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Flashcards in Sexual Dysfunction Deck (25)
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1
Q
Definition of impotence?
A
Failure to attain erection of sufficient strength to carry out sexual intercourse - at least 25% of the time. PREVALENCE is HIGH (50% of men over 50)
2
Q
What's thought to drive increased rates of impotence with older age?
A
Vascular problems.
3
Q
2 neural systems leading to erection?
A
1) Central, forebrain limbic system -> generates sexual drive
2) Maintained by circulating androgens
- Increased parasymp inflow, decreased symp outflow
- Local parasymp reflex arc in response to tactile stimuli (penis--> spinal cord--> penis)
4
Q
3 specific physiological events in the penis that cause erection?
A
1) Relaxation of helicine arteries in corpora cavernosa.
2) Relaxation of smooth muscle of trabeculae in corpora cavernosa.
3) Impeded venous drainage due to engorged corpora cavernosa.

First 2 GENERATE erection, 3rd one MAINTAINS erection
5
Q
What drives blood vessel relaxation in erectile tissue at the molecular/cellular level? (She emphasized this..)
A
NO -> guanylate cyclase -> increased cGMP -> maintains vasodilation (erection)

- NO induces local changes in blood flow
- NO comes from 2 different sources (endothelial cells and from post synaptic parasymp neurons)
6
Q
What are a few prescribed drugs that cause impotence?
A
Beta-blockers, ACEIs, anticholinergics, antihistamines, Disulfiram SSRIs, estrogens
7
Q
6+ common causes of impotance?
A
1) Prostatectomy etc. (local reflex arc interrupted by scar tissue)
2) Diabetes, hypothyroidism
3) Vascular disease
4) Chemo/radiotherapy
5) Neuro disease (MS) and trauma
6) Liver and/or renal failure
8
Q
Various ways to Dx ED?
A
Bulbocavernosis reflex test (test nerves)
Nocturnal Penile Tumescence (test for erections while sleeping)
Inject vasodilators (test for vascular cause)
Ultrasound or MR angiography
...but this isn't commonly done.
9
Q
4 ways to treat underlying causes of ED?
A
1) Counseling if psychogenic.
2) Surgery if local abnormality (rare).
3) Adjust meds, if iatrogenic.
4) Testosterone, if androgen deficient.
10
Q
What is alprostadil? How is it given?
A
A PGE1 analogue.
Intracavernosal injection (ouch) or intrameatal suppository.
11
Q
What is the class of the drugs of choice these days for ED?
A
Oral PDE 5 inhibitors (Viagra)
12
Q
What is a PDE 5 inhibitor (Sildenafil aka Viagra) actually do?
A
Inhibits cGMP phosphodiesterase isozyme 5, which will maintain vasodilation (but will NOT initiate erection--> for that need parasympathetic activation)
13
Q
4 Important notes about the pharmokinetics of PDE 5 inhibitors?
A
1) Rapidly absorbed- rapid onset of acton
2) Concentrations peak at 30-90 minutes
3) Metabolized by CYP 3A4.*** (more likely to get priapism!)
4) Active metabolite prolongs the effect (longer half life than you'd anticipate)
5) Excreted renally
14
Q
What is complication of PDE 5 inhibitors, especially if taking drugs that compete for CYP 3A4?
A
Priapism -> ischemic pain.
15
Q
Aside from ED, what is another indication for PDE 5 inhibitors?
A
Primary Pulmonary Hypertension (shows that they're not totally specific for erectile tissue- do work on all PDE enzymes in body)
16
Q
3 Common, less severe side effects of PDE 5 inhibitors?
A
1) Reduced esophageal motility -> reflux.
2) Altered color vision (blue green tinge)
3) Headache, flushing, rhinitis.
17
Q
3 Cardiovascular adverse effects of PDE 5 inhibitors?
A
1) Hypotension and 2) Subsequent tachycardia -> can cause stroke or MI.
3) Platelet inhibition.
18
Q
What's one particularly fatal drug to combine with PDE 5 inhibitors?
A
Nitrates for angina. Big problem- lots of old guys with chest pain trying to get busy... Taking both can lead to severe hypotension and can be lethal.
19
Q
3 theories as to the origin of female sexual dysfunction (FSD)?
A
1) Vascular
2) Hormone
3) Dissatisfaction
20
Q
5 categories of things that cause female sexual dysfunction?
A
1) Psychological (anxiety, depression, etc.)
2) Diabetes / atherosclerosis
3) Trauma (physical)
4) Drugs (SSRIs, etc.)
5) Urinary incontinence (with associated anxiety)
21
Q
What physiological test, rarely done, can provide an objective measure of physiological arousal?
A
Measuring vaginal pH - should increase during arousal.
22
Q
Medical assessment for sexual dysfunction (i.e. things to rule out)? (4-5 things)
A
Diabetes, pituitary, thyroid disease
Neuro stuff: MS, trauma
23
Q
3 categories of treatment for female sexual dysfunction?
A
Education
Hormone Replacement Therapy (E, sometimes T)
Vascular treatment
24
Q
3 forms of vascular treatment of female sexual dysfunction?
A
PDE5 inhibitors. (esp for SSRI-induced FSD)
Clitoral vacuum pump (Eros therapy)
L-arginine topical
25
Q
How might L-arginine topical treatment work?
A
L-arginine is substrate for NO synthesis, might increased NO.
(but this is under evaluation)