Lecture 1 - Drugs of Sex

Question 1

Which drugs increase libido?

Answer 1

testosterone (male and female)

dopamine

Question 2

Which drugs decrease libido?

Answer 2

prolactin (male and female)
estrogen (male –negative feedback – decrease testosterone)
serotonin (SSRI)

Question 3

How do you treat premature ejaculation?

Answer 3

Local anesthetics

other drugs that delay orgasms have been used (like clomipramide, thioridazine, MAOIs, benzos)
HOWEVER they also inhibit libido

Question 4

Do dopamine agonists increase or decrease libido?

Answer 4

increase

Question 5

Prostaglandin E

Answer 5

alprostadil

relaxes smooth muscle

most commonly used pre-Viagra (65% efficacy)
two forms: injectable and urethral suppository

vasodilation

SE:
hypotension
mild penile pain
occasional priapism

Question 6

Sildenafil

Answer 6

Viagra

PDE5 inhibitors

works on erection
NOT libido

peak plasma concentrations for sildenafil @ 1hr (pts should be instructed to take viagra 1 hour prior to anticipated intercourse)

Question 7

PDE5 Inhibitors are indicated for ED, as well as what else?

Answer 7

BPH

PAH (pulmonary arterial hypertension)

Question 8

What are the adverse effects of PDE5 inhibitors?

Answer 8

hypotension
HA, flushing, indigestion

less commonL visual disturbances, acute hearing loss

Question 9

How is PDE5 inhibitors metabolized?

Answer 9

CYP3A4

Question 10

What happens when you take nitrates on top of PDE5 inhibitors?

Answer 10

large decrease in BP
syncope
lower cardiac perfusion
MI

Question 11

What is the MOA of anti-ED drugs?

Answer 11

relaxation of smooth muscle in corpora cavernosa