What are the 4 general causes of impaired erection?
- Vascular,
- Neurologic,
- Psychogenic,
- Hormonal
Loss of Libido = androgen deficiency
•What are the 3 Drug Classes that lead to ED?**
- Anticholinergics
- Dopamine antagonists
- Estrogens, antiandrogens
T/F CNS depresants cause ED
True
What are some misc. meds that cause ED?
- Finasteride, Dutasteride
- Lithium
- MAOi
- Gemfibrozil (for HLD)
- Clofibrate
- INF
- Opioids
What is “Dry Sex” & Retrograde Ejaculation
- Delayed or absent ejaculation
- Ejaculate passes retrograde into the bladder, instead of toward the anterior urethra
What are 1st line Least Invasive ED tx? (4)
- Vaccum erection device (onset 30 mins)
- PED5i
- Intracavernosal injections/ intraurethral inserts
- Penile prosthetics
What are the 4 PDE5s?
- Sildenafil (blue vision)
- Tadalafil (back pain)
- Vardenafil
- Avanafil
What can you not give if your patient takes a PDE5?
* this is on the test*
Nitrates
Where are PDE5 receptors found besides the genitals? (3)
- Peripheral vascular tissue
- Tracheal smooth muscle
- Platelets (flushing, HA, congestion, dyspepsia)
Where are PDE6 found? * think vision*
- Rods and cones = blurred vision
* Cyanopsia (blue vision) from Sildenafil (blue pill)*
Where are PDE11 found? * think muscles*
- Striated muscle
Which PDE5 can be taken with food?
Tadalafil
T/F should Sildenafil be reduced if taken with a CYP P450 inhibitor?
True - keeps the drug around longer
What are the 4 most common side effects of PDE5s?
- HA
- Facial Flushing
- Dyspepsia
- Dizziness
T/F Sudden unilateral, painless blindness is also known as Nonarteritic anterior ischemic optic neuropathy (NAION)?
True
What is a Side Effect of Vardenafil?
- Prolonged QT interval
Priapism is mostly associated with __________ and __________. What are risk factors? (SLIM)
- Sildenafil and vardenafil
- RF = Sickle cell anemia, Leukemia, Multiple myeloma, Increased PDE5 usage
How do you treat Priapism? (5)
- Ice packs
- Have the patient walk up stairs (arterial steal phenomenon)
- Oral Pseudoephedrine (alpha agonist)
- Aspiration of cavernosum
- Phenylephrine, epinephrine, methylene blue injection into cavernosum
What happens if your patient is on PDE5s and takes nitrates?
What can you treat the angina with?
- > Severe Hypotension is the SE
- Non-nitrate containing agents
- calcium channel blockers
- adrenergic antagonist
- morphine
When is Testosterone replacement recommended?
- Any hypogonadism, low libido, or low T
T/F: Testosterone replacement regiments do not directly correct ED.
- True
* improves libido = corrects for secondary ED*
Methyltestosterone or Fluoxymesterone is not recommended because…
- Methyl: Hepatotoxicity (first pass hepatic catabolism)
- Fluoxy: Hepatoxicity
When should you administer the testosterone patch
- at bedtime
What drug’s side effects give you mood swings, gynecomastia, polycythemia, HLD?
- IM Testosterone (Cypionate or Enanthate)
