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16 Cards in this Set

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Erectile dysfunction

Common cause- peripheral neuropathy, atherosclerosis, HTN


Also spinal injury, depression, stroke

Drugs that cause ED

Alcohol


Anticancer (leuprolide, flutamide, busulfan, cyclophosphamide)


Anticholinergics


Antidepressants-SSRI, SNRI


Antihypertensive- beta blockers, clonidine, methyldopa


Antipsychotics- haloperidol, chlorpromazine, fluphenazine, thioridazine


BPH- finasteride, dutasteride, silodosin


Digoxin


H2RA- cimetidine, nizatidine, ranitidine


Nicotine


Opioids (chronic)- methadone

Non- drug Tx

Lifestyle


Vacuum devices, implant/surgery


Yohimbe(not good, has ADR), L-arginine, panax ginseng

Drug tx

1st line- PDE-5 inhibitors- eg. tadalafil


2nd- Alprostadil(inj/urethral supp)


Alt uses for PDE-5: sildenafil (viagra and revatio): viagra=ED, Revatio= PAH/ tadalafil(Cialis and Adcirca): cialis=ED and BPH, Adcirca= PAH

PDE-5 inhibitors

Local release of nitric oxide -> more cGMP and muscle relaxation-> more blood flow


CI- nitrate or riociguat use


Warning- impaired color discrimination, hearing/vision loss, hypotension, priapism (>4hr; get help)


Sx- HA, flush, dyspepsia, muscle/back pain (tadalafil, lasts <2days)


Best on empty stomach (tadalafil doesnt matter)


No more than 1 dose/day

Sildenafil

Viagra, revatio (PAH)


50mg 1hr before sex


Revatio- 5-20mg TID

Tadalafil

Cialis(bph and ed), adcirca (PAH)


10mg 30min. Before sex


The weekend pill


Adcirca- 40mg qd

Vardenafil

Levitra, staxyn odt


10mg before sex

Avanafil

Stendra


100mg 15min. Before sex

Conditions that require lower dose

3A4 inhibitors


Alpha blockers


Hepatic impairment


Renal impairment (except viagra)


Lower by half

Alprostadil

Prostaglandin E1- vasodilation


Inj or urethral suppository


Invasive and painful, doesnt last as long as PDE-5 inhibitors

Caverject, Edex

Alprostadil injection


Inj 1.25-2.5mg into base of penis and titrate for effect(5-10min. For 1 hr)


CI- sickle cell anemia, multiple myeloma, leukemia, penile implant, deformation


Sx- pain, priapism, scarring


Refrigerate, recon before use

Muse

Alprostadil urethral pellet


Insert 125-250mcg into urethra


CI- Urethral stricture, hypospadias and curvature


Sx- pain, priapism


Urinate before insertion


Refrigerate

Hypoactive sexual desire disorder

Low sexual desire that causes marked distress or interpersonal difficulty, not due to drug or health condition

5-HT1a agonist and 5-HT2a antagonist

For hypoactive sexual desire disorderFlibanserin- AddyiREMS avoid if pregnant100mg qhs, dc if no benefit 8wkBoxed- hypotension, alcohol, 3A4 inhibitors, hepatic impairmentCI- same as boxed

Flibanserin

5-HT1A agonist and 5-HT2A antagonist


Premenopausal women only


Addyi


100mg qhs, dc if no benefit 8wks


Boxed- severe hypotension risk with alcohol, mod/sev 3A4 inhibitor, or hepatic impairment


CI- same as boxed


Warning- hypotension, CNS depression


Sx- dizziness, nausea, insomnia, dry mouth, somnolence