Sexual Dysfunction - Quiz 3

Question 1

What is ED?

Answer 1

Difficulty getting or sustaining an erection for sex

Question 2

HSDD drugs are only indiated for who?

Answer 2

Premenopausal women only

Question 3

What is an antidepressant that doesn’t cause sexual dysfunction?

Answer 3

Buproprion

Question 4

Medications that can cause ED?

Answer 4

1. Alcohol
2. Antidepressants (SSRIs, SNRIs)
3. Antihypertesives (beta-blockers, clonidine, thiazides)
4. First gen antipsychotics
5. Prolactin raising second gen
6. BPH meds (finasteride, dutasteride, silodosin)

Question 5

Non pharm tx for ED?

Answer 5

1. Weight loss
2. Quitting tobacco
3. Reducing alcohol intake

Question 6

Natural products for ED?

Answer 6

1. Yohimbe
2. L-arginine
3. Panax ginseng (increases risk for bleeding)

Question 7

What is the first line tx for ED?

Answer 7

PDE-5 inhibitors:
1. Slidenafil
2. Vardenafil
3. Tadalafil
4. Avanafil

Question 8

Reasons for PDE5 inhibitor treatment failure?

Answer 8

Timing of dose

Question 9

PDE5 inhibitor indicated for BPH?

Answer 9

Tadalafil (Cialis): 5 mg PO QD

Question 10

PDE5 inhibitors that can treat PAH?

Answer 10

1. Sildenafil (Revatio)
2. Tadalafil (Adcirca, ALyq)

Question 11

Describe the MOA of PDE5-I?

Answer 11

Inhibits the degradation of cGMP upon NO release to relax the smooth muscles in the arteries increasing blood flow maintaining an erection

Requires libido to work

Question 12

Sildenafil

Answer 12

Revatio, Viagra

Question 13

Tadalafil

Answer 13

Cialis, Adcirca, Alyq

Question 14

Vardenafil

Answer 14

Levitra

Question 15

Avanafil

Answer 15

Stendra

Question 16

Starting dose of Viagra?

Answer 16

50 mg

Question 17

Starting dose of Cialis?

Answer 17

10 mg

Question 18

Starting dose of Levitra?

Answer 18

10 mg

Question 19

Starting dose of Stendra

Answer 19

100mg

Question 20

When would you see a reduction in PDE5I starting dose? What are the lower doses?

Answer 20

1. ≥65YO
2. Using an alpha blocker
3. Using CYP3A4 inhibitor
4. Severe renal and hepatic impairment

Reduce dose by 50%

Question 21

CI for PDE5I?

Answer 21

Nitrates

Question 22

ADRs of PDE5I?

Answer 22

1. Impaired color discrimination
2. Hearing loss
3. Vision loss
4. Hypotension
5. Priapism
6. Chest pain
7. HA, flushing, DZ, dyspepsia
8. Back pain (tadalafil)

Question 23

How should you take PDEIs?

Answer 23

Sildenafil: 1 hr before
Vardenafil: 1 hr before
Tadalafil: 30 min before
Avanafil: 15-30 min before

Sildenafil and vardenafil can have decreased activity with high fat foods or large meals

Don’t take more than 1 dose per day

Question 24

Why are PDE5I CI with nitrates?

Answer 24

Can cause severe hypotension

Question 25

What is another class of drug used for ED other than PDE5I?

Answer 25

Prostaglandin E1: Alprostadil (Caverject, Muse)

Question 26

MOA of PG E1?

Answer 26

Vasodilator allowing blood flow into the cavernosal arteries -> enlarging the penis

Question 27

Difference between Caverject and Muse

Answer 27

**Caverject:** Intracavernous injection **Muse:** Require refrigeration (Urethral pellet)

Question 28

ADRs of alprostadil?

Answer 28

Penile pain, priapism

Question 29

Drugs indicated for hypoactive sexual desire disorder? Drug classes?

Answer 29

5-HT1A agonist/5-HT2A antagonsit: Filbanserin (Addyi) Nonselective melanosortin receptor agonist: Bremelonotide (Vyleesi)

Question 30

Formulation os Vyleesi?

Answer 30

Injection

Question 31

BBW of Addyi?

Answer 31

CI: acohol due to severe hypotension and syncope (REMS program) Combination with CYP3A4 inhibitors

Question 32

ADR of Filbanserin?

Answer 32

1. Hypotension 2. Syncope

Question 33

CI for bremelonatide?

Answer 33

Uncontrolled hypertension or CVD

Question 34

Alprostadil

Answer 34

Caverject, Muse

Question 35

Filbanserin

Answer 35

Addyi

Question 36

Bremelanotide

Answer 36

Vyleesi

Question 37

Counseling points for all PDE5i?

Answer 37

1. When to take it 2. Sexual activity can put strain on heart 3. Cause: priapism, orthostasis and hypotension, DZ, HA, flushing, and indigestion 4. Tinnitus 5. Vision changes

Question 38

Counseling for tadalafil (Cialis)

Answer 38

Can cause back pain (last up to 2 days)