Owen 12-14-07 Erectile Dysfunction

Front 1

Probability of having some form of ED for men aged __ yrs. or older is about 55%.

Back 1

Probability of having some form of ED for men aged 40 yrs. or older is about 55%.

Front 2

ED is Usually defined as______,_____, or _____

Back 2

psychogenic, organic or mixed

Front 3

Erection involves _____________ of cavernosal smooth muscle whereas detumescence involves ________

Back 3

relaxation

contraction

Front 4

Transmitter of the NANC system

Back 4

NO

Front 5

GTP is converted to cGMP by what?

Back 5

activated guanylyl cyclase

(activeated by NO)

Front 6

cGMP causes erection. cGMP is converted to GMP by what?

Back 6

PDE 5

Front 7

What inhibits PDE 5 to allow for more cGMP to stick around?

Back 7

sildenafil

Front 8

Neurotransmitters/neuromodulators involved in penile smooth muscle relaxation:

Back 8

Acetylcholine
Nitric Oxide
Vasoactive intestinal polypeptide
Prostaglandin E1
Calcitonin gene-related peptide

Front 9

Neurotransmitters/neuromodulators involved in penile smooth muscle contraction:

Back 9

Norepinephrine
Endothelin-1
Neuropeptide Y
ATP

Front 10

What is better for the high risk (cardio, endo) pt?

a) sildenafil
b) sildenafil apomorphine

Back 10

sildenafil apomorphine

Front 11

Potential risk factors for ED

Back 11

Aging
Smoking
Hypertension
Hyperlipidemia
Diabetes mellitus
Vascular disease
Depression
Variety of drugs

Front 12

Antihypertensives that can cause erectile dysfunction

Back 12

Clonidine, methyldopa, hydrochlorothiazide, beta adrenoceptor antagonists

Front 13

Psychotropics that can cause erectile dysfunction

Back 13

Monoamine oxidase inhibitors, tricyclic antidepressants, phenothiazines, benzodiazepines

Front 14

CNS depressants that can cause erectile dysfunction

Back 14

Sedatives, narcotics, ethanol, anxiolytics

Front 15

Miscellaneous Drugs that cause erectile dysfunction

Back 15

Atropinics, estrogens, cimetidine, anticancer drugs

Front 16

Traditionally(direct intracavernosal injection)
P_________: Direct relaxation of cavernosal smooth muscle due to action on intracellular calcium levels. May also be a contribution from inhibition of PDE.
Ph________________: irreversible alpha receptor antagonist.

Back 16

Traditionally(direct intracavernosal injection)

Papaverine: Direct relaxation of cavernosal smooth muscle due to action on intracellular calcium levels. May also be a contribution from inhibition of PDE.
Phenoxybenzamine: irreversible alpha receptor antagonist.

Front 17

Papaverine and Phenoxybenzamine

Their monotherapy largely discontinued - high incidence of penile _________ & penile f_______ nodules

Back 17

Papaverine and Phenoxybenzamine

Their monotherapy largely discontinued - high incidence of penile fibrosis & penile fibrotic nodules

Front 18

direct intracavernosal injection

In several countries a Trimix strategy widely used (mixture of ph________, p___________ & ____). Pharmacologic synergy = lower dose results in reduction in incidence of penile fibrosis.
The use of _____ as monotherapy exceeds the use of all other injectables.

Back 18

direct intracavernosal injection

In several countries a Trimix strategy widely used (mixture of phentolamine, papaverine & PGE1). Pharmacologic synergy = lower dose results in reduction in incidence of penile fibrosis.
The use of PGE1 as monotherapy exceeds the use of all other injectables.

Front 19

PGE1 (__________)

Back 19

PGE1 (alprostadil)

Front 20

PGE1: Prime action is on _________ mobilization, but there may also be a prejunctional action affecting neurotransmitter release.

Back 20

PGE1: Prime action is on calcium mobilization, but there may also be a prejunctional action affecting neurotransmitter release.

Front 21

Attempt to reduce the pain at injection site –____________ delivery system developed for alprostadil. (decreased responder rate & magnitude of response, high incidence of urethral burning & itching)

Back 21

Attempt to reduce the pain at injection site –intra-urethral delivery system developed for alprostadil. (decreased responder rate & magnitude of response, high incidence of urethral burning & itching)

Front 22

Sildenafil only works under conditions of______________

Back 22

sexual stimulation.

Front 23

Pharmacokinetics(Time to peak conc):

Sidenafil (VIAGRA)

Vardenafil (LEVITRA)

Tadalafil (CIALIS)

Back 23

Sidenafil (VIAGRA) 60 min

Vardenafil (LEVITRA) 50 min

Tadalafil (CIALIS) 120 min

Front 24

Pharmacokinetics(Half-life)

Sildenafil

Vardenafil

Tadalafil

Back 24

Sildenafil 3-4 hours

Vardenafil 4-5 hours

Tadalafil 18 hours

Front 25

Pharmacokinetics(Food interaction)
Sildenafil

Vardenafil

Tadalafil

Back 25

Pharmacokinetics(Food interaction)
Sildenafil YES

Vardenafil YES

Tadalafil NO

Front 26

All 3 PDE-5 inhibitors are metabolized by the cytochrome ________ enzyme.

Back 26

P450 3A4

Front 27

Inhibitors of CYP3A4, such as __________, __________, _____________ will decrease the clearance of these drugs.

Back 27

cimetidine, ketoconazole and erythromycin

Front 28

PDE-5 Inhibitors adverse effects

Back 28

Headache
Flushing
Dyspepsia
Nasal congestion
Disturbances in color vision (loss of blue/green discrimination) reported with sildenafil, probably because of inhibition of PDE-6 (a PDE found in the retina that is impt in color vision). Tadalafil does not appear to disrupt PDE-6.

Front 29

Concurrent _______ ________ are ABSOLUTELY contraindicated due to the ability of the PDE inhibitors to potentiate the activity of NO

Back 29

Concurrent organic nitrates are ABSOLUTELY contraindicated due to the ability of the PDE inhibitors to potentiate the activity of NO

Front 30

PDE5 inhibitors will augment the response to drugs that activate NO synthesis; these are primarily ____________, isosorbide methylnitrate or other nitrate-based medications.This drug interaction can result in life-threatening hypotension due to profound NO mediated vasodilation.

Back 30

PDE5 inhibitors will augment the response to drugs that activate NO synthesis; these are primarily nitroglycerin, isosorbide methylnitrate or other nitrate-based medications.This drug interaction can result in life-threatening hypotension due to profound NO mediated vasodilation.

Front 31

______ nitrate, which is sometimes used illicitly, should NEVER be combined with PDE5 inhibitors.

Back 31

Amyl nitrate, which is sometimes used illicitly, should NEVER be combined with PDE5 inhibitors.

Front 32

Concurrent treatment with _____ adrenergic antagonists (used to alleviate symptoms associated with benign prostatic hyperplasia) is contraindicated (due to potential hypotension with combination therapy). EXCEPTION: __________ may be used safely with ________.

Back 32

Concurrent treatment with alpha adrenergic antagonists (used to alleviate symptoms associated with benign prostatic hyperplasia) is contraindicated (due to potential hypotension with combination therapy). EXCEPTION: Tamsulosin may be used safely with tadalafil.

Front 33

A novel sublingual formulation of the dopamine agonist, ____________, has been developed specifically for treatment of patients with ED. (Nausea is said to subside with continued use.)

Back 33

A novel sublingual formulation of the dopamine agonist, apomorphine, has been developed specifically for treatment of patients with ED. (Nausea is said to subside with continued use.)