Pharm of Erectile Dysfunction Flashcards
What is the diagnostic tool for ED?
IIED= International Index of Erectile Dysfunction
15 questions put into 5 categories
PDE-6
also works on retina –> increased sensitivity to light, blurred vision, loss of blue-green discrimination
sildenafil»vardenafil
PDE-11
also works on skeletal muscle –> back and muscle aches
tadalafil»>all others
C/I for PDE5 inhibitors
TAKING NITRATES (causes hypotension)
CYP3A4 inhibitors
Antihypertensive meds and alcohol can cause hypotension
caution: diseases that might cause priapism, CAD, vasodilatory disorders
Nonarteritic Anterior Ischemic Optic Neuropathy (NAION)
blood flow blocked to the optic nerve
rapid onset of painless unilateral vision loss
RECOMMEND TERMINATION OF DRUG THERAPY
Counseling tips for PDE5 inhibitors
take on empty stomach/ low-fat meal (sildenafil, vardenafil)
several doses tried before tx failure
avoid excessive alcohol
What is alprostadil?
synthetic prostaglandin E1 analog
increases cAMP –> smooth muscle relaxation –> increase blood flow and filling –> prolong erection
alleviates multiple causes but has weird administration and $$$
Alprostadil efficacy
no drug interactions
no dose adjustment needed in liver/ renal failure
Alprostadil side effects
LOCAL (less systemic rxns)
penile pain, cavernosal scarring, priapism, bleeding from urethra (dizziness, hypotension)
Counseling tips for Caverject (alprostadil)
store at ROOM TEMP reconstitute prior to use inject 5-10 min before desired erection erection will last for approx 1 hour NEVER INJECT ON THE HEAD OR THE TIP (use the sides of the shaft)
Counseling tips for MUSE (alprostadil)
intraurethral suppositories store IN REFRIDGERATOR recomm. emptying bladder before use administer 5-10 min prior to intercourse rotate sites may cause pain NOT good for bad dexterity/ sight
Hypogonadism S/Sx
testosterone <300ng/dL, dec libido and muscle strength, depression
Treatment:
Hypogonadism Treatment
supplemental testosterone
**does not directly treat ED but improves libido (secondary ED)
CI/ Precautions for hypogonadism and HRT
USE CAUTION IN BPH AND PROSTATE CANCER
monitor for liver tox (esp with PO forms)
NOT for men w/ normal testosterone levels
stop if no improvement in 3 months
Counseling tips for hypogonadism and HRT
PO NOT PREFERRED (increased hepatotox since poor bioavailability)
buccal= bypasses first pass
IM= less frequent dosing; increase mood swings
implanted= pellet may be extruded
patch= good absorption
topical gel should NOT be applied to genitals and should be applied in the AM
