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NAPLEX - OUR cards > Sexual dysfunction > Flashcards

Sexual dysfunction Flashcards

1
Q

Most common cause of erectile dysfunction (ED)

A

reduced blood flow to the penis

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2
Q

ED can be an early sign of what disease?

A

cardiovascular disease

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3
Q

Drug classes that can cause sexual dysfunction

A 
SSRI's/SNRI's (decr libido)
Anhihypertensives
Antipsychotics:
1st-gen
2nd gen that raise prolactin (risperidone, paliperidone)

BPH meds (finasteride, dutasteride, silodosin) retrograde ejaculation

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4
Q

Natural meds used for ED

A

Yohimbe (insufficient evidence)
L-arginine (possibly effective) can cause same side effects of PDE5 inhibitors
Panax ginseng (possibly effective)

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5
Q

Which PDE5 inhibitor is approved to treat BPH?

A

tadalafil (Cialis)

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6
Q

Whihc PDE5 inhibitors are approved for pulmonary HTN?

A

tadalafil (Adcirca)

sildenafil (Revatio)

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7
Q

MOA of PDE5 inhibitors

A

inhibits the breakdown of cGMP

cGMP relaxes the smooth muscle in the arteries and increases blood flow to the penis

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8
Q

PDE5 inhibitors also increase libido (t/f)

A

FALSE

these drugs won’t be effective if pt does not have a libido

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9
Q

When would you consider using a decr dose of a PDE5 inhibitor?

A

Age 65 +
Pts also using an alpha blocker
Use of a CYP3A4 inhibitor
Severe renal/liver disease

Reduce dose by 50%

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10
Q

PDE5 inhibitor contraindications

A

Do not use with nitrates of riociguat

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11
Q

PDE5 inhibitor warnigns

A 
changes in color vision
Hearing loss
Vision loss (rare)
Hypotension
Priapism (erection 4+ hours)
CVD
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12
Q

PDE5 inhibitor side effects

A 
HA
flushing 
dizziness
dyspepsia
blurred vision 
sensitivity to light
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13
Q

sildenafil brand and dosing

A

Viagra

Start at 50 mg daily
25-100 mg daily
Take 1 hr before intercourse

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14
Q

Vardenafil brand and dosing

A

Levitra, Staxyn ODT (only available in 10 mg)

Start at 10 mg
5-20 mg daily
take 1 hr before sex

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15
Q

tadalafil brand and dosing

A

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

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16
Q

Tadalafil renal dosing

A

CrCL 30-50: 5 mg prn

crCl < 30: 5 mg PRN q72h

17
Q

Avanafil brand and dosing

A

Stendra

start at 100 mg
50-200 mg
Take 15-30 mins before sex

18
Q

Longest acting PDE5 inhibitor:

A

tadalafil

19
Q

How many hours must you wait to give a nitrate after taking each PDE5 inhibitor?

A

Avanafil: 12 hrs
Sildenafil/vardenafil: 24 hours
tadalafil: 48 hrs

20
Q

PDE5 inhibitors should be used with caution with all antihypertensive meds, esp this class:

A

alpha-1 blockers

incr risk of hypotension and falls

21
Q

PDE5 inhibitor metabolism

A

CYP3A4

dose adjustment required when used with a CYP3A4 inhibitor

22
Q

Duration of action of each PDE5 inhibitor

A

avanafil/vardenafil/sildenafil: 4-6 hrs

tadalafil: 36 hrs

23
Q

What drug can be used for ED if PDE5 inhibitors are contraindicated?

A

Alprostadil

Protaglandin E1: vasodilator which incr penile blood flow

24
Q

Alprostadil intracavernous injection

A

Caverject
Edex

1.25-2.5 mg into the base of the penis
Max 1 x/day and 3x/week

25
Q

Onset of action and duration of Caverject

A

onset: 5-10 mins
Duration: ~1 hr

26
Q

Alprostadil urethral pellets

A

Muse

125-250 mcg pellet into urethra
Urinate before admin

max 2 x/day

27
Q

Alprostadil storage

A

Refrigerate

28
Q

Drug used to treat Hypoactive sexual Desire Disorder (HSDD) in premenopausal females

A

Flibanserin (Addyi)

29
Q

Flibanserin MOA

A

5-HT1a agonist and 5ht2a antagonist

Dose: 100 mg qHS

30
Q

Flibanserin contraindications

A

Use w/ alcohol (severe hypotension and syncope)

use w/ mod-strong CYP3A4 inhibitors

31
Q

Flibanserin side effects

A 
dizziness 
somnolence
Nausea
fatigue 
Warning about hypotension and syncope

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