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9 Cards in this Set
- Front
- Back
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Causes of Erectile DysfunctionNicotine
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**Reduced blood flow to the penis**
Hormone imbalances (low testosterone) Psychological issues (depression, stress) Neurological illness |
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Drugs that cause sexual dysfunction
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BP meds
Antipsychotics Antidepressants Atomoxetine BPH drugs Chemo drugs that decrease sex hormone levels Cimetidine Opioids (chronic use); includes methadone |
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Phosphodiesterase-5 (PDE-5) inhibitors
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MOA - increase blood flow to the penis following sexual stimulation; DO NOT increase desire
CONTRA - concurrent use w/ nitrates Warnings - color discrimination impairment, hearing loss, vision loss, hypotension, priapism SE - HA, flushing, dyspepsia, erythema, color vision changes BEST when taken on empty stomach; avoid w/ fatty food |
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Viagra
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Sildenafil
PDE-5 inhibitor 50 mg PO 1 hr before intercourse Use 25 mg in pts > 65 y/o, hepatic impairment, CrCl < 30 mL/min, or if on strong CYP 3A4 inhibitors |
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Levitra, Staxyn ODT
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Vardenafil
PDE-5 inhibitor 10 mg PO 1 hr before intercourse Use 5 mg in pts > 65 y/o, hepatic impairment, CrCl < 30 mL/min, or if on strong CYP 3A4 inhibitors |
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Cialis
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Tadalafil
PDE-5 inhibitor 10 mg PO 1 hr before intercourse *OR* 2.5-5 mg QD TAKE w/ or w/o food Decrease dose to 5-10 mg w/ renal impairment or moderate liver impairment DO NOT use in CrCl < 30 mL/min or severe liver impairment |
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Stendra
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Avanafil
PDE-5 inhibitor 100 mg PO 30 min before intercourse TAKE w/ or w/o food CONTRA in seere renal or liver impairment; strong CYP 3A4 inhibitors Decrease dose w/ moderate CYP 3A4 inhibitors |
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PDE-5 Inhibitor Drug Interactions
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CONTRA w/ nitrates d/t potential for excessively low blood pressure
If pt has used PDE-5 inhibitor and then developed angina, DO NOT use nitroglycerin until after 12 hrs (avanafil), 24 hrs (sildenafil, vardenafil), or 48 hrs (tadalafil) CAUTION w/ use of alpha antagonists d/t hypotensive effect |
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Alternative agents to treat ED
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Caverject (intracavernosal alprostadil) - inject via syringe into penis, causes erection 5-10 min after injection; refrigerate
MUSE (transurethral alprostadil) - pellets inserted into urethra; PREG Category C Tri-Mix gel (papaverine, phentolamine, alprostadil) - get inserted into urethra; NOT FDA approved; compounded gel |
