Men's Health Flashcards
The production of nitrous oxide occurs in what nervous system?
Parasympathetic
What is the first line treatment for ED?
PDE5
What is the mechanism of NO?
Nitrous oxide diffuses across the membrane of smooth muscle = increase GTP –> cGMP will cause cascade –> decrease intracellular calcium = relaxation = vasodilation = blood flows IN = erection
Why is PDE 5 Enzyme a target for ED?
Because it degrades cGMP
Inhibit clearance = increase cGMP = decreases Ca2+
Where is PDE 5 found?
Penis
PDE 5 Inhibitors can cause what?
Drop in BP due to relaxation of vascular smooth muscle
What are the adverse effects of PDE4 Inhibitors?
HA, Flushing, Dyspepsia, Nasal Congestion, and others
Which PDE 5 has the highest incidence of HA and Flushing?
Vardenafil
What is another A/E of Silfenafil?
Visual: BLUE hue, blurred vision, light sensitvity
What is another A/E of Vardenafil?
Prolonged QT Interval
What is another A/E of Tadalafil?
Back pain, myalgia, pain in limbs
Sildenafil has the most effect in what tissue target?
Rods/Cones in Eyes
Vardenafil has the most effect in what tissue target?
Vascular/Cardiac
Tadalafil has the most effect in what tissue target?
Skeletal Muscle
Avanafil has the most effect in what tissue target?
Vascular/Cardiac
Nitrates and PDE 5 Inhibitors used together causes what?
Significant and Serious drop in BP
What is Priapism and is it an A/E of PDE 5?
Sustained erection >4hrs and YES
What is Non-Arteritis Anterior Ischemic Optic Neuropathy and is it an A/E of PDE 5?
Temporary or permeant blindness
YES
In what scenario would a PDE 5 inhibitor NOT work?
If there was a decrease in the ability to produce NO
What is Alprostadil and its MOA?
PGE1, increase cAMP = decrease Ca2+
Is Alprostadil independent or dependent on NO?
INDEPENDENT
What is Phentoalmine?
Alpha Adrenergic Antagonist
What is Papaverine?
Nonspecific PDE Inhibitor
Are Phentoalmine and Papaverine independent or dependent on NO?
INDEPENDENT
What are the A/Es of Alprastodil, Phentoalmine, and Papaverine?
- Priaprism
- Pain of Injection
- Fibrosis w/Long term use
- Non-Penile Vasodilation
Where is testosterone produced?
Leydig Cells = men
Corpus Luteum and Adrenal Cortex = women
When is the time of highest diurnal release of testosterone?
At waking
What has a 5x affinity for androgen receptors compared to testosterone?
Dihydrotestosterone DHT
What are the Androgen effects?
- Sexual differentiation and maturation
- Increases muscle mass
- Bone growth
- Erythropoiesis
- Sexual drive
- Male pattern baldness
- Prostatic hyperplasia
What are the side effects of androgen replacement therapy?
- Priapism
- Prostatic Hyperplasia
- Prostate Cancer
- Gynecomastia
When would you want to block androgens?
BPH or Prostate Cancer
What are anti-androgens for BPH?
Finasteride and Dutasteride
What is the MOA and A/E of finasteride and dutasteride?
5-a-reductase inhibition
Decreased libido, impotence, and gynecomastia
What alpha-1 blockers are used for BPH and their MOA?
Tamsulosin, Silodosin, and Alfuzosin
Cause relaxation of smooth muscle and improve urine flow
What are A/Es of alpha-1 blockers?
- Cardiovascular (less of a problem for alfuzosin)
- Orthostatic Hypotension
- Tachycardia
- Congestion
What are Androgen Receptor Antagonists used as 2nd line option for prostate cancer?
Flutamide and Bicalutamide
