Sexual Dysfunctions Flashcards
Chapter 50
What is the common type of sexual dysfunction in males?
- Erectile Dysfunction
- Problems with ejaculation
- Low Libido
What is the common types of sexual dysfunction in females?
- Inability to reach orgasm (anorgasmia)
- Painful intercourse or Hypoactive sexual desire disorder (HSDD)
What is the causes for erectile dysfunction?
- reduced blood flow to the penis
What are some comorbid conditions that could contribute to erectile dysfunction?
- Cardiovacular (HTN or Atherosclerosis
- Neuropathic (Diabetes)
ED could be a early warning sign for someone developing cardiovascular diseases
What are some medications that could causes erectile/sexual dysfunctions?
- Alcohol
- Antidepressants (Especially SSRIs and SNRIs)
- Antihypertensives (Beta-Blockers, Clonidine, Thiazides)
- Antipsychotics (1st gens like Chlorproamazine)
- BPH medications (Finasteride, Dutasteride, Silodosin)
What are some non drug treatments for erectile dysfuntion
- Lifestyle change (wieght loss, quitting tobacco, reducing alcohol intake
What are some natural products that could help with erectile dysfunction?
- Yohimbe: can cause GI Issues, anxiety, more severe health issues (not recommended)
- L-Arginine: Dizziness, Lightheadedness, Flushing (Similar SE to PDE-5i)
- Panex Ginsing: increased bleeding risk
What are some of the drug treatments for erectile dysfunction?
- PDE-5 Inhibitors (1st line)
- Alprostadil (if PDE-5i fail; injection into penis or suppository into penis)
PDE-5i can also be use for BPH and Pulmoary Arterial HTN
What is the way that an erection occurs?
- Seuxal stimulation causes Nitric Oxide to be released, which will increase cGMP causing smooth muscle relaxation. This allows more blood to flow into penis = ERECTION
What is the MOA of Phosphodiesterase 5 Inhibitors?
- Blocks cGMP from grading
What are the PDE-5 inhibitors that are used?
- Sildenadil (Viagra)
- Tadalafil (Cialis)
What is the recommended dosing for Sildenafil?
- 25 - 100 mg daily PRN (on demand)
- Start at 50 mg; ~1H before sex
- Start at 25 mg in select conditions (different card)
What is the recommended dosing for tadalafil?
- Daily Dosing: 2.5 - 5 mg daily (2.5 in liver/renal impairment)
- 5 - 20 mg daily PRN (on demand)
- Start at 10 mg; ~30 mins before sex
- Start at 5 mg in select conditions (different card)
What are some contraindictoins for PDE-5i used for Erectile Dysfunction?
- DO NOT use with Nitrates (severe HYPOtension)
What are some warnings for PDE-5i used for Erectile Dysfunction?
- Impaired color discriminations (color blindness basically)
- Hearing loss, Vision loss, Hypotension (why the SE happen)
- Priapism (erection < 4H)
- Chest Pain = medical help asap
What are some side effects for PDE-5i used for Erectile Dysfunction?
- Headache, Flushing, Dizziness, Dyspepsia
- Back Pain with Tadalafil
What are some additional notes for PDE-5i used for Erectile Dysfunction?
- Decreased effectiveness when taken with large meals
- NO MORE than ONE dose per day
What are the select conditions in which you would decrease the dose of the PDE-5i?
- > 65 years old
- Using alpha blocker
- Using 3A4 inhibitor
- Severe renal/liver disease
What is the MOA for Alprostadil?
- Prostaglandin E1; vasodilator that allow blood to flow into the cavernals arteries = erection
What are some side effects for alprostadil used for Erectile Dysfunction?
- Penile pain, Priapism (because its an injection and suppository into the penis)
What are the drug treatment options for someone with HSDD?
- Filbanserin (Addyi)
- Bremelanotide (Vylessi)
What are some Boxed warnings for Filbanserin used for HSDD?
- Contraindicated with alcohol: increases risk of HYPOtension and fainting (REMS)
What are some warnings for filbanserin used for Erectile Dysfunction?
- Hypotension, Fainting (REMS)
