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53 Cards in this Set
- Front
- Back
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ED is defined as
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consistent inability to acheive or maintain an erection sufficient for sexual activity
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Causes of ED include
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psychogenic, organic, or mixed
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_____ men 40 and over have some form of ED
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55%
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The process of erection involves
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relaxation of cavernosal smooth muscle
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detumescence involves
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contraction of cavernosal smooth muscle
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Erections involves the _____ of smooth muscle, while detumescence involves ______
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relaxation
contraction |
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Erection size is limited by
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tunica albuginea
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During an erection, the ______ is compressed thus decreasing _______
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dorsal veins
venous outflow |
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The role of both PGE1 and ACh in erection is to
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stimulate the production/release of NO
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NO does what
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vasodilation (relaxation -> erection)
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PGE1 has what role in detumescence
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modulates the degree of contraction (by stimulating NO and limiting it)
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Detumescence and SM contraction is done by the _____ nervous system and _____ transmitter
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sympathetic
norepinephrine |
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Relaxation of the SM and subsequent erection is accomplished by _______ system actions of ______
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non-adrenergic non-cholinergic system
NO |
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Both PGE1 and _____ from the _____ nervous system stimulate the release of NO from the endothelium
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ACh
parasympathetic |
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Transmitters involved in relaxatoin/erectoin
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ACh
NO Vasoactive intestinal polypeptide PGE1 Calcitonin gene-related peptide |
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Transmitters involved in SM contraction/detumescence
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NE
Endothelin-1 Neuropeptide Y ATP |
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____ and ____ are released from the SNS terminal along with norepinephrine
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Neuropeptide Y
ATP |
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Erections are initiated and sustained by cellular levels of _____ in the corpus cavernosum
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cGMP
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____ converts GTP to cGMP
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guanylyl cyclase
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______ breaks cGMP down, thus returning the penis to detumescence
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PDE5
(phosphodiesterase 5) |
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Risk factors for ED include (8)
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Aging
Smoking HTN Hyperlipidemia DM Vascular disease Depression Variety of Drugs |
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Drug classes that can cause ED include (4)
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anti-HTN
Psychotropics CNS depressants Misc |
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anti-HTN that can cause ED include
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clonidine
methyldopa HCTZ B-antagonists |
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Psychotropic drugs that can cause ED include
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MAOI
Tricyclics Phenothiazines Benzodiazepines |
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CNS depressants that can cause ED include
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sedatives
narcotics EtOH anxiolytics |
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Misc drugs that can cause ED include
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Atropines
Estrogens Cimetidine anti-cancer drugs |
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Traditional treatment of ED includes ________ via _____ that directly relaxes the cavernosal smooth muscle by affecting ______ levels
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Papaverine
direct intracavernosal injection calcium |
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_______ is an irreversible alpha receptor antagonist used to tx ED
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Phenoxybenzamine
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Monotherapy with phenoxy and papaverine has been d/c due to incidences of
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penile fibrosis and fibrotic nodules
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The use of _____ is the most used injectable monotherapy
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PGE1
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Alprostadil is a _____ analogue that does what?
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PGE1
acts on calcium mobilization |
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AEs of alprostadil include
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pain at injectoin site
fibrotic episodes (<1%) |
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Local delivery is necessary for alprostadil because
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it's poorbly absorbed PO and breaks down rapidly in blood stream, reducing systemic concentration
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_____ can be used to reduce injectoin-site pain when administering alprostadil
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intra-urethral delivery
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PDE5 inhibitors work by
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inhibiting PDE5 and the subsequent breakdown of cGMP, allowing sustained erection
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_____ was the first PO agent for ED and only works under ______
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Sildenafil (Viagra)
conditions of sexual stimulation |
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Times to peak concentrations of
Sildenafil _____ Vardenafil _____ Tadalafil ______ |
60 min
50 min 120 min |
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Half lives of
Sildenafil _____ Vardenafil _____ Tadalafil ______ |
3-4 hrs
4-5 hrs 18 hrs |
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Sildenafil is ____
Vardenafil is ____ Tadalafil is ____ |
Viagra
Levitra Cialis |
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The two PDE5 inhibitors with food interaction, which typically involves foods with _____, are _____ and ____
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high-fat
sildenafil vardenafil |
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All PDE5 inhibitors are metabolized by the ______ enzyme
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p450 3a4
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Inhibitors of the p4503a4 enzyme such as ____, ____, and ____ will ______ the clearance of the PDE5 inhibitors
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cimetidine
ketoconazole erythryomycin decrease |
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AEs of the PDE5 inhibitors include
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headache
flushing dyspepsia nasal congestion (above are all sxs of increase vasodilation) Disturbances in color vision |
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Disturbances in color vision have been reported with ______ and is probably due to
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sildenafil
non-selective inhibition of PDE6 (PDE found in retina) |
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Color vision disturbances have not been reported with ____
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tadalafil
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Drug interactions with PDE5 include
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organic nitrates
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Organic nitrates are ______ with PDE5 inhibitors because they can _____ and cause _____
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ABSOLUTELY CONTRAINDICATED
Potentiate effect of NO, which is further synthesized from nitrate drugs (makes sense derp!) Hypotensive crisis |
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Nitrates contraindicated for use with PDE5 inhibitors include
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nitroglycerin
isosorbide methylnitrate other nitrate meds |
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Illicit nitrate never to be used with PDE5 inhibitors
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Amyl nitrate
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_____, commonly used to treat BPH, are contraindicated for use with PDE5
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alpha adrenergic antagonists
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The alpha antagonist _____ may be used with _____
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tamsulosin
tadalafil |
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Because the CNS is involved in signaling to the penis and integrates the erectile response, the DA agonist _____ has been developed to treat ED
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apomorphine
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Apomorphine is a ______ delivered drug
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sublingually
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