ED, BPH

Question 1

Sildenafil
Tadalafil
Vardenafil
Avanafil

Answer 1

PDE-5 inhibitors

Question 2

True or false: PDE-5 inhibitors don’t CREATE erections, they FACILITATE erections

Answer 2

TRUE

Question 3

Longest lasting PDE5 inhibitor

Answer 3

Tadalafil 18-36 hours

Question 4

PDE-5’s with FASTEST onset (15 minutes)

Answer 4

Tadalafil & Avanafil

Question 5

PDE-5 with slowest onset

Answer 5

Vardenafil (1 hour)

Question 6

AEs of PDE-5 inhibitors

Answer 6

headache, facial flushing, nasal congestion, dyspepsia, myalgia, bac pain, hypotension, dizziness, hearing impairment, priaprism
RARE - ischemic optic neuropathy

Question 7

Which 2 PDE-5 inhibitors can cause blurred vision, inability to distinguish between blue and green?

Answer 7

Vardenafil

sildenafil

Question 8

What is the biggest contraindication with PDE-5 inhibitors?

Answer 8

CARDIOVASCULAR RISK

Question 9

Which cardiovascular drug to be cautious of when prescribing a PDE-5 inhibitor, and what guidelines do you give regarding the interaction?

Answer 9

Nitrates + PDE-5.

Do not take within 24 hours of each other (48 hours w/ tadalafil)

Question 10

Which ED drug works by stimulating adenyl cyclase, causing increased cAMP and increased blood flow, allowing erection?

Answer 10

Alprostadil

Question 11

Alprostadil is used for what disorder?

Answer 11

Erectile dysfunction
(2nd line treatment)

Question 12

How is alprostadil administered?

Answer 12

IV - FAST onset

Question 13

True or False: Testosterone supplementation can be started as long as the serum Testosterone levels are high

Answer 13

FALSE! must be LOW to consider this

Question 14

What are the contraindications of using Testosterone supplementation?

Answer 14

prostate cancer
erythrocytosis
uncontrolled HF
sleep apnea

Question 15

What is the ratio of epithelial to stromal tissue in the prostate?

Answer 15

1:5 (more stromal tissue)

Question 16

Of the BPH medications, which is preferred over the other and why?

Answer 16

Alpha antagonists preferred over 5-alpha reductase

-faster, and improve symptoms regardless of prostate size

Question 17

Do 5-alpha reductase medications work fast or slow?

Answer 17

slow - delayed onset up to 6 months to reach full efficacy

Question 18

Terazosin
Doxazosin
Alfuzosin
Tamsulosin
Silodosin
(prazosin)

Answer 18

Alpha adrenergic antagonists (BPH)

Question 19

Alfuzosin and Silodosin are contraindicated in what type of impairment?

Answer 19

hepatic

use others w/ caution

Question 20

Which alpha adrenergics are NONUROSELECTIVE?

Answer 20

Terazosin and Doxazosin

Question 21

Which alpha adrenergics are UROSELECTIVE?

Answer 21

Alfuzosin, Tamsulosin, Silodosin

Question 22

What does uroselective mean?

Answer 22

targets alpha 1A and 1D receptors, which dominate the prostate, urethra, bladder

Question 23

NONUROSELECTIVE alpha adrenergics have an increased risk of what complication?

Answer 23

CV effects - binds peripheral receptors, causing hypotension

Question 24

True or false: since alpha adrenergic antagonists lower BP, they are safe for hypertension monotherapy

Answer 24

FALSE!

higher risk of heart failure this way

Question 25

What are some other adverse effects of alpha adrenergics?

Answer 25

ejaculation disorders, rhinitis and malaise, floppy iris/small pupil syndrome

Question 26

Finasteride | Dutasteride

Answer 26

5-alpha reductase inhibitors

Question 27

This class of BPH medication shrinks prostate after 6 months of use

Answer 27

5-alpha reductase inhibitors

Question 28

Whereas alpha adrenergics are used for symptom relief, what are 5-alphas used for?

Answer 28

prevention of BPH complications and progression.

Question 29

Contraindication of 5-alpha reductase inhibitors?

Answer 29

PREGNANCY - may cause feminization of male fetus

Question 30

``` Which adverse effect of 5-alpha reductase inhibitors is false: decreased libido ED ejaculation disorder decreased testosterone ```

Answer 30

Decreased testosterone (should be INCREASED)

Question 31

when is combo therapy 5-alpha reductase + alpha antagonists used?

Answer 31

when monotherapy is unsuccessful OR if patient at high risk of complications.

Question 32

25% of ED is caused by what?

Answer 32

medications

Question 33

CONTRAINDICATIONS for testosterone supplementation

Answer 33

High serum Testosterone, prostate cancer, sleep apnea, uncontrolled HF

Question 34

alpha antagonists work best if prostate is ______, while 5-alpha's work best if prostate is _____

Answer 34

small; large

Question 35

what is first dose syncope?

Answer 35

syncope with first dose of Terazosin/Doxazosin (BPH meds) - start with lower dose and titrate up