Sexual Dysfunction

Question 1

1. Flibanserin and Bremelanotide are fda approved to treat hypoactive sexual desire disorder in who?
2. in both sexes what can cause sexual dysfunction?
3. which drug does not have these sexual side effects?
4. Most common cause of ED is reduced blood flow to the penis which can be common in pt’s with ?
5. What other conditions could contribute to ED?

Answer 1

1. pre menopausal women only
2. ssri or snri
3. bupropion
4. htn and atherosclerosis and conditions that cause neuropathy like diabetes
5. Depression, stress, spinal cord injury, stroke

Question 2

5 Key drugs/drug classes that can cause ED:

A, A, A, A, B

Answer 2

alcohol

antidepressants (SNRI’s and ssris especially)

antihypertensives (beta blockers, clonidine, thiazides)

ANtipsychs (1st gen like chlorpromazine) or 2nd gen like risperidone, paliperidone

BPH meds (Finasteride, dutasteride, and silodosin)

Question 3

Natural products used to treat ED?

Ginseng can incr the risk of?

Answer 3

1. yohimbe, L arginine, panax ginseng
2. bleeding

Question 4

Drug TX:

1. wats first line for tx of ED? (4 drugs in drug class)
2. The drugs in this class can be used for other conditions such as which drug with which condition?
3. Sildenafil (Revatio) and Tadalafil (Adcirca) are also used in?

Answer 4

1. pde5 inhibs
   -sildenafil, vardenafil, tadalafil, avanafil
2. tadalafil (Cialis) for BPH, which can treat concurrent ED
3. PAH

Question 5

PDE5 inhibs:

1. Following sexual stim there’s a release of? which increases ___ and causes ___
2. This permits ___ resulting in an erection.
3. WHat do PDE5 inhibs block?
4. Note that PDE5 inhibitors DO NOT INCR ____ which must be present for the drugs to work

Answer 5

1. nitric oxide; cGMP ; smooth muscle relaxation
2. blood to flow in
3. block PDE5 from degrading cGMP
4. Libido

Question 6

PDE5 Inhibs:

1. Sildenafil
   a. brand name?
   b. start dosing ?
2. Vardenafil
   a. dosing?
3. Tadalafil
   a. brand name?
   b. daily dosing?
   c. on demand dosing?
   d. (part of on demand dosing) Start at ____ at least ___ before sexual activity
4. Avanafil
   a. for on demand dosing, how soon before sex should you take it?

Answer 6

1. viagra
   b. start at 50 mg, take ONE HOUR before sexual activity

2a. Start at 10 mg, take ONE HOUR before sexual activity

3a. Cialis
b. 2.5-5 mg
c. 5-20 mg daily PRN
d. 10 mg, 30 mins

4a. 15-30 mins

Question 7

PDE5 Inhibs:

1. CI’s?
2. Warnings for:
   -Impaired ___
   -___ and ____ loss
   -H
   -P, seek medical care if erection lasts how long?
   -If ___ occurs, seek immediate medical help
3. Side effects : H, F, D, D, and B (mostly with tadalafil)
4. Silden and Varden can have decr efficacy if taken with?
5. For ED, no more than how many doses is recc per day?

Answer 7

1. dont use with nitrates or riociguat
2. color discrimination
   -hearing, vision
   -hypotension
   -priapism, > 4 hrs
   -chest pain
3. HA, Flushing, dyspepsia, dizziness, Back pain
4. high fat or large meal
5. 1 dose

Question 8

Whats the typical starting dose for :

1. Viagra
2. Levitra and Cialis
3. Stendra
4. In what scenarios should you reduce the dose? (4)

For the following: State what the dose is reduced to if these criteria r met

5. Viagra
6. Levitra and Cialis
7. Stendra

Answer 8

1. 50 mg
2. 10 mg
3. 100 mg
4. > = 65 yrs old
   using an alpha blocker
   using CYP3A4 inhib
   Severe renal or liver disease
5. 25 mg
6. 5 mg
7. 50 mg

Question 9

PDE5 Inhibs: DDI’s

1. Moderate and strong CYP 3a4 inhibitors such as ___ (3) incr drug levels of PDE5 Inhibs so what should you do?

Answer 9

1. grapefruit juice, protease inhibs, azole antifungals

-lower starting doses

Question 10

1. Whats the name of the drug thats injected into the penis or a pellet is inserted through urethra to enlarge the penis?
2. How does it work?
3. Alprostadil pellets must be ____
4. general side effects for this drug class? (2)

Answer 10

1. alprostadil
2. its a prostaglandin E1 which is a vasodilator that allows blood to flow thru into cavernosal arteries
3. refridgerated
4. penile pain and priapism

Question 11

Hypoactive Sexual Desire Disorder: Flibanserin and Bremelanotide

1. Flibanserin MOA?
2. indicated for use in ___ only
3. BBW for Flibanserin (3)
4. Flibanserin Warnings of? (2)
5. Bremelanotide
   a. How supplied? (formulation)
6. Bremelanotide
   -CI: Dont use with ___ or known ___

Answer 11

1. agonist activity at 5HT1A and antag activity at 5HT2A
2. pre menopausal
3. CI with alcohol due to incr risk of severe hypotension and syncope

REMS program required

CI in combo with mod or strong CYP3A4 inhibs

4. hypotension and syncope
5. injection
6. uncontrolled htn, cardiovasc disease