypical” psychotics have more

or less sexual dysfunction effects?

A

less

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Q

SSRIs and sex:

A

1) vv libido (30-50%)
2) difficult orgasm
3) vv compliance do to sexual side effect

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Q

Trycyclics and sex:

A

1) impotence
2) vv lube (anticholinergic)
3) impaired orgasm (alpha 1 block)
4) enhanced serotonin(vv libido)

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Q

MAOIs and sex:

A

1) difficult organsm

2) ejaculatory failure (phenelzine)

Q

Antidepressants w fewer

side effects:

A

1) bupropion
2) mirtazapine
3) vilazodone
4) trazodone

Q

bupropion sexual side effects:

A

enhanced libido reports (DA?)

Q

Mirtazapine (allpha 2 blcoker)

sexual side effects:

A

may ^ libido but also highly sedative

Q

Trazodone sexual side effects:

A

mixed reports (^libido but anorgasm amd rarely priapism)
* also highly sedative

Q

Benzodiazepine sexual

side effects:

A

1) sedation
2) delayed orgasm
3) ejaculatory failure

Q

Antiseizure med sexual side

effects:

A

SOME assoc w decreased libido

& performance difficulty

Q

Which antiseizure med ^ libido?

A

ethosuximide

Q

Which drug vv libido by ^prolactin

& estradiol?

A

cimetidine

Q

How do opioids vv libido?

A

^ prolactin

Q

Important to not with

recreational drugs:

A

1) acute & chronic effects differ

2) dose related differences

Q

Acute effects of alcohol:

A

1) small dose: disinhibiting, ^libido,

2) ^dose: delayed or diminished orgasm

Q

Chronic effects of alcohol:

A

1) neuropathy related impotence
2) vv testosterone (low libido, vv secondary
sex characteristics

Q

Acute marijuana effects:

A

1) low dose: enhanced sensory, disinhibition, ^empathy

2) ^dose: impotence, anxiety

Q

Chronic marijuana effects:

A

1) vv spermatogenesis
2) vv testosterone (low libido, impotence),
irregular menses, anovulation

Q

Acute cocaine effects:

A

1) low dose: ^DA (^libido), delayed orgasm

2) ^dose: direct stim of erection

Q

Chronic cocaine effects:

A

1) loss of libido

2) ejaculatory failure

Q

Acute opiod effects:

A

^sexual activity may be do to

disinhibition

Q

Chronic opiod effects:

A

1) low libido (2/3)
2) ED (1/2)
3) ejaculatory delay (2/3)

Q

LSD and sex:

A

^sensory

Q

MDA (ecstacy) and sex:

A

^sexual feelings and empathy

Q

PCP and sex:

A

Not assoc w sexual activity.

vv sensation, depression, psychosis

Q

Premature ejaculation tx:

A

1) local anesthetic
2) other experimented agents also
vv libido (clomipramine, thioridazine, MAOIs, benzos)

Q

Testosterone uses:

A

1) vv gonadal fx

2) ^libido in men and women (lower dose)

Q

testosterone side effects:

A

1) may accelerate prostate cancer

2) atherosclerosis?

Q

What are some dopamine

antagonists?

A

1) L-DOPA
2) bromocriptine
3) ampomorphine
4) methylphenidate (Ritalin)
5) buproprion (wellbutrin)

Q

L-DOPA uses:

A

Parkinson’s antecdote

Q

Prolactinemia tx:

A

bromocriptine

Q

ED folk remedies:

A

stimulants (kava, coca, strychnine),cannabis,betel nuts,bear gall bladder,rhino horn, ginseng, yohimbine

most ineffective

Q

Yohimbine ED txs

A

1) current rx: yocon, erex
2) MOA: alphpa 2 antagonist
3) effects: ^libido, ED improved
4) efficacy: uncertain

Q

Yohimbine side effects:

A

nausea, sweating, tremor, ^BP&HR,

anxiety, irritability

Q

Smooth muscle relaxants used

to tx ED include:

A

1) papverine
2) phentolamine
3) prostaglandin E

Q

Adverse effects of papaverine:

A

bradycardia, HoTN, priapism,

hepatotoxicity, penile fibrosis

Q

Phentolamine ED MOA:

A

alpha 1 blocker
(blocks symp smooth muscle contraction)

*papaverine adjunt, may interfere w orgasm

Q

How is prostaglandin E

administered for ED?

A

injection or urethral suppository

Q

Adverse effects of

prostaglandin E include:

A

HoTN, penile pain, ocassional priapism

Q

Phosphodiesterase Inhibitors

used to tx ED include:

A

1) sildenafil (viagra)
2) avanafil (stendra)
3) vardenafil (levitra)
4) tadafil (cialis)

Q

Viagra ADME:

A

1) peak conc @ 1 hr
2) 4 hour half life
3) ~ 4 hr duration

Q

Peak conc avanafil:

A

30 - 45 min

Q

Peak conc vardenafil:

A

30 min - 2 hrs

effective4 hrs, half life4-5 hrs

Q

peak conc tadalafil:

A

1 - 6 hrs

effective 36 hrs, half life 18 hrs

Q

BPH tx:

A

cialis (tadafil)

* avoid alpha blockers when taking cialis

Q

Pulmonary HTN tx:

A

revatio (sildenafil)

*sxs & exercise capacity improved

Q

Adverse effects of PDE inhibitors:

A

Common: HoTN, headache, flushing,indegestion

Less common: visual disturbances, acute
hearing loss, nasal congestion, rash,
diarrhea

Q

How are PDE inhibitors

metabolized?

A

CYP3A4

Q

What are the adverse effects of

PDE inhibitors and nitrates?

A

BP drop, syncope, lower cardiac perfusion,

MI (128 in deaths in first 8 months of use)

Q

What is the MOA for ED drugs?

A

relaxation of smooth muscle in

corpora cavernosa

Q

Estrogen uses:

A

1) vaginal atrophy, dryness, dyspareunia
2) libido?
3) helpful in menopause

Q

Low lidido tx for women:

A

androgen/testosterone patch may

enahnce libido and satisfaction

Q

Osphena MOA:

A

selective (vaginal) estrogen receptor modulator

Q

Female effects of sildenafil

may include:

A

genital engorgement

limited success

Q

Tx of female sexual dysfunction:

A

1) DA agonists (libido)
2) bupropion (DA enhancer)
3) alprostadil (PGE cream)
4) phenotolamine (alpha blocker)
5) neutraceuticals, filbanserin, bremelanotide(experamental)

Q

Filbanserin MOA:

A

5-HT agonist, 5-HT2 antagonist

development on hold

Q

Bremelanotide MOA:

A

1) melanocortin synthetic / alpha MSH
2) centrally stim libido male & female
3) original nasal spray withdrawn
4) subcutaneous formula in trials