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35 Cards in this Set

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What are the 4 phases of the sexual response cycle (where disorders may occur)?
1. disorder of sexual desire (starts in the brain*)
2. disorders of sexual arousal
3. orgasmic disorders
4. resolution phase: sexual pain disorders
Causes of chronic disturbances in sexual function:
Organic or psychogenic (difficult to discern)
Causes of acute disturbances in sexual function:
Usually drug-induced
What are the 2 sexual desire disorders?
1. hypoactive sexual desire disorder
2. sexual arousal disorder
What are the 2 sexual desire disorders?
1. hypoactive sexual desire disorder
2. sexual arousal disorder
***Hypoactive Sexual Desire Disorder***
***Hypoactive Sexual Desire Disorder***
What is the most common sexual dysfunction disorder?
Hypoactive sexual desire disorder
What must a physician consider before prescribing meds for hypoactive sexual desire?
Physician must consider all possible organic factors that could account for presence of hypoactive sexual desire.
What is the most common psychiatric problem accompanied by decreased libido?
Depression
What symptoms are generally associated with antipsychotic meds?
Erectile dysfunction, anorgasmia, and hypoactive sexual desire
What is a main feature of major depressive disorder?

Does treatment with antidepressants help?
Diminished libido

Treatment with antidepressants can help, but diminished libido is also a S/E of these drugs
What should a physician do if a low libido is determined to be a side effect of an anti-depressant medication?
1. tolerance to this S/E may develop if pt can just stay on the drug a couple more weeks
2. can reduce the dose of the drug if it doesn’t reduce therapeutic efficacy
3. add bupropion or substitue with buproprion
4. use trazodone
5. yohimbine at a low dose may reverse low libido
***Sexual Aversion Disorder***
***Sexual Aversion Disorder***
What is sexual aversion disorder?
=aversion and active avoidance of genital sexual contact with a sexual partner
How do you treat sexual aversion disorder?
Only with psychotherapy
***Disorder of sexual arousal***
***Disorder of sexual arousal***
What 2 disorders fall under the category of sexual arousal disorders?
1. male erectile disorder
2. female sexual arousal disorder
***Male Erectile Disorder (ED)/Impotence***
***Male Erectile Disorder (ED)/Impotence***
How are the causes of ED classified?
1. organic
2. psychogenic
What is the most common endocrinopathy associated with ED?

What other medical problems cause sexual problems in men and women?
-Diabetes mellitus (due vascular changes)**

-Others: hyperprolactinemia*, hypothyroidism, hyper- and hypoadrenocorticolism, hypogonadal states, pituitary dysfunctions; vascular changes; uncontrolled HTN or meds for HTN; neurological problems; male GU conditions: post-prostatectomy, S/Es of cancer treatment, etc.
-Females: atrophic vaginitis, infections of vagina and ext genitalia, postsurgical complications, endometriosis, uterine prolapse, S/Es of cancer treatments, etc.
Sexual pain disorders:
1. dyspareunia – pain during intercourse
2. vaginismus – spasm of vagina prevents intercourse
***Pharmacotherapy of Erectile Dysfunction (ED)***
***Pharmacotherapy of Erectile Dysfunction (ED)***
What is the MOA of the drugs used for ED?**
What is the MOA of the drugs used for ED?**
What is the main neurotransmitter mediating penile erection?
Nitric oxide (L-arginine is converted to NO by nitric oxide synthetase)
What physiologic events cause normal erection?
Sexual arousal leads to release of NO from non-adrenergic, non-cholinergic nerve endings that innervate penile and clitoral arteries → NO stimulates release of guanylate cyclase (GC) → GC converts guanosine triphosphate to 3’5’-cGMP → cGMP* is critical for smooth muscle relaxation of corpora cavernosa of penis (similar events probably occur in clitoris) → increased blood flow and penile engourgement
Why are PDE5 inhibitors used?
breakdown of cGMP is mediated by PDE5 (therefore inhibing PDE5 prolongs action of cGMP causing a sustained erection
Viagra*: Name? Duration of action? S/Es?
What should you not combine it with?*
Sildenafil*
S/Es: headache, visual disturbances (seeing blue lights; PDE5 in retina), facial flushing, rhinitis, orthostasis and syncope, priapism (rare)
60 minute duration of action (t1/2: 1-4 hours)
do NOT combine with NO donors (e.g. nitroglycerin)!** - Viagra is not safe in combo with nitrates!
Viagra does NOT enhance sexual desire
Cialis*: name? half-life?
What is an advantage of it?
Tadalafil*
Longer half-life = 17 hours
No interaction with alcohol
Levitra*: name? half-life?
How is it with antihypertensives?
Good for what specific patients?
Vardenafil*

Sightly longer t1/2 than Sildenafil

No significant effect on BP and fairly safe in combo w/ other hypertensives

Good for “difficult to treat patients”*: diabetics and radial prostatectomy**
How are PGE-5 inhibitors metabolized?
Metabolized by CYP3A4
***Premature Ejaculation***
***Premature Ejaculation***
PE is related to what problem?
What can be given to help with PE?
Decreased central serotonergic NT and/or receptor dysregulation: postulated 5-HT-2C hyposensitivity* or 5-HT-1A hypersensitivity* (thus giving SSRIs desensitizes these receptors → increased receptor activation)**

Must give these drugs chronically

It is mainly a neurobiological phenomena
PE drug therapy:
Paroxetine
Sertraline
Fluoxetine
Clomipramine
(S/E is low libido)
What is Yohimbine’s MOA?
Yohimbine is an alpha-2 receptor antagonist → enhances penile erections by inhibiting penile venous outflow
What self-injectable meds can be used for ED?

When are they needed?
Injectables: papaverine and phentolamine (injected into the corpora cavernosa)

When used: neurogenic and vasculogenic causes; some psychogenic instances refractive to other psych interventions