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1. Pharm II > Erectile Dysfuncion > Flashcards

Erectile Dysfuncion Flashcards

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1
Q

What can indicate androgen deficiency?

A

Loss of libido

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2
Q

Loss of erections may result from..

A

arterial, venous, neuro, hormonal, psycho causes

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3
Q

What are RFs for ED?

A
  • HTN
  • HLD
  • DM
  • Metabolic syndrome
  • Smoking
  • Etoh abuse
  • Psycho etiologies
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4
Q

What meds can cause ED?

A
  • Anticholinergic (paroxetine, sertraline, fluvoxamine, & fluoxetine more commonly)
  • Dopamine antagonists: increase prolactin levels, inhibiting testosterone production
  • Estrogens, antiandrogens
  • CNS depressants
  • Agents that decrease penile BF
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5
Q

How is tx initiated?

A

W/ least invasive forms 1st

  • Vacuum erection devices
  • oral phosphodiesterase inhibitors (1st line)
  • intracavernous injections or intraurethral inserts
  • penile prosthesis
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6
Q

Goal of tx

A
  • improve quantity/quality of erections suitable for intercourse
  • considered satisfactory by pt & partner
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7
Q

What type of tx has a slow onset of action & is not discreet?

A

Vacuum erection devices

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8
Q

Vacuum erection devices are most effective for….

A

a couple in a stable relationship

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9
Q

Which type of med is considered convenient & effective regardless of the etiology of ED?

A

Phosphodiesterase inhibitors

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10
Q

What is the failure rate among phosphodiesterase inhibitors?

A

30-40%

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11
Q

Phosphodiesterase inhibitors are contraindicated in….

A
  1. Nitrate users
    - Can cause severe hypotension
  2. Those w/ high cardiovascular risk
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12
Q

Reversible inhibitors of phosphodiesterase isoenzyme type 5 - MOA & location

A
  • Decreases catabolism of cGMP

- Found in genital tissue

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13
Q

Type 5 is also found in…

A
  • peripheral vascular tissue
  • tracheal SM
  • platelets
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14
Q

Phosphodiesterase isoenzyme type 6 is localized to…

A

the rods & cones of the eye

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15
Q

Inhibition of isoenzyme type 6 ADEs

A
  • blurred vision

- cyanopsia (MC w/ sildenafil)

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16
Q

Where is phosphodiesterase isoenzyme type 11 localized?

A

striated muscle

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17
Q

Inhibition of isoenzyme type 11 ADEs

A

myalgia & muscle pain (MC w/ tadalafil)

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18
Q

What decreases the absorption of sildenafil & vardenafil by 1 hour?

A

Food!

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19
Q

How should staxyn be taken?

A
  • W/out liquid or food

- On the tongue to dissolve

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20
Q

Can you combine tadalafil or avanafil w/ Etoh?

A

No!

Can cause orthostatic hypotension

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21
Q

Is tadalafil affected by food?

A

No, does not affect rate or absorption

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22
Q

Can avanafil be taken w/ food?

A

Yes!

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23
Q

Which drug is not recommended in pts w/ hepatic impairment?

A

Tadalafil

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24
Q

When should sildenafil doses be decreased?

A

When any potent cytochrome P450 3A4 inhibitor is used

  • Cimetidine
  • Erythromycin, Clarithromycin
  • Ketoconazole, itraconazole
  • Ritonavir, saquinavir
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25
When should tadalafil doses be reduced?
When the MOST POTENT cytochrome P450 3A4 inhibitors are used - Ketoconazole - Ritonavir
26
What are the most common ADEs of isoenzyme type 5?
- HA - Facial flushing - Dyspepsia - Congestion - Dizziness
27
Describe nonarteritic anterior ischemia optic neuropathy (NAION)
- Unilateral, painless blindness (may be irreversible) | - Decreased BF to optic nerve
28
NAION RFs? (5 categories)
- Glaucoma, macular degeneration, diabetic retinopathy - HTN - Hx of eye surgery or trauma - Age > 50 - Smoking
29
What ADE is unique to tadalafil? Why?
Low back pain | - May be linked to inhibition of type 11 phosphodiesterase
30
What ADE is unique to vardenafil?
QT prolongation
31
Priapism is most commonly seen in what 2 meds?
Sildenafil & vardenafil (have shorter half-lives)
32
What is priapism associated w/?
Excessive doses of phosphodiesterase inhibitors
33
How do you treat priapism?
- Oral pseudoephedrine, 60-120 mg orally - Aspiration of the corpus cavernosum & intracavernous injection of alpha-adrenergic agents or methylene blue - Phenylephrine, epinephrine, or methylene blue may be instilled into the corpus cavernosa
34
What causes the drug interaction btwn phosphodiesterase inhibitors & nitrates? (2 major factors)
- Nitrates alone can produce hypotension | - Nitrates increase levels of cGMP
35
How do you manage a pt w/ ED & a low cardiovascular risk?
Start on phosphodiesterase inhibitor
36
How do you manage a pt w/ ED & an intermediate cardiovascular risk?
Pt should undergo complete cardio workup & treadmill stress test to determine tolerance to increased myocardial energy consumption
37
Describe low cardiovascular risk (5)
- < 3 RFs - Well-controlled HTN - Mild CHF - Mild valvular disease - MI > 8 wks ago
38
Describe intermediate cardiovascular risk (5)
- ≥ 3 RFs - Mild or mod stable angina - MI or stroke within 2-8wks - Mod CHF - Hx of stroke, TIA, or PAD
39
Describe high cardiovascular risk (7)
- Unstable/refractory angina - Uncontrolled HTN - Severe CHF - MI or stroke within 2wks - Mod or severe valvular disease - High risk arrhythmias - Obstructive hypertrophic CM
40
What is the MOA of testosterone tx?
- Directly stimulates androgen receptors | - May stimulate nitric oxide synthase
41
What are 2 examples of oral testosterone supplements? Are they recommended?
1. Methyltestosterone 2. Fluoxymesterone *Not recommended due to hepatotoxicity!
42
How should you time the dose of the testosterone buccal system?
Remove every morning & evening while brushing teeth
43
What are 3 examples of parenteral testosterone supplements?
1. Cypionate IM injection 2. Enathate IM injection 3. Undecanoate IM injection
44
Who is cypionate IM injection contraindicated in?
Pts w/ severe hepatic or renal impairment
45
Supraphysiologic serum concentrations of cypionate has been linked to...
mood swings
46
What occurs when testosterone transdermal patch is administered at bedtime?
Serum concentrations of testosterone in the usual circadian pattern are produced
47
What 4 locations are recommended for the transdermal patch?
1. Upper arm 2. Back 3. Abdomen 4. Thigh
48
When using the transdermal patch, you should avoid..
Swimming, showering, or washing site for 3 hrs
49
How should you apply testosterone gel?
- Cover application site to avoid inadvertent transfer to others - Wash hands w/ soap & water after administration
50
What 3 locations are recommended to apply testosterone gel (Androgel 1%)?
1. shoulders 2. upper arms 3. abdomen
51
When using testosterone gel, children & women should avoid...
contact w/ unclothed or unwashed application sites
52
What 2 locations should you apply Androgel 1.6%?
Shoulders & upper arms
53
Where should you apply testosterone transdermal spray?
front & inner thighs
54
How & where should you apply testosterone transdermal solution?
- 1st apply antiperspirant or deodorant | - Then apply to axilla
55
Who is required to administer testosterone subcutaneous implant pellets?
Trained health professional
56
Subcutaneous implant pellets: How long is the onset?
Delayed for 3-4 months after initial dose
57
What are 3 ADEs of oral testosterone & alkylated androgens
1. HLD 2. Na retention 3. Hepatotoxicity*
58
What is an ADE of transdermal patches?
Dermatitis
59
What are 4 ADEs of IM cypionate or enanthate?
1. Mood swings 2. Gynecomastia 3. Polycythemia 4. HLD
60
What is an ADE of subcutaneous implants?
Extruded accidentally
61
What are 2 ADEs of the buccal system?
1. Gum irritation | 2. Bitter taste
62
What is the MOA of Alprostadil--Prostaglandin E1?
SM relaxation of arterial vessels & sinusoidal tissues in the corpora --> enhanced blood flow & blood filling of the corpora
63
Alprostadil--Prostaglandin E1: What is the duration of erection?
No more than 1 hr
64
What is the most invasive tx option for ED?
Penile prothesis

1. Pharm II (11 decks)

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