Limp Dick

Question 1

How is the delivery of alprostadil unique from other drugs in its class?

Answer 1

intra-urethral placement or intra-cavernosal injection. This allows minimal systematization and rapid onset with effects that can last hours.

ALP-robably not inject my dick

Question 2

What unique ADEs does alprostadil have compared to PDE-5 inhibitors?

Answer 2

Rarely CV effects.

Also penis pain because you are injecting into it

Question 3

What drugs are absolutely contraindicated with PDE-5 inhibitors?

Answer 3

contraindicated with NITRATES. will cause severe hypotension.
Also possible interaction with alpha-blockers (hypotension), and drugs affecting CYP activity.

Vardenafil -interactions can cause QT prolongation

Question 4

Which PDE-5 inhibitor is most likely to elicit QT prolongation?

Answer 4

vardenafil has interactions with >70 drugs that cause risk of QT prolongation

Question 5

MOA of alfuzosin

Answer 5

a1 receptor antagonist to treat BPH and ED. Relaxes smooth muscle in prostate and bladder neck.

Question 6

ADE of alfuzosin

Answer 6

GI - xerostomia, nausea
CNS - dizziness, somnolence, asthenia, headache, insomnia
Abnormal retrograde ejaculation.
Floppy iris syndrome

Do NOT have to titrate because has less effects on CV system

Question 7

MOA of avanafil

Answer 7

PDE-5 inhibitor approved for ED. PDE5 normally degrades cGMP, a vasodilator. less PDE5 means more cGMP means vasodilation. One of the fastest acting PDE-5 inhibitors (15 min)

Question 8

ADE of avanafil

Answer 8

non-arteritic ishcemic optic neurpathy, sudden hearing loss, unstable angina.
You’ll be deaf and blind and have a heart attack but your penis will work.

Question 9

MOA of alprostadil

Answer 9

PGE1 analog. Upregulates adenylate cyclase which increases cAMP, increasing protein kinase A, causing decrease in intracellular Ca++, ultimately leading to smooth muscle relaxation –> increased blood flow to penis

Question 10

ADE of alprostadil

Answer 10

pain and rarely CV effects

Question 11

MOA of sildenafil

Answer 11

cGMP-specific PDE-5 inhibitor. (increases cGMP to promote blood flow). Viagra.

Question 12

ADE of sildenafil

Answer 12

Can be delayed by a high fat meal. Non-arteritic ishcemic optic neuroapthy, sudden hearing loss.
Priapism.

Question 13

MOA of tadalafil

Answer 13

PDE5 inhibitor. Slower onset. (2-4 hrs) Longest half-life (35 hrs)

Question 14

ADE of tadalafil

Answer 14

non-arteritic ishcemic optic neuropathy, sudden hearing loss.
CV adverse effects like angina, MI and tachycardia
Priapism

Question 15

MOA of vardenafil

Answer 15

PDE5 inhibitor. Levitra. 1 hr bioavailable. Delayed by high fat meals.

Question 16

ADE of vardenafil

Answer 16

QT prolongation. (V-ardenafil = cardioVASCULAR)

Non-arteritic ischemic optic neuropathy, sudden hearing loss, angina, MI.

Question 17

MOA of yohimbine

Answer 17

a2 receptor anatagonist (auto-receptor agonist) that vasodilates (via increasedNO) and inhibits the function of monoamine oxidase enzymes (MAOI).

Question 18

ADE of yohimbine

Answer 18

high doses can cause priapism
Crosses BBB so anxiety, antidiuresis, dizzinesss, headache, HTN, tremor, etc.

Interactions with tyramine and caffeine on MAOI action.

Worsens renal function.

Question 19

MOA of testosterone replacement therapy?

Answer 19

unknown, but plays important role in erectile function. 65% of treated men have improvement.