men's and women's health: ED

Question 1

PDE5i: agents and moa

Answer 1

increase intracavernosal cGMP levels by competitively inhibiting the PDE5 enzyme

sildenafil = vardenafil = tadalafil = avanafil

Question 2

which PDE5i is the most selective?

Answer 2

avanafil

Question 3

which PDE5i has the longest duration of action?

Answer 3

taalafil

Question 4

which PDE5i does not have to be taken with regards to food?

Answer 4

tadalafil

Question 5

c/i of PDE5i

Answer 5

nitrates

Question 6

sildenafil dosing

Answer 6

taken 1 hour before sex and effective up to 4 hours

50-100mg on empty stomach

reduced dose of 25mg if used with strong cyp3a4 inhibitors (will incr serum conc of sildenafil) or alpha-1 blockers or pt w CrCl<30 or moderate hepatic impairment

Question 7

coadm of PDE5i with alpha-1 blockers

Answer 7

may cause symptomatic hypoTN
- stabilise alpha-1 blocker dose prior to starting PDE5i at a reduced dose
- tamsulosin and silodosin are better tolerated a1 blockers

Question 8

vardenafil dosing

Answer 8

taken 1 hour before sex and effective up to 4 hours

10-20mg on empty stomach

5mg for pt>= 65yo

reduced dose of 2.5mg for coadm with a1 blockers or strong cyp3a4 inhibitors

Question 9

tadalafil dosing

Answer 9

PRN: 10-20mg about 30 mins before sex

coadm with strong cyp3a4 inhibitor: 10mg not more than once every 3 days

daily tx: 2.5-5mg OD

coadm with strong cyp3a4 inhibitor: 2.5mg OD

Question 10

avanafil dosing

Answer 10

100-200mg as early as 15 mins before sex

reduced dose of 50mg if coadm with a1 blocker or moderate inhibitor of cyp3a4
^ 50mg should be taken 30 mins before sex

Question 11

PDE5i adr

Answer 11

flushing, headache, dyspepsia, nasal congestion, blue vision, hearing loss

Question 12

if a person has taken pde5i and now taking nitrates, develops a chest pain

Answer 12

delay nitrates at least:
- 12hrs for avanafil
- 24hrs if sildenafil or vardenafil
- 48hrs if tadalafil
^ longer if renal or hepatic dysfunction

Question 13

PGE1: agent and moa

Answer 13

alprostadil
- vasodilator
- inhibit/override sympathetic vasoconstrictors, acting as a vasodilator: accelerated arterial inflow + impeded venous outflow

Question 14

alprostadil adm method and dosing

Answer 14

intraurethral or intracavernosal
= 2.5mcg for initial dose titration, may be incr to 5mcg or 10mcg (achieve erection long enough but does not exceed 1hr)

Question 15

vascular etiologies of ED

Answer 15

cvd, htn, dm, hld, smoking, major surgery or radiotherapy

Question 16

drug induced etiologies of ED

Answer 16

antihypertensives, antidepressants, antipsychotics, antiadrogens, recreational drugs, alcohol

Question 17

neurologic etiologies of ED

Answer 17

spinal cord and brain injuries, PD, AD, multiple sclerosis, stroke, major surgery or radiotherapy of prostate

Question 18

hormonal etiologies of ED

Answer 18

hypogonadism, hyperprolactinemia, hyper and hypothyroidism, hyper and hypocortisolism