Men's Health Exam 3

Question 1

PDE5 inhibitors MOA

Answer 1

inhibit PDE5 -> inhibits break down of cGMP -> helps prolong that erection

Question 2

What are the PDE5 inhibitors?

Answer 2

• Cialis (tadalafil)
• Levitra (vardenafil)
• Viagra (sildenafil)
• Stendra (avanafil)

Question 3

Why does PDE5i cause a drop in BP?

Answer 3

PDE5 is also present in vascular smooth muscle

Question 4

ADE of Sildenafil

Answer 4

Visual problems (blue hue, blurred vision, light sensitivity)

Question 5

ADE of Vardenafil

Answer 5

• Headache
• Flushing
• Prolonged QT interval

Question 6

ADE of Tadalafil

Answer 6

• Headache
• Back pain
• myalgia
• pain in limbs

Question 7

PDE6

Answer 7

• located in rods / cones in eyes

- affected by Sildenafil the most

Question 8

PDE1

Answer 8

• have vascular / cardiac effects
• affected by Vardenafil the most
• equally affected by Sildenafil and Avanafil

Question 9

PDE11

Answer 9

• located in skeletal muscle

- affected by Tadalafil the most

Question 10

PDE5 Inhibitor Adverse Effects

Answer 10

• drop in blood pressure
• Priapism
• Non-arteritic anterior ischemic optic neuropathy (not responsible for this on test)

Question 11

When would PDE5 inhibitors not work?

Answer 11

if there was a decrease in the ability to produce NO

Question 12

What are the non-NO dependent mechanisms to get an erection?

Answer 12

• PGE1 attaches to receptor that converts ATP into cAMP which induces that erection
• cAMP is in turn degraded by PDE2,3,4

Question 13

Pharmacological Treatments for ED

Answer 13

• PDE5i
• PGE1 (alprostadil)
• a-adrenergic antagonist (phentolamine)
• non-specific PDE inhibitor (papaverine)

Question 14

MOA of phentolamine

Answer 14

• a-adrenergic antagonist

- blocks sympathetic acitivty to end erection (can be used in combo w/ papaverine)

Question 15

MOA of papaverine

Answer 15

• non-specific PDE inhibitor

- inhibits breakdown of cAMP

Question 16

Adverse effects of non-NO dependent medicines

Answer 16

• Priapism (erection > 4 hours)
• Pain of injection
• Fibrosis with long-term use
• Non-penile vasodilation (only if injection technique is poor)

Question 17

DHT

Answer 17

• produced from testosterone by 5a-reductase

- has 5x affinity for androgen receptors vs. testosterone

Question 18

Androgen Effects

Answer 18

• Sexual differentiation & maturation
• Increases muscle mass
• Bone growth
• Erythropoiesis (increase; concern for anemia)
• Sexual drive (increase)
• Male pattern baldness
• Prostatic hyperplasia

Question 19

LH

Answer 19

stimulates spermatogenesis and production of testosterone

Question 20

Side effects of androgen replacement therapy

Answer 20

– Priapism
– Prostatic hyperplasia
– Prostate cancer
– Gynecomastia (via aromatase)

Question 21

Why would you want to block androgens?

Answer 21

if patient has BPH or prostate cancer

Question 22

medications used for BPH

Answer 22

• 5a-reductase inhibitors
• Alpha-1 blockers
• Androgen receptor antagonists

Question 23

5a-reductase inhibitors drugs

Answer 23

– Finasteride

– Dutasteride

Question 24

ADE of 5a-reductase inhibitors

Answer 24

• decreased libido
• impotence
• gynecomastia

Question 25

What is a useful ADE of finasteride?

Answer 25

Hair growth

Question 26

MOA of 5a-reductase inhibitors

Answer 26

blocks the production of DHT

Question 27

MOA of Alpha-1 blockers

Answer 27

relaxation of smooth muscle and improved urine flow

Question 28

Alpha-1 blockers drugs

Answer 28

• Tamsulosin
• silodosin
• alfuzosin

Question 29

ADE of Alpha-1 blockers

Answer 29

– Orthostatic hypotension
– Tachycardia
– Nasal congestion

Question 30

Androgen receptor antagonists drugs

Answer 30

– Flutamide

– Bicalutamide

Question 31

ADE of Androgen receptor antagonists

Answer 31

• decreased libido
• feminization
• change in body hair
• effects on RBC production
• anemia
• bone health such as osteoporosis