Geriatrics: Erectile dysfunction

Question 1

Function of cGMP

Answer 1

mediates smooth muscle relaxation -> erection

Question 2

PDE5 function

Answer 2

degrades cGMP

Question 3

Diuretics associated with ED

Answer 3

Thiazides
Spironolactone

Question 4

Antihypertensives associated with ED

Answer 4

CCBs
BBs
Methyldopa
Clonidine
Reserpine
Guanethidine

Question 5

Cardiac or cholesterol drugs associated with ED

Answer 5

Digoxin
Gemfibrozil
Clofibrate

Question 6

Antidepressants associated with ED

Answer 6

SSRIs
TCAs
Lithium
MAOIs

Question 7

Tranquilizers associated with ED

Answer 7

Butyrophenones
Phenothiazines

Question 8

H2 antagonists associated with ED

Answer 8

Ranitidine
Cimetidine

Question 9

Hormones associated with ED

Answer 9

Progesterone
Estrogen
Corticosteroids
LH- releasing hormone agonists
5a reductase inhibitors
cyproterone acetate

Question 10

Cytotoxic agents associated with ED

Answer 10

Methotrexate

Question 11

Immunomodulators associated with ED

Answer 11

Interferon-a

Question 12

Anticholinergic agents associated with ED

Answer 12

Disopyramide
anticonvulsants

Question 13

Recreational drugs associated with ED

Answer 13

Alcohol
Cocaine

Question 14

Analgesics associated with ED

Answer 14

Opioids
Acetaminophen

Question 15

PDE5 Inhibitors

Answer 15

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

Question 16

Low risk criteria for PDE5i treatment

Answer 16

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

Question 17

Intermediate risk criteria for PDE5i treatment

Answer 17

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

Question 18

High risk criteria for PDE5i treatment

Answer 18

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

Question 19

Sildenafil (Viagra)

Answer 19

Dose: 50 mg/day (25-100)
Onset: 30-60 min
Duration: 2-4 hours
Nitrate wait time: 24hrs
“little blue pill”
“Vitamin V”

Question 20

Vardenafil (Levitra, Staxyn)

Answer 20

Dose: 10mg (5-20mg)
Available as ODT
Onset: 60 min
Duration: 4-6 hrs
Nitrate wait time: 24h

Question 21

Tadalafil (Cialis)

Answer 21

Dose: 10mg (5-20mg)
Onset: 30-45 min
Duration: 24-36 hrs
Nitrate wait time: 48 hrs
“the weekender”

Question 22

Avanafil (Stendra)

Answer 22

Dose: 100mg (50-200mg)
Onset: 15 min
Duration: 4-6 hrs
Nitrate wait time: 12 hrs??? (24 hrs)
“the quickie”

Question 23

Blurred/Blue vision with PDE5 inhibitors

Answer 23

Sildenafil > Vardenafil ~ Avanafil > Tadalafil

Question 24

If initially ineffective, what should a patient do?

Answer 24

Try 7-8 doses before deeming treatment ineffective and seeking another.