Geriatrics: Erectile dysfunction Flashcards
Function of cGMP
mediates smooth muscle relaxation -> erection
PDE5 function
degrades cGMP
Diuretics associated with ED
Thiazides
Spironolactone
Antihypertensives associated with ED
CCBs
BBs
Methyldopa
Clonidine
Reserpine
Guanethidine
Cardiac or cholesterol drugs associated with ED
Digoxin
Gemfibrozil
Clofibrate
Antidepressants associated with ED
SSRIs
TCAs
Lithium
MAOIs
Tranquilizers associated with ED
Butyrophenones
Phenothiazines
H2 antagonists associated with ED
Ranitidine
Cimetidine
Hormones associated with ED
Progesterone
Estrogen
Corticosteroids
LH- releasing hormone agonists
5a reductase inhibitors
cyproterone acetate
Cytotoxic agents associated with ED
Methotrexate
Immunomodulators associated with ED
Interferon-a
Anticholinergic agents associated with ED
Disopyramide
anticonvulsants
Recreational drugs associated with ED
Alcohol
Cocaine
Analgesics associated with ED
Opioids
Acetaminophen
PDE5 Inhibitors
Smooth muscle relaxation -> inflow of blood to corpus cavernosum
Contraindication: nitrate therapy
ADE:
- hypotension (additive effects with alpha blockers)
- Decreased lower esophageal sphincter tone -> GERD
Low risk criteria for PDE5i treatment
Can be started on PDE5i:
- asymptomatic CVD with < 3 risk factors
- well controlled HTN
- Mild congestive HF (stage I-II)
- Mild valvular heart disease
- MI > 8 weeks ago
Intermediate risk criteria for PDE5i treatment
CV workup prior to prescribing PDE5i:
- has >/= 3 CVD risk factors
- mild to moderate stable angina
- recent MI or stroke within the last 2-8 weeks
- moderate congestive HF (stage III-IV)
- Hx of stroke, TIA, or PAD
High risk criteria for PDE5i treatment
PDE5i treatment contraindicated:
- unstable or refractory angina
- uncontrolled HTN
- severe CHF (stage V)
- recent MI or stroke within the past 2 weeks
- Moderate - severe valvular heart disease
- high risk cardiac arrhythmias
- obstructive hypertrophic cardiomyopathy
Sildenafil (Viagra)
Dose: 50 mg/day (25-100)
Onset: 30-60 min
Duration: 2-4 hours
Nitrate wait time: 24hrs
“little blue pill”
“Vitamin V”
Vardenafil (Levitra, Staxyn)
Dose: 10mg (5-20mg)
Available as ODT
Onset: 60 min
Duration: 4-6 hrs
Nitrate wait time: 24h
Tadalafil (Cialis)
Dose: 10mg (5-20mg)
Onset: 30-45 min
Duration: 24-36 hrs
Nitrate wait time: 48 hrs
“the weekender”
Avanafil (Stendra)
Dose: 100mg (50-200mg)
Onset: 15 min
Duration: 4-6 hrs
Nitrate wait time: 12 hrs??? (24 hrs)
“the quickie”
Blurred/Blue vision with PDE5 inhibitors
Sildenafil > Vardenafil ~ Avanafil > Tadalafil
If initially ineffective, what should a patient do?
Try 7-8 doses before deeming treatment ineffective and seeking another.