Chapter 50: Sexual Dysfunction

Question 1

Which meds are used to treat hypoactive sexual desire disorder (HSDD) & which patients can use it

Answer 1

Filbanserin (Addyi)
Bremelanotide (injection)

PREmenopausal women only

Question 2

Filbanserin can cause which SE

Answer 2

fainting , hypotension,

Question 3

Filbanserin CI

Answer 3

alcohol (REMS required); 3A4 inhibitors

Question 4

Bremelanotide CI

Answer 4

uncontrolled HTN or known CVD

Question 5

ED is common in people with which medical conditions

Answer 5

HTN, atherosclerosis, diabetes

Question 6

Key drugs that can cause ED

Answer 6

• Alcohol
• Antidepressants (esp SSRIs and SNRIs)
• BB, clonidine
• FGAs (e.g., chlorpromazine), prolactin-raising SGAs (e.g., risperidone, paliperidone)
• Finasteride, dutasteride, and silodosin (mostly retrograde ejactulation)

Question 7

Natural products that can be used for ED

Answer 7

yohimbe, L-arginine, ginseng

Question 8

Which ED med is also used for BPH

Answer 8

Tadalafil

Question 9

Which ED meds are also used for PAH

Answer 9

sildenafil and tadalafil

Question 10

PED5 inhibitors MOA

Answer 10

sexual stimulation → release of NO → increases cGMP → smooth muscle relaxation → blood flows in → erection
PDE5i block PDE-5 from degrading cGMP

Question 11

T/F: PDE5 inhibitors can also increase libido

Answer 11

FALSE - sexual desire must be present for these drugs to work

Question 12

Sildenafil brand name

Answer 12

Viagra

Question 13

Tadalafil brand name

Answer 13

Cialis

Question 14

Sildenafil starting dose and when should it be taken

Answer 14

50 mg

~1 hour before sexual activity

Question 15

Vardenafil starting dose and when should it be taken

Answer 15

10 mg

~1 hour before sexual activity

Question 16

Tadalafil starting dose and when should it be taken

Answer 16

10 mg

at least 30 min before sexual activity

Question 17

Tadalafil on demand dosing

Answer 17

5-20 mg daily PRN

Question 18

Avanafil starting dose and when should it be taken

Answer 18

100 mg

15-30 min before sexual activity

Question 19

PDE5i CI

Answer 19

do not use with nitrates or riociguat

Question 20

PDE5i warnings

Answer 20

impaired color discrimination, hearing loss, vision loss, hypotension, priapism

Question 21

Seek emergency medical help with PDE5i if erection lasts > __ hrs

Answer 21

4

Question 22

PDE5i SE

Answer 22

HA, flushing, dizziness, dyspepsia, back pain (mostly with tadalafil)

Question 23

Which PDE5 inhibitors can have decreased efficacy if taken with high-fat or large meal

Answer 23

Sildenafil and vardenafil

Question 24

PDE5i doses should be decreased by 50% if:

Answer 24

> /= 65 years old
Using alpha blocker
Using 3A4 inhibitor
Severe renal or liver disease

Question 25

Alprostadil MOA

Answer 25

prostaglandin E1 vasodilator

Question 26

Alprostadil formulations

Answer 26

injected into the penis or a pellet is inserted through the urethra

Question 27

Alprostadil SE

Answer 27

penile pain, priapism

Question 28

Filbanserin MOA

Answer 28

agonist at 5-HT1A and antagonist at 5-HT2A receptors