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15 Cards in this Set

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Why is liver failure relevant in the context of impotence?
Liver failure means no androgen formation...no testosterone, no libido, etc.
Why is incidence of impotence increased with age?
Atherosclerosis, decreased testosterone levels, antihypertensive drugs.
Where does sexual drive originate?
Frontal limbic system
What is PGE1's role in impotence?
PGE1 is a vasodilator. Inject PGE1 into penis...rules out vasculature problems.
What is the series of events surrounding erection?
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
Vasodilation occurs via what primary chemical
NO! Parasympathetic outflow from brain causes NO release, which increases cGMP, which causes smooth muscle relaxation and vasodilation.
What is the DUAL NEURAL CONTROL of ERECTION.
Central initiating events from limbic frontal system.

Also local reflex arc of penis --> spinal cord --> penis
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.
How do you treat erectile dysfunction?
No androgen? Testosterone

Psychogenic - counseling

Genital abnormality - surgery

Drug-induced - adjust regimen
What type of PDE inhibitors are Viagra/Cialis/Levitra?
PGE5 inhibitors! PDE5 is the isomer most commonly found in the genitalia. Blocks cGMP breakdown.

Works by maintaining vasodilatory response!!
What metabolizes the PDE5 inhibitors?
CYP3A4, metabolized in liver!

High volume of distribution. Rapid absorption.
When are PGE5 inhibitors contra-indicated?
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
What are the 4 groups of side-effects to the PDE5 inhibitors?
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)
How do PDE5 inhibitors work?
They inhibit PDE5 from breaking down cGMP. cGMP causes smooth muscle relaxation and vasodilation.
What are the three theories for FEMALE SEXUAL DYSFUNCTION?
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.