Erectile dysfunction

Question 1

Drugs that cause erectile dysfunction

Answer 1

• Anti-hypertensive
• Anti-depressants
• Anti-psychotics
• Thiazide diuretics
• Cytotoxic drugs

Question 2

Treatment

Answer 2

• First line: phosphodiesterase type 5 inhibitor
• Alprostadil (prostaglandin analogue)

Question 3

Phosphodiesterase type 5 inhibitor: MOA

Answer 3

inc blood flow to penis to help achieve an erection

Question 4

Phosphodiesterase type 5 inhibitor: drugs

Answer 4

• Sildenafil (1h before sex, delayed onset w food)
• Tadalafil (30 min before sex - LA)
• Vardenafil (25-60min before sex)
• Avanafil (15-30min before sex; delayed onset w food)

Question 5

Phosphodiesterase type 5 inhibitor: indication

Answer 5

• Erectile dysfunction
• Sildenafil: Pulmonary arterial hypertension

Question 6

Phosphodiesterase type 5 inhibitor: CI

Answer 6

• Hypotension
• Recent stroke
• ACS (MI or unstable angina)
• Vasodilation
• Sex inadvisable

Question 7

Phosphodiesterase type 5 inhibitor: side effect

Answer 7

Vasodilation
- Hypotension
- Flushing
- Headache
- Dyspepsia
- Nasal congestion
- Palpitations
- Tachycardia

Question 8

Phosphodiesterase type 5 inhibitor: interaction

Answer 8

• Nitrates/Antihypertensive/diuretic → hypotension
• Cytochrome 3A4 Enzyme inhibitor (macrolides, rate limiting CCB, grapefruit juice, fluconazole + ketoconazole → INC plasma levels = toxicity