Sexual Dysfunction Flashcards
Which of the following statements concerning the phosphodiesterase-5 inhibitors is correct?
a. They don’t need to be dose adjusted d/t renal or hepatic dysfunction.
b. A benefit to avanafil is that it can be taken closer to intercourse (15 min).
c. A disadvantage of tadalafil is that it’s the shortest acting (effects wear off within a couple of hours).
d. When used for erectile dysfunction, they should only be used as needed within a specified time period before planned intercourse.
e. These drugs can be used safely in pts with CV disease.
b
Tadalafil is known as the “weekend pill” because it lasts the longest.
JC is a 59 y/o male pt. His med conditions include HTN, dyslipidemia, gout, obesity, and ED. His meds include enalapril, allopurinol, atorvastatin, and tadalafil. He’s currently hospitalized with an acute infection. The infection is being treated with voriconazole. Other meds added during the hospital stay are IV furosemide and diltiazem. Which meds have interactions with tadalafil?
a. Enalapril and atorvastatin
b. Voriconazole and diltiazem
c. Furosemide and allopurinol
d. Atorvastatin only
e. Diltiazem only
b
Voriconazole is a strong 3A4 inhibitor, and diltiazem is a moderate 3A4 inhibitor. Both can increase the effects of tadalafil.
A 68 y/o male is prescribed vardenafil for sexual dysfunction. HIs current meds include aspirin, metformin, Lantus Solostar, lisinopril, and verapamil. What is the appropriate starting dose of vardenafil for this pt?
a. 25 mg
b. 10 mg
c. 5 mg
d. 50 mg
e. 100 mg
c
Starting doses of PDE-5 inhibitors should be reduced by 50% in males >/= 65 years, using an alpha blocker, or CYP3A4 inhibitor (e.g., verapamil), and severe renal or liver disease.
When dispensing a PDE-5 inhibitor, the pharmacist must include counseling on the possibility of these adverse reactions:
a. Sudden decrease in vision in one or both eyes, which may be permanent
b. Sudden loss of hearing, or ringing in the ears, which may be permanent
c. Sudden loss of the sense of smell, which may be permanent
d. Headache
e. Flushing
a, b, d, e
All of the following can contribute to erectile dysfunction except:
a. Diabetes
b. Depression
c. Stress
d. Spinal cord injury
e. Gout
e
Which of the following best describes the MOA of the PDE-5 inhibitors?
a. They decrease cGMP, causing vasoconstriction of smooth muscle in the arterial vessels of the penis.
b. They degrade cGMP, which leads to relaxation of vascular smooth muscle and decreased blood flow to the vessels of the penis.
c. They block the breakdown of cGMP, leading to relaxation of smooth muscle in the arterial vessels of the penis.
d. They release nitric oxide, which decreases cGMP and causes decreased blood flow to the vessels of the penis.
e. They increase libido, which means the pt will have a higher desire for sex and therefore enhanced ability to obtain an erection.
c
A pt will begin sildenafil therapy for ED. His only other medical condition is HTN, for which he uses amlodipine and chlorthalidone. Choose the correct counseling statements.
a. Tell your doctor if you drink grapefruit juice, as it will increase the effects of this medication, and you may need a lower starting dose.
b. This medication can cause low BP and dizziness; be careful standing up until you get used to it.
c. Take sildenafil the morning of the day that you plan to have sexual intercourse.
d. Rarely, sildenafil can cause vision problems; tell your doctor if you can’t identify colors well.
e. Rarely, sildenafil can cause a painful erection that lasts longer than 4 hours; if this happens, get emergency treatment.
a, b, d, e
- Viagra should be taken about 1 hour before intercourse.
- Grapefruit juice is a 3A4 inhibitor that can increase the level of 3A4 substrates, including PDE-5 inhibitors.
A physician calls the pharmacy to ask for a recommendation for an ED tx for a patient. The patient takes Flomax, aspirin, rosuvastatin, and a multivitamin. The most important piece of info that the pharmacist can tell the physician is:
a. A PDE-5 inhibitor can be started without the need for dose adjustments or any other concerns.
b. The 1st line tx in this pt would be alprostadil (Caverject), as it’s the least invasive tx.
c. A PDE-5 inhibitor should only be started if the pt is on stable dose of Flomax and isn’t experiencing side effects.
d. The combo of PDE-5 inhibitor and Flomax will increase the risk of HTN.
e. A good choice for this pt is avanafil (Stendra), as it’s approved for ED and BPH.
c
- Flomax is a selective alpha-1 blocker used for BPH. Alpha-1 blockers and PDE-5 inhibitors can cause hypotension when used together (and thus use of an alpha-blocker warrants a lower starting dose than normal).
- Cialis is indicated for both BPH and ED.
The PDE-5 inhibitors are contraindicated with the following drugs:
a. Nimodipine
b. Nitrofurantoin
c. Nitrostat
d. Isosorbide mononitrate
e Ranolazine
c, d
It’s an absolute contraindication to use PDE-5 inhibitors with nitrates. This includes all formulations (short and long-acting) as well as illicit drugs (“poppers,” such as amyl nitrate and butyl nitrate). PDE-5 inhibitors are also contraindicated with riociguat.
Select the correct brand names for the different forms of tadalafil.
a. Revatio and Adcirca
b. Adcirca and Cialis
c. Levitra and Staxyn
d. Stendra and Staxyn
e. Cialis and Staxyn
b
