Lecture 11

Question 1

What is the difference between erectile dysfunction and impotence ?

Answer 1

ED : inability to maintain an erection and permit sexual intercourse

Impotence : inability of the male to perform an sexual act

Question 2

What is sexuality ?

Answer 2

its more than intercourse
there is the behaviour, intimacy , identity etc….

Question 3

What happens to sexuality at an older age ?

Answer 3

Delayed arousal , less rigid
weak orgasm
plateau prolonged
Detumescence is rapid

Question 4

What system cause the penis to be flaccid ?

Answer 4

sympathetic
arterial/smooth muscle contract

Question 5

What system causes the penis to erect ?

Answer 5

parasympathetic
vasodilation
less PVR

Question 6

What are the risks factors for ED ?

Answer 6

Lifestyle : smoking , sedentrary, alcohol, bicycle, nigh shifts, diet

Psychological: stress, anxiety, partner conflict, misinformation

Disease ( affecting testosterone) :inflammation, renal/liver, endocrine, CV, neuro ,Covid

Medications: antiHTN, antiandrogenic, hormones, NSAIDs, opioids, SUB ( heroin, smoking, cocaine), Psych ( SSRI, SNRI, TCA, MOAis) neuroleptics

Question 7

What is the mechanism that makes COVID a risk factor for ED ?

Answer 7

inflammation
sensory loss
subclinical hypogonadism!
Impaired pulmonary hemodynamics

Question 8

Which psych medications has less ED effects ?

Answer 8

Buproprion and mirtazipine

Question 9

What are the diff Tx types for ED ?

Answer 9

1st line: PDE5i

2nd line: intraurethral alprostadil (PGE1) , vacumm erection

3rd line: Penile prosthetic

Question 10

What are the non-pharm for ED ?

Answer 10

Counsel both partners

smoking cessation
avoid EtOH, substance misues
healthy diet, exercise and adequate sleep

Question 11

What is the main effect of PDE5i ?

Answer 11

less smooth muscle muscle and vasodilation
increase blood flow

Question 12

What is the dosing regiment for sildenafil ?

Answer 12

1 dose / 24 hours

Question 13

What is the dosing regiment for tadafil ?

Answer 13

3 doses / week
daily = 5 mg

Question 14

Which of the PDE5i has the longer time before sexual activity ?

Answer 14

36 hours - tadafil

Question 15

Which of the PDE5i should be taken without any food ?

Answer 15

Sildenafil and vardenafil
fasting
decrease Cmax with a high-fat meal

Question 16

Which of the PDE5i has more selectivity ?

Answer 16

Tadalafil and Vardenafil

Question 17

What is the metabolism of PDE5i ?

Answer 17

CYP 3A4

Question 18

What are the SE of PDE5i ?

Answer 18

flushing
headhache
Dyspepsia
Nasal congestion
Visual disturbance

Question 19

What are the safety measures for PDE5i ?

Answer 19

melanoma
NAION ( optic neuropathy)
Glaucoma
change in colour

Question 20

which medication should be avoid or CI for PDE5i ?

Answer 20

CI: nitrates, alpha-antagonists ( terazosin/doxazosin)

Question 21

Which of the alpha antagonist s is safer with PDE5i ?

Answer 21

non-selective : tamsulosin

Question 22

What are the potential reasons for failure of PDE5i ?

Answer 22

people
Condition
treatment ( choice or dose)

Question 23

What is the MOA of PGE1 in ED?

Answer 23

increase cAMP by inhibiting AC for sm relaxation, erection,

no need for endogenous NO

Question 24

What is aloprostadil ?

Answer 24

PGE1i

Question 25

How is alprostadil is given ?

Answer 25

injected on the side of the penis
start low doses

Question 26

What are the SE of alprostadil ?

Answer 26

PGE5i
penile pain
priapism

Question 27

Which conditions can increase the risk of priapism ?

Answer 27

sicke cell, multiple myeloma, leukemia, anatomical deformity of the penis

Question 28

What is the triple Tx for ED ?

Answer 28

Papaverine ( nonspecific PD5i)
Phentolaine ( alpha antagonist)
PGE1

Question 29

what are the NHP for ED?

Answer 29

Yohimbine
Panax ginseng
L-argininge

Question 30

PDE5i can be reinforced with the following with _____ ?

Answer 30

L-arginige

Question 31

What is the MOA of trazodone in ED ?

Answer 31

facilitated 5HT and DA pathways