Sexual Dysfunction/BPH Flashcards
1
Q
Common Comorbidities with ED
A
- HTN
- Atherosclerosis
- Neuropathy, diabetes
- Depression
- Stress
- Spinal Cord Injury
- Stroke
2
Q
Drugs that Cause ED/Sexual Dysfxn
A
- Alcohol
- Antidepressants: SSRIs and SNRIs
- Anti-HTN: B-blockers, clonidine, thiazides
- Antipsychotics: first-generation (chlorpromazine), prolactin raising 2nd gen (risperidone, paliperidone)
- BPH Meds: Finasteride, dutasteride, silodosin (retrograde ejaculation)
3
Q
Natural Products for ED
A
- Yohimbe - “insufficient evidence” and concerning SE
- L-arginine - “possibly effective,” similar SE to PDE5i, avoid additive effects
- Panax ginseng - “possibly effective,” bleeding risk
4
Q
Viagra
A
- Sildenafil (Revatio used for PAH)
- Start at 50 mg ~1 hour before sex
- Decreased efficacy with high-fat or large meal
5
Q
Levitra/Staxyn
A
- Vardenafil
- Start at 10 mg ~1 hour before sex
- Decreased efficacy with high-fat or large meal
6
Q
Cialis
A
- Tadalfil (Adcirca for BPH)
- Also used for BPH
- Daily dosing: 2.5-5 mg QD
- On-demand dosing: 5-20 mg PRN, start at 10 mg ~30 minutes before sex
- SE: back pain
7
Q
Stendra
A
- Avanafil
- Use 15-30 minutes before sex
8
Q
PDE5i Information
A
- CI: Use with nitrates (hypotensive risk)
- Warning: impaired color discrimination, hearing loss, vision loss, hypotension, priapism (>4 hr), seek medical help with chest pain
- SE: HA, flushing, dizziness, dyspepsia
- No more than 1 dose per day if used for ED
9
Q
Decreased PDE5i Dose Criteria
A
- > = 65 yo
- Using alpha-blocker
- Using CYP3A4 inhibitor
- Severe renal or liver disease
- Reduce starting doses in half (Viagra - 25 mg, Levitra/Cialis - 5 mg, Stendra - 50 mg
10
Q
PDE5i DDI
A
- Absolute CI with nitrates
- Make sure patient is stable on alpha-1 blocker before starting PDE5i (no hypotension/dizziness)
- May need to adjust doses with CYP3A4 inducers/inhibitors
11
Q
Prostaglandin E1
A
- Aloprostadil
- Vasodilator that is either injected into penis or inserted (pellet) into urethra
- Must refrigerate pellets
- SE: Penile pain, priapism
12
Q
Drugs that Worsen BPH
A
- Centrally-acting anticholinergics
- Drugs with anticholinergic SE: antihistamines, decongestants, phenothiazines, TCAs
- Caffeine
- Diuretics
- SNRIs
- Testosterone products
13
Q
Sxs of BPH
A
- Hesitency, intermittent urine flow, straining/weak stream
- Urinary urgency, leaking, dribbling
- Incomplete bladder emptying
- Urinary frequency (nocturia)
- Bladder obstruction
- Severe renal failure
14
Q
Natural Products for BPH
A
- Saw palmetto: unlikely to be effective
- Lycopene: for prostate cancer prevention, no evidence for BPH use
15
Q
Alpha-1 Blocker Information
A
- First-line for moderate to severe sxs of BPH
- Can be used with 5 alpha reductase inhibitor (hypotension risk with PDE5i)
- Cause relaxation of smooth muscle in prostate/bladder neck and reduces outlet obstruction to improve urinary flow
- Warning: orthostatic hypotension, syncope, intraoperative floppy iris syndrome (cataract surgery)
- SE: Dizziness, fatigue, HA, abnormal ejaculation
- Non-selective drugs often given at bedtime to minimize hypotensive SE
- May take 4-6 weeks to take full effect
