Test 4 - ED & BPH Medications (Josh)

Question 1

What causes an erection?

Answer 1

sexual stimulation –> Nitric Oxide –> cGMP –> relaxes muscles allowing blood to fill penis

Question 2

MOA: PDE-5 Inhibitors

Answer 2

PDE-5 is an enzyme in the body that breaks down cGMP, not allowing muscle to relax

PDE-5 inhibitors block this process, allowing muscles to relax and blood to fill penis

Question 3

What other indications are PDE-5 Inhibitors good for?

Answer 3

1) ED
2) PAH (Pulmonary Arterial Hypertension)
3) BPH (Benign Prostate Hypertrophy)

Question 4

What are contraindications for PDE-5 Inhibitors?

Answer 4

• Nitrates
• Alpha Blockers
• Hypotension meds

Question 5

Why are nitrates contraindicated for PDE-5 Inhibitors?

Answer 5

Nitrates increase cGMP and PDE-5 Inhibitors block breakdown of cGMP, therefore you have PROFOUND HYPOTENSION

Question 6

Common A/E of PDE-5 Inhibitors?

Answer 6

All due to vasodilator

• Headache
• Flushing
• Dyspepsia
• Nasal Congestion

Question 7

Rare A/E of PDE-5 Inhibitors?

Answer 7

• Hypotension
• Priapism (erection > 6 hers)
• Hearing Loss
• Vision Disturbances (blue tinge)

Question 8

Why report an erection longer than 4 hours?

Answer 8

Can cause permanent ED and impotence

Question 9

Which meds are PRN and which is the ‘weekender’?

Answer 9

Sildenafil - PRN (30-60 mins before the deed)
Vardenafil - PRN (30-60 mins before the deed)
Tadalafil - weekender (lasts 36 hours)

Question 10

What is the Pathophysiology of BPH?

Answer 10

Benign Prostate Hypertrophy

• prostate gets too late and impinges on the urethra

Question 11

Which class of meds are used w/ BPH?

Answer 11

Alpha Blockers

5-Alpha Reductase Inhibitors

Question 12

Which class of meds reduce prostate size?

Answer 12

5-Alpha Reductase Inhibitors

• 5-Alpha Reductase converts Testosterone into DHT that then enlarged the prostate (and causes baldness)
• These meds block that and prostate will eventual decrease in size

Question 13

Do Alpha Blockers reduce prostate size?

Answer 13

NO, they just dilate the urethra (site of Alpha-1 receptors) decreasing obstruction of urethra

Question 14

Which BPH meds can also treat hypertension?

Answer 14

Doxazosin

Terazosin

Question 15

What is ‘first dose phenomenon’ when it comes to BPH meds?

Answer 15

Orthostatic hypotension on first dose

• take at bedtime
• stand up slowly
• stay hydrated

Question 16

What would happen if you take an Alpha Blocker for BPH while taking a PDE-5 Inhibitor for ED?

Answer 16

Too much dilation

BP will bottom out

Question 17

Alpha-1 blockers end in what?

Answer 17

-osin

DoxazOSIN
TerazOSIN
AlfuzOSIN
TamsulOSIN

Question 18

PDE-5 Inhibitors end in what?

Answer 18

-afil

SildenAFIL
VardenAFIL
TadalAFIL

Question 19

Which ED medication can be used for BPH?

Answer 19

tdalafil (the weekender)

Question 20

If taking a nitrate, how long to wait before taking an ED drug?

Answer 20

24 hours (or longer)

Nitrates

• nitroglycerin
• isosorbide dinitrate

Question 21

5-Alpha Reductase Inhibitors end in what?

Answer 21

-asteride

DutASTERIDE
FinASTERIDE

Question 22

What does 5-Alpha Reductase do?

Answer 22

It is an enzyme that converts Testosterone into Dihydrotestosterone (DHT) that causes the prostate to grow and the hair to go

Question 23

A/E of 5-Alpha Reductase Inhibitors?

Answer 23

• artificially lowers PSA (thus masking potential prostate cancer)
• high risk of prostate cancer
• ejaculatory probes
• gynecomastoma (watch for breast tenderness)

Question 24

Pregnancy risk category of 5-Alpha Reductase Inhibitors?

Answer 24

X

• don’t even touch it (highly lipid soluble)
• don’t give blood b/c pregnant woman can get blood

Question 25

How long does it take 5-Alpha Reductase Inhibitors to take full effect?

Answer 25

3-6 months b/c it takes time for prostate to decrease insize