Sexual dysfunction Flashcards
Most common cause of erectile dysfunction (ED)
reduced blood flow to the penis
ED can be an early sign of what disease?
cardiovascular disease
Drug classes that can cause sexual dysfunction
SSRI's/SNRI's (decr libido) Anhihypertensives Antipsychotics: 1st-gen 2nd gen that raise prolactin (risperidone, paliperidone)
BPH meds (finasteride, dutasteride, silodosin) retrograde ejaculation
Natural meds used for ED
Yohimbe (insufficient evidence)
L-arginine (possibly effective) can cause same side effects of PDE5 inhibitors
Panax ginseng (possibly effective)
Which PDE5 inhibitor is approved to treat BPH?
tadalafil (Cialis)
Whihc PDE5 inhibitors are approved for pulmonary HTN?
tadalafil (Adcirca)
sildenafil (Revatio)
MOA of PDE5 inhibitors
inhibits the breakdown of cGMP
cGMP relaxes the smooth muscle in the arteries and increases blood flow to the penis
PDE5 inhibitors also increase libido (t/f)
FALSE
these drugs won’t be effective if pt does not have a libido
When would you consider using a decr dose of a PDE5 inhibitor?
Age 65 +
Pts also using an alpha blocker
Use of a CYP3A4 inhibitor
Severe renal/liver disease
Reduce dose by 50%
PDE5 inhibitor contraindications
Do not use with nitrates of riociguat
PDE5 inhibitor warnigns
changes in color vision Hearing loss Vision loss (rare) Hypotension Priapism (erection 4+ hours) CVD
PDE5 inhibitor side effects
HA flushing dizziness dyspepsia blurred vision sensitivity to light
sildenafil brand and dosing
Viagra
Start at 50 mg daily
25-100 mg daily
Take 1 hr before intercourse
Vardenafil brand and dosing
Levitra, Staxyn ODT (only available in 10 mg)
Start at 10 mg
5-20 mg daily
take 1 hr before sex
tadalafil brand and dosing
Cialis
Daily dosing: 2.5-5 mg daily
PRN dosing: 5-20 mg PRN (usually start at 10 mg)
Take at least 30 mins before sex
Tadalafil renal dosing
CrCL 30-50: 5 mg prn
crCl < 30: 5 mg PRN q72h
Avanafil brand and dosing
Stendra
start at 100 mg
50-200 mg
Take 15-30 mins before sex
Longest acting PDE5 inhibitor:
tadalafil
How many hours must you wait to give a nitrate after taking each PDE5 inhibitor?
Avanafil: 12 hrs
Sildenafil/vardenafil: 24 hours
tadalafil: 48 hrs
PDE5 inhibitors should be used with caution with all antihypertensive meds, esp this class:
alpha-1 blockers
incr risk of hypotension and falls
PDE5 inhibitor metabolism
CYP3A4
dose adjustment required when used with a CYP3A4 inhibitor
Duration of action of each PDE5 inhibitor
avanafil/vardenafil/sildenafil: 4-6 hrs
tadalafil: 36 hrs
What drug can be used for ED if PDE5 inhibitors are contraindicated?
Alprostadil
Protaglandin E1: vasodilator which incr penile blood flow
Alprostadil intracavernous injection
Caverject
Edex
1.25-2.5 mg into the base of the penis
Max 1 x/day and 3x/week
