Sexual Dysfunction Flashcards
(19 cards)
1st stage of erection
-Sensory sexual stimulation mediates
CNS – acetylcholine, NE
-needed even for viagra
vacuum erection devices are used for
older pts, first line for these pts
PDE 5 MOA
Phosphodiesterase mediates the catabolism of cGMP
cGMP is a vasodilatory neurotransmitter in corporal tissue
Isoenzyme 5 found in genital tissue
Also found in peripheral vascular tissue, tracheal smooth muscle and platelets
Inhibitors of PDE-5 decrease catabolism of cGMP
4 hr DOA, 30 min-1 hr onset
sildenafil
vardenafil
24-36 hr DOA, 2 hour onset
tadalafil
15-30 min onset, 6 hr DOA
avanafil, dissolvable tab
who should we not give PDE-5 Inh to?
pts on nitro or isosorbide
MC form of testosterone replacemtent
gel, wait 5-6 hours to wash
Androgel, Testim, Fortesta, Axiron
alprostadil
- aka prostaglandin E1
- Stimulates adenyl cyclase, increasing cAMP production causing smooth muscle relaxation of the arterial blood vessels to and sinusoidal tissues in the corpora
- intracavernosal injection or intrautrethral insert
trazadone
- non FDA approved
- likely antagonizes a-adrenergic receptors
papaverine
- non FDA approved
- Inhibits cavernosal phosphodiesterase, decreasing metabolic breakdown of cAMP
- not commonly used as monotherapy, intracavernosal injection
phentolamine
Competitive nonselective α-adrenergic blocker
Reduces peripheral adrenergic tone and enhances cholinergic
Most often given as intracavernosal injection
apomorphine
stimulates dopamine in the brain which is believed to enhance the sexual response
flibanserin
-used for females w/low sexual desire
MOA: unclear, serotonin downregulation which may affect the release of dopamine and NE
-BBW for severe hypotension and syncope with alcohol or cyp3A4 inhibitors, soly available through REMS program
ospemifene
- SERM
- PO QD improves vaginal tissue dryness and thinness, reducing pain during sexual intercourse
- ADR: hot flashes, vaginal discharge, muscle spasms and excessive sweating.
- boxed warning - may stimulate the growth of the endometrium and increase DVT and stroke risk.
prasterone
inactive endogenous steroid and is converted into active androgens and/or estrogens
Vaginal insert at bedtime
erection physio
Arterial blood flow increases filling sinusoids within the corpora
Swelling and elongation
Prolonged by decrease in venous outflow
Balanced in flaccid state
Smooth muscle relaxation occurs, enhancing arterial blood flow and filling of the corpora
Mediated by acetylcholine, nitric oxide, cGMP, cAMP
Decreases calcium concentrations
how do drugs cause ED?
dopamine antagonists-Inhibit prolactin inhibitory factor, increasing prolactin, blocking testosterone and decreasing libido
Diuretics, β-blockers, methyldopa, clonidine-reduce arteriole blood to corpora
ADR of PDE-5 INH
HA, facial flushing, dyspepsia, nasal congestion, dizziness, hypotension, blue light
