Sexual Dysfunction

Question 1

What is a common medication in both male and females that cause sexual dysfunction?

Answer 1

SSRI and SNRI

**bupropion is an antidepressant that does NOT cause sexual dysfunction(:

Question 2

What are the most common causes of ED?

Answer 2

hypertension
atherosclerosis
diabetes (neuropathy!)

Question 3

What drugs cause erectile dysfunction?

Answer 3

Alcohol!!!!
Antidepressants
Antihypertensives
Antipyschotics (1st gen)
— prolactin raising (risperidone, paliperidone)
BPH medications:
- finasteride
-dulasteride
- silodosin

Question 4

What natural products may help with ED?

Answer 4

L-arginine
yohimbe
panax ginseng (bleeding!)

Question 5

What is the process of erection of the penis?

Answer 5

Nitric oxide is released –> guanylate cyclase –> cGMP which relaxes smooth muscle in the arteries of the penis –> blood flows in to create an erection

Question 6

PDE-5 inhibitors

Answer 6

Sildenafil (Viagra)
Tadalafil (Cialis)
Verdenafil

PDE-5 inhibitors block the degradation of cGMP to erect the penis

Question 7

Cialis

Answer 7

***also used for BPH
CI: nitrate
Warning: color discrimination, hearing loss, vision loss, HYPOtension, priapism (> 4 hrs)

SE: HA, flushing, dyspepsia, back pain (MOST with tadalafil)

take 10 mg at least 30 minutes before sexual activity

Question 8

Viagra dosing

Answer 8

start 50 mg at least 1 hour before sexual activity

Question 9

When would you want to decrease the starting dosing of a PDE-5 inhibitor?

Answer 9

patient >/= 65 years
using alpha blocker
using CYP3A4 inhibitor
severe renal or liver disease

*** if any of these decrease PDE-5 inhibitor dose by 50%
Cialis 10 mg –> 5 mg
Viagra 50 mg–> 25 mg

Question 10

What are some counseling points for PDE-5 inhibitors?

Answer 10

-take no more than 1 dose per day
- these medications do not increase libido, must be present for medication to work
- May cause vision or hearing loss
-take Cialis (tadalafil) 30 minutes before
-take Viagra (Sildenafil) 1 hour before

Question 11

If a PDE-i is not effective for ED, what is the next option?

Answer 11

Alprostadil - a prostaglandin E1 that vasodilations

either injected into penis or pellet is inserted

PAINFUL

Question 12

What are some treatments for hypoactice sexual desire disorder?

Answer 12

5-HT1 agonist/5-HT2A antagonist
-filbanserin

Melanocortin receptor agonist:
-bremelanotide

Question 13

Filbanserin

Answer 13

treatment for hypoactive sexual desire

CI with alcohol due to HYPOTENSION
—-REMS required!!!!
do not use with CYP3A4 inhibitors

Question 14

Bremelanotide

Answer 14

CI: uncontrolled HTN or known CVD

Question 15

What PDE-i can cause back pain?

Answer 15

Tadalafil (Cialis)