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Pharmacology-Exam #1 (Summer) > ED > Flashcards

Flashcards in ED Deck (65)
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1

List the anticholinergics agents that can cause ED

1. Antihistamines
2. Antiparkinsonian
3. TCA's
4. Phenothiazine
5. SSRI's

2

List the Dopamine Antagonist that can cause ED. MOA?

Metoclopramide, Phenothiazines
Increase PRL, which inhibits testicular testosterone production

3

List the Estrogens, antiandrogens that can cause ED. MOA?

1. LH-RH
2. Digoxin
3. Spironolactone
4. Ketoconazole
5. Cimetidine

Suppress tesosterone-mediated stimulation of libido

4

List the CNS depressants that can cause ED. MOA?

1. Barbiturates
2. Narcotics
3. Benzodiazepines
4. Short-term use of large doses of alcohol
5. Anticonvulsants

Suppress perception of psychogenic stimuli

5

List the agents thats decrease penile blood flow/reduce arteriolar flow to corpora cavernosa

1. Diuretics
2. Peripheral β-adrenergic antagonists
3. Central sympatholytics: Methyldopa, Clonidine

6

Who are vacuum erection devices most effective for? Why?

Couple in a stable relationship
Slow onset & not discrete

7

Yohimbine MOA

May reduce peripheral alpha adrenergic tone permitting cholinergic tone= Vasodilate

8

Yohimbine ADE's

1. Anxiety
2. Insomnia
3. Tachycardia (increases NE)
4. HTN (increases NE)

9

What are the 3 main concepts of PDE-I?

1. Effective regardless of the ED etiology
2. Fail in 30-40% of pt's
3. CI in pt's taking Nitrates

10

PDE-5-I MOA

Decreases catabolism of cGMP to the inactive form

11

Where is PDE type 5 enzyme found in the body?

1. Genital tissue
2. Peripheral vascular tissue
3. Tracheal smooth muscle
4. Platelets

12

Where is PDE type 6 enzyme found in the body?

Rods and cones of the eye

13

What SE is PDE type 6 enzyme associated with?

Blurred vision

14

Define Cyanopsia

Seeing everything tinted blue

15

What PDE-I is Cyanopsia MC in?

Sildenafil (Viagra)

16

Where is PDE type 11 enzyme found in the body?

Striated muscle

17

What SE is PDE type 11 enzyme associated with? What PDE-I is this MC in?

Myalgia and muscle pain
Tadalafil

18

List the PDE-5's that food decreases absorption by 1 hour

1. Sildenafil (Viagra)
2. Vardenafil (Levitra)

19

List the PDE-5's that may be taken with food/food does not affect drug absorption

1. Tadalafil (Cialis)
2. Avanafil (Stendral)

20

List the PDE-5 that should be taken WITHOUT any food or liquid

Vardenafil (STAXYN)

21

List the PDE-5's that may cause orthostatic hypotension when taken with large amounts of ethanol?

1. Tadalafil (Cialis)
2. Avanafil (Stendral)

22

What PDE-5 is CI in sever hepatic disease?

Tadalafil

23

When should you decrease the Sildenafil dose?

With the use of any potent Cytochrome P450 3A4 inhibitors

24

List the MOST POTENT Cytochrome P450 3A4 inhibitors

1. Ketoconazole
2. Ritonavir

Others: Erythromycin, Clarithromycin, Cimetidine, itraconazole

25

What PDE-5-I is the only PDE-I that does NOT inhibit enzyme 6 (a PDE-6-I) ?

Tadalafil

26

What PDE-5-I is the only PDE-I that is NOT an active metabolite?

Tadalafil

27

How long does it take for Tadalafil to reach peak plasma level?

2 hrs

28

What is the time of onset of Tadalafil? Duration?

Onset=45 minutes
Duration=24-36 hrs

29

MC PDE-5-I ADE's

1. HA
2. Dizziness
3. Facial Flushing
4. Dyspepsia
5. Nasal congestion

30

What is a MAJOR ADE of PDE-5-1? Sx's of this ADE?

Nonarteritic anterior ischemic optic neuropathy (NAION):
-Sudden, unilateral, painless blindness
-D/t decreased blood flow to optic nerve
-May be irreversible

31

What patients are at risk for NAION?

1. Glaucoma
2. Macular degeneration
3. Diabetic retinopathy
4. HTN
5. Undergone eye surgery/eye trauma
6. 50+
7. Smokers

32

What ADE is unique to Tadalafil?

Low back pain

33

What ADE is unique to Vardenafil?

QT Prolongation

34

What is a rare, but urologic emergency PDE-5-I ADE?

Priapism

35

What PDE-5-I's is priapism MC in? Why?

Sildenafil and Vardenafil
Shorter plasma half-lives

36

How can you help prevent priapism?

Avoid EXCESSIVE DOSES

37

Conservative Priapism treatment measures

1. Ice packs
2. Walk up stairs (artery steal phenomenon)
3. External perineal compression
4. Oral pseudoephedrine, 60-120 mg

38

If these conservative measures fail, next step in treating priapism?

Needle aspiration of corpus cavernous with intracavernous injection:
1. Phenylephrine/Epinheprhine(alpha agonists)
2. Methylene blue

39

PDE-5-I drug interaction

Organic Nitrates: Severe Hypotension

40

List the Low CV Risk's

1. Asx CV dz w/ <3 RF's
2. Well-controlled HTN
3. Mild CHF (Class I or II)
4. Mild valvular heart dz
5. MI > 8 wks

41

Management approach in pt's with Low CV risks?

Patients can be stated on PDE-I's

42

List the Intermediate CV Risk's

1. > or equal to 3 RF's for CVD
2. Moderate CHF (Class III)
3. Mild/Moderate, STABLE angina
4. MI or Stroke in the past 2-8 wks
5. H/o CVA, TIA, or PAD

43

Management approach in pt's with Intermediate CV risks?

Complete CV work-up and stress test to determine tolerance to increased myocardial energy consumption (during sex)

44

List the High CV Risk's

1. Unstable/refractor angina
2. Uncontrolled HTN
3. Severe CHF (Class IV)
4. Moderate/Severe valvular dz
5. MI or Storke w/in past 2 wks
6. High-risk cardiac arrhythmia
7. Obstructive hypertrophic cardiomyopathy

45

Management approach in pt's with high CV risks?

PDE-I CI

46

Sx's of late-onset hypogonadism? (decreased testosterone levels starting at age 40)

1. Gynecomastia*
2. Decreased libido
3. ED
4. Small testes
5. Decreased muscle mass

47

What may the patient develop if late-onset hypogonadism is left untreated?

1. Anemia
2. Osteoporosis

48

Who is testosterone replacement NOT recommended in?

1. Men with NORMAL testosterone levels
2. Asx hypogonadism
3. Isolated ED

49

Testosterone MOA

1. Corrects sx's of hypogonadism
2. Directly stimulate androgen receptors in CNS (responsible for sex drive)
3. Stimulate NO synthase

50

Why is Methyltestosterone
and Fluoxymesterone NOT recommended?

Heptatotoxicity

51

What do you want to make sure you do with the administration/dosing with testosterone buccal system? Why?

Time the dose so that buccal system is removed q AM and PM toothbrushing d/t:
1. Gum irritation
2. Bitter taste

52

What is IM Testosterone Cypionate CI?

Severe Hepatic or Renal impairment

53

IM Testosterone Cypionate and Enanthate ADE's

1. Mood swings
2. Gynecomastia
3. Polycythemia
4. Hyperlipidemia

54

What testosterone treatment produces normal circadian pattern of testosterone levels?

1. Patch- IF placed at night
2. Gel

55

Testosterone gel ADE

May be transferred to others who rub against the treats skin

56

Testosterone Transdermal solution (Axiron) application instructions

1. Limit application to AXILLA
2. Apply deodorant prior to application of Axiron

57

Time of onset in Testosterone SQ implant pellet?

Delayed= 3-4 months

58

Testosterone SQ implant pellet ADE

Pellet may be extruded accidentally, losing drug effect

59

Oral Alkylated androgen ADE

Hepatotoxicity

60

What testosterone treatment produces normal pattern of serum androgen metabolites

1. Patch
2. Gel

61

Aloprostadil (Caverject and Edex intracavernosal) MOA

Smooth muscle relaxation of arterial blood vessels and sinusoidal tissues in corpora= Enhanced blood flow

62

Onset of Alporstadil? Duration of erection?

Onset= 5-15 minutes= RAPID
Duration= No more than 1 hr

63

What do you combine with intraurethral alprostadil (MUSE) to improve the treatment response?

Penile contsriction band

64

What should you advise your patient to do before administrating intraurethral alprostadil (MUSE)?

Empty bladder, voiding completely

65

What is the MOST INVASIVE treatment option in ED?

Penile Prosthesis