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15 Cards in this Set
- Front
- Back
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Why is liver failure relevant in the context of impotence?
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Liver failure means no androgen formation...no testosterone, no libido, etc.
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Why is incidence of impotence increased with age?
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Atherosclerosis, decreased testosterone levels, antihypertensive drugs.
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Where does sexual drive originate?
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Frontal limbic system
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What is PGE1's role in impotence?
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PGE1 is a vasodilator. Inject PGE1 into penis...rules out vasculature problems.
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What is the series of events surrounding erection?
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Increase in parasympathetics and inhibition of sympathetics.
Local tactile stimuli: REFLEX ARC...penis --> spinal cord --> penis Relaxation of helicine vessels in corpus cavernosa (VASODILATION) Compression of engorged corpus cavernosa impedes venous return Sacral efferents also responsible for ejaculation |
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Vasodilation occurs via what primary chemical
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NO! Parasympathetic outflow from brain causes NO release, which increases cGMP, which causes smooth muscle relaxation and vasodilation.
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What is the DUAL NEURAL CONTROL of ERECTION.
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Central initiating events from limbic frontal system.
Also local reflex arc of penis --> spinal cord --> penis |
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What is the downside to cGMP-increasing drugs?
What is downside to PDE1 injection? |
cGMP is very general molecule used in different pathways. Can effect color vision, vasodilation in other vascular beds, regurgitation
PGE1 has a half-life of only 15 minutes. |
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How do you treat erectile dysfunction?
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No androgen? Testosterone
Psychogenic - counseling Genital abnormality - surgery Drug-induced - adjust regimen |
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What type of PDE inhibitors are Viagra/Cialis/Levitra?
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PGE5 inhibitors! PDE5 is the isomer most commonly found in the genitalia. Blocks cGMP breakdown.
Works by maintaining vasodilatory response!! |
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What metabolizes the PDE5 inhibitors?
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CYP3A4, metabolized in liver!
High volume of distribution. Rapid absorption. |
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When are PGE5 inhibitors contra-indicated?
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PATIENTS ON NITRATES!!! NITRATES ARE ALREADY VASODILATORS. (taken for angina/chest pain)
Patients on CYP3A4 inhibitors. Patients with hepatic dysfunction Patients with renal complications (since already have low BP, taken vasodilators not a good idea.) Elderly too |
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What are the 4 groups of side-effects to the PDE5 inhibitors?
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Vasodilation: headaches, flushing
Cardiovascular: Hypotension (resultant tachycardia) GI: Esophogeal relaxation...regurgitation Visual: some reintal color loss because Levitra and Viagra are weak PDE6 inhibitors. NOT TADALAFIL (cialis) |
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How do PDE5 inhibitors work?
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They inhibit PDE5 from breaking down cGMP. cGMP causes smooth muscle relaxation and vasodilation.
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What are the three theories for FEMALE SEXUAL DYSFUNCTION?
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The HORMONAL theory (decreased estrogen levels) and VASCULAR theory (both age-related)
and DISSATISFACTION theory (counseling, behavioral therapy) Important to differentiate between dysfunction and disatisfaction. |
