Exam 4 - Sexxx Flashcards by Kristian Melby

Q

Sex Pharm

Limitations

A

1) taboo
2) animal studies hormonal > brain
2) male focus

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Q

Factors Affecting

Sexual Activity

A

1) Physical/Mental Health
2) Hormone status, mood circumstance
3) Psych conditioning, expectations
4) Drug use

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Q

Libido

A

Sex drive (hypothalamus, limbic/reward
system)

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Q

Performance

A

Male: erection, ejactulation
Female: lubrication, organsm

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Q

Hormones & NTsthat increase

libido include:

A

1) testosterone (male/female)
2) dopamine
3) estrogen? (females)
4) LH/FSH?

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Q

Hormones & NTs that

decrease libido:

A

1) prolactin (male/female)
2) estrogen (male)
3) serotonin
4) progesterone?

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Q

How do DA receptor agonists

& antagonist effect libido?

A

DA agonists ^^ libido

DA antagonist vv libido

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Q

How do alpha 2 blockers effect

libido?

A

^ libido by ^ NEpi in synapse

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Q

How do beta blockers & alpha

2 agonists effect libido?

A

decrease libido

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Q

How do nicotinic agonists

effect libido?

A

may ^ libido by enhancing DA

release

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Q

How do muscarinic antagonists

affect libido?

A

decrease libido

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Q

How does serotonin (5-HT)

effect libido?

A

decrease libido

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Q

Male Sexual Response:

parasympathetic

A

1) penile engorgement & erection

2) closure of bladder neck

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Q

Female Sexual Response:

parasympathetic

A

1) clitoral erection

2) lubrication

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Q

Male Sexual Response:

sympathetic

A

1) seminal emission
2) ejactualtion
2) detumescence (de-erection)

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Q

Female Sexual Response:

sympathetic

A

1) contraction of uterus, vagina,

fallopian tubes

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Q

Male Sexual Response:

somatic

A

erection and orgasm contribution

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Q

Female Sexual Response:

somatic

A

contribution to orgasm

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Q

Typical mechanisms for drug

related decreased libido:

A

1) increased prolatin secretion
2) anti-androgenic effect
3) block DA, NE, orAch
4) sedation
5) enhance 5-HT

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Q

Typical mechanisms for drug

interference w erection:

A

1) peripheral anti-muscarinic action

2) decreased blood flow

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Q

Typical mechanisms for drug

interference of orgasm:

A

1) alpha 1 blockade
2) local anethetic
3) sedative effects

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Q

Anti-HTNs with high incidence

of sexual dysfunction:

A

1) ganglionic blockers
2) Clonidine & methyldopa
3) alpha 1 blockers
4) beta blockers

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Q

Ganglionic blockers cause:

A

complete failure of erection and orgasm

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Q

Clonidine & methyldopa cause:

A

decreased libido and impotence via

sympatholytic effects

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Alpha 1 blockers cause:

^incidence of ejaculatory failure | no erection effect

Beta blockers cause:

5 - 10% incidence of ED | lower libido reported

Spironolactone causes:

decreased libido and frequent | impotence

MOA of spironolactone | sexual dysfunction:

1) blocks DHT from receptor 2) inhibits 5 alpha reductase (testosterone) 3) ^prolactin

Thiazide diuretic induced | sexual dysfunction:

1) 5 - 30% incidence 2) impotence 3) vv libido 4) difficult ejaculation * MOA uncertain

Anti-HTNs with fewer side | effects include:

1) Ca channel blockers 2) ACE inhibitors 3) ARBS 4) direct renin inhibitors

Antipsychotics vv libido by:

1) DA block 2) CNS anticholinergic effect 3) CNS sedative effect

Antipsychotics cause ED by:

peripheral anticholinergic effects

Antipsychotics cause problems | with orgasm by:

alpha 1 blockade

Do "atypical" psychotics have more | or less sexual dysfunction effects?

less

SSRIs and sex:

1) vv libido (30-50%) 2) difficult orgasm 3) vv compliance do to sexual side effect

Trycyclics and sex:

1) impotence 2) vv lube (anticholinergic) 3) impaired orgasm (alpha 1 block) 4) enhanced serotonin (vv libido)

MAOIs and sex:

1) difficult organsm | 2) ejaculatory failure (phenelzine)

Antidepressants w fewer | side effects:

1) bupropion 2) mirtazapine 3) vilazodone 4) trazodone

bupropion sexual side effects:

enhanced libido reports (DA?)

Mirtazapine (allpha 2 blcoker) | sexual side effects:

may ^ libido but also highly sedative

Trazodone sexual side effects:

``` mixed reports (^libido but anorgasm amd rarely priapism) * also highly sedative ```

Benzodiazepine sexual | side effects:

1) sedation 2) delayed orgasm 3) ejaculatory failure

Antiseizure med sexual side | effects:

SOME assoc w decreased libido | & performance difficulty

Which antiseizure med ^ libido?

ethosuximide

Which drug vv libido by ^prolactin | & estradiol?

cimetidine

How do opioids vv libido?

^ prolactin

Important to not with | recreational drugs:

1) acute & chronic effects differ | 2) dose related differences

Acute effects of alcohol:

1) small dose: disinhibiting, ^libido, | 2) ^dose: delayed or diminished orgasm

Chronic effects of alcohol:

1) neuropathy related impotence 2) vv testosterone (low libido, vv secondary sex characteristics

Acute marijuana effects:

1) low dose: enhanced sensory, disinhibition, ^empathy | 2) ^dose: impotence, anxiety

Chronic marijuana effects:

1) vv spermatogenesis 2) vv testosterone (low libido, impotence), irregular menses, anovulation

Acute cocaine effects:

1) low dose: ^DA (^libido), delayed orgasm | 2) ^dose: direct stim of erection

Chronic cocaine effects:

1) loss of libido | 2) ejaculatory failure

Acute opiod effects:

^sexual activity may be do to | disinhibition

Chronic opiod effects:

1) low libido (2/3) 2) ED (1/2) 3) ejaculatory delay (2/3)

LSD and sex:

^sensory

MDA (ecstacy) and sex:

^sexual feelings and empathy

PCP and sex:

Not assoc w sexual activity. | vv sensation, depression, psychosis

Premature ejaculation tx:

1) local anesthetic 2) other experimented agents also vv libido (clomipramine, thioridazine, MAOIs, benzos)

Testosterone uses:

1) vv gonadal fx | 2) ^libido in men and women (lower dose)

testosterone side effects:

1) may accelerate prostate cancer | 2) atherosclerosis?

What are some dopamine | antagonists?

1) L-DOPA 2) bromocriptine 3) ampomorphine 4) methylphenidate (Ritalin) 5) buproprion (wellbutrin)

L-DOPA uses:

Parkinson's antecdote

Prolactinemia tx:

bromocriptine

ED folk remedies:

stimulants (kava, coca, strychnine), cannabis, betel nuts, bear gall bladder, rhino horn, ginseng, yohimbine * most ineffective

Yohimbine ED txs

1) current rx: yocon, erex 2) MOA: alphpa 2 antagonist 3) effects: ^libido, ED improved 4) efficacy: uncertain

Yohimbine side effects:

nausea, sweating, tremor, ^BP&HR, | anxiety, irritability

Smooth muscle relaxants used | to tx ED include:

1) papverine 2) phentolamine 3) prostaglandin E

Adverse effects of papaverine:

bradycardia, HoTN, priapism, | hepatotoxicity, penile fibrosis

Phentolamine ED MOA:

alpha 1 blocker (blocks symp smooth muscle contraction) *papaverine adjunt, may interfere w orgasm

How is prostaglandin E | administered for ED?

injection or urethral suppository

Adverse effects of | prostaglandin E include:

HoTN, penile pain, ocassional priapism

Phosphodiesterase Inhibitors | used to tx ED include:

1) sildenafil (viagra) 2) avanafil (stendra) 3) vardenafil (levitra) 4) tadafil (cialis)

Viagra ADME:

1) peak conc @ 1 hr 2) 4 hour half life 3) ~ 4 hr duration

Peak conc avanafil:

30 - 45 min

Peak conc vardenafil:

30 min - 2 hrs | effective 4 hrs, half life 4-5 hrs

peak conc tadalafil:

1 - 6 hrs | effective 36 hrs, half life 18 hrs

BPH tx:

cialis (tadafil) | * avoid alpha blockers when taking cialis

Pulmonary HTN tx:

revatio (sildenafil) | *sxs & exercise capacity improved

Adverse effects of PDE inhibitors:

Common: HoTN, headache, flushing, indegestion Less common: visual disturbances, acute hearing loss, nasal congestion, rash, diarrhea

How are PDE inhibitors | metabolized?

CYP3A4

What are the adverse effects of | PDE inhibitors and nitrates?

BP drop, syncope, lower cardiac perfusion, | MI (128 in deaths in first 8 months of use)

What is the MOA for ED drugs?

relaxation of smooth muscle in | corpora cavernosa

Estrogen uses:

1) vaginal atrophy, dryness, dyspareunia 2) libido? 3) helpful in menopause

Low lidido tx for women:

androgen/testosterone patch may | enahnce libido and satisfaction

Osphena MOA:

selective (vaginal) estrogen receptor modulator

Female effects of sildenafil | may include:

genital engorgement | limited success

Tx of female sexual dysfunction:

1) DA agonists (libido) 2) bupropion (DA enhancer) 3) alprostadil (PGE cream) 4) phenotolamine (alpha blocker) 5) neutraceuticals, filbanserin, bremelanotide (experamental)

Filbanserin MOA:

5-HT agonist, 5-HT2 antagonist | development on hold

Bremelanotide MOA:

1) melanocortin synthetic / alpha MSH 2) centrally stim libido male & female 3) original nasal spray withdrawn 4) subcutaneous formula in trials