Name all Alprostadil formulation?
Intracavernosal Injection
Transurethreal System
Name all Phosphodiesterase Type-5 Inhibitors (PDE5)?
Avanafil (Stendra)
Sildenafil (Viagra)
Tadalafil (Cialis)
Vardenafil (Levitra)
Name Intracavernosal Injections availably?
Caverject or Edex
Name Transurethral System availably?
MUSE
Whats the contraindications do PDE5 (Phosphodiesterase Type-5 inhibitors?
Use of any organic nitrates, nitroglycerin, (sublingual, or capsules) IMDUR, isosorbidie dinatrate ir monotitrate. Any nitrate prouct have a absolute contradiction.
Relative : Alpha 1 -blockers (Severe Hypotenstion)
What are the non-pharmalogical treatment options for erectile dysfunction?
- Vacuum erection devices
- Penile Prosthetic implants
- Venous and arterial surgery
Non FDA - Approved drug therapies for erectile dysfunction?
- Trazodone -Proerectogenic MOA unclear
- Yohimbine -Central α-2 antagonist
- Papaverine -Opium alaloid that inhibits phosphodiesterase
- Phentolamine - nonselective α-2 antagonist
What are the first line agents used for ED (Erectile Dysfunction)?
Phosphodiesterase Type-5 Inhibitors (PDE5)
What is the mechanism of action for Phosphodiesterase Type-5 inhibitors?
They enhance the effect of nitric oxide through the inhibition of PDE 5. They do not directly cause penile erection but affect the mans response to stimulation. They do not work without stimulation.
What is the brand name of Avanafil?
Stendra
What is the brand name of Sildenafil?
Viagra
What is the brand name of Tadalafil?
Cialis
What is the brand name of Vardenafil?
Levitra or Staxyn
What are the four systems necessary for penile erection?
- Vascular 2.Neurologic 3.Hormonal 4.Psychogenic
Name causes of Physical/Organic Erectile dysfunction?
(Vascular) What are the details?
Vascular disease: Compromised blood flow to coups cavernous.
PAD (Peripheral artery disease),
PVD (Peripheral vascular disease),
HTN,
Atherosclerosis
Name causes of Physical/Organic Erectile dysfunction?
(Neurological) What are the details?
Neurological disease: impaired nerve conduction
Stroke,
Spinal Cord Injury,
Diabetes
Name causes Physical/Organic Erectile dysfunction?
(Hormonal) What are the details?
Hormonal: Hypogonadism leads to decrease testosterone.
Secondary ED
Name causes of Physical/Organic Erectile dysfunction?
(Anatomical) What are the details?
Pelvic trama and Peyronie’s disease
Phosphodiesterase 5-Type Inhibitory (PDE5) patient education?
- No effect in absence of stimulation
- s/s hypotension
- Does not stop STDs
- Do not take with nitrates
Phosphodiesterase 5-Type Inhibitor (PDE5) Drug interactions?
CYP3A4 inhibitors
Grapefruit juice
Dosing and population dosing for Sildenafil (Viagra®)?
Sildenafil (Viagra®) dosing
a. 50 mg po as needed 1 hour before sexual activity
b. 25 – 100 mg/day; no more than once daily
c. Start 25 mg po in certain populations:(↓ below)
- Age > 65
- Hepatic impairment
- CrCl < 30 ml/min
- CYP 3A4 inhibitors
- Stable α-blocker use
AE: (PDE 6) Abnormal Vision
Duration ~ 4-5 hours
Dosing and population dosing for Tadalafil (Cialis®)?
Tadalafil (Cialis®)
a. 10 mg po as needed 1 hour before sexual activity
b. 20 mg maximum
c. Start 5 mg in certain populations:
- Moderate renal disease
- Mild to moderate hepatic disease
- Potent CYP 3A4 inhibitors
- Stable α-blocker use
**AE: Myalgia (PDE 11)
Duration ~ 36 hours**
Dosing and population dosing for Vardenafil (Levitra®)?
Vardenafil (Levitra®)
a. 10 mg po as needed 1 hour before sexual activity
b. 20 mg maximum
c. Start 2.5 to 5 mg in certain populations:
i. Age > 65
i. Mild to moderate hepatic disease
iii. Potent CYP 3A4 inhibitors
iv. Stable α-blocker dose
Adverse reactions: Abnormal vision (PDE 6)
(Staxyn®) :Orally disintegrating tablet DOES NOT have a faster onset of action compared to regular oral formulations
Duration ~ 4-5 hours
DI: QT prologation?
Dosing and population dosing for Avanafil (Stendra®)?
Avanafil (Stendra®)
a. 100 mg po as needed 30 minutes before sexual activity
b. 50 – 200 mg/day; no more than once daily
c. Start 50 mg in certain populations:
- i. Moderate CYP 3A4 inhibitors
- ii. Stable α-blocker dose
- *d. Do not use in CrCl < 30 ml/min or ESRD/HD
e. Do not use in severe hepatic impairment**
Duration ~ 4-5 hours
AE: Abnormal vision (PDE 6)
CI: Nitrates and Alpha1- Blockers (Absolute)
