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35 Cards in this Set
- Front
- Back
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What are the 4 phases of the sexual response cycle (where disorders may occur)?
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1. disorder of sexual desire (starts in the brain*)
2. disorders of sexual arousal 3. orgasmic disorders 4. resolution phase: sexual pain disorders |
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Causes of chronic disturbances in sexual function:
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Organic or psychogenic (difficult to discern)
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Causes of acute disturbances in sexual function:
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Usually drug-induced
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What are the 2 sexual desire disorders?
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1. hypoactive sexual desire disorder
2. sexual arousal disorder |
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What are the 2 sexual desire disorders?
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1. hypoactive sexual desire disorder
2. sexual arousal disorder |
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***Hypoactive Sexual Desire Disorder***
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***Hypoactive Sexual Desire Disorder***
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What is the most common sexual dysfunction disorder?
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Hypoactive sexual desire disorder
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What must a physician consider before prescribing meds for hypoactive sexual desire?
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Physician must consider all possible organic factors that could account for presence of hypoactive sexual desire.
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What is the most common psychiatric problem accompanied by decreased libido?
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Depression
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What symptoms are generally associated with antipsychotic meds?
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Erectile dysfunction, anorgasmia, and hypoactive sexual desire
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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 |
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What should a physician do if a low libido is determined to be a side effect of an anti-depressant medication?
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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 |
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***Sexual Aversion Disorder***
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***Sexual Aversion Disorder***
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What is sexual aversion disorder?
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=aversion and active avoidance of genital sexual contact with a sexual partner
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How do you treat sexual aversion disorder?
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Only with psychotherapy
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***Disorder of sexual arousal***
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***Disorder of sexual arousal***
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What 2 disorders fall under the category of sexual arousal disorders?
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1. male erectile disorder
2. female sexual arousal disorder |
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***Male Erectile Disorder (ED)/Impotence***
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***Male Erectile Disorder (ED)/Impotence***
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How are the causes of ED classified?
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1. organic
2. psychogenic |
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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. |
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Sexual pain disorders:
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1. dyspareunia – pain during intercourse
2. vaginismus – spasm of vagina prevents intercourse |
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***Pharmacotherapy of Erectile Dysfunction (ED)***
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***Pharmacotherapy of Erectile Dysfunction (ED)***
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What is the MOA of the drugs used for ED?**
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What is the MOA of the drugs used for ED?**
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What is the main neurotransmitter mediating penile erection?
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Nitric oxide (L-arginine is converted to NO by nitric oxide synthetase)
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What physiologic events cause normal erection?
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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
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Why are PDE5 inhibitors used?
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breakdown of cGMP is mediated by PDE5 (therefore inhibing PDE5 prolongs action of cGMP causing a sustained erection
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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 |
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Cialis*: name? half-life?
What is an advantage of it? |
Tadalafil*
Longer half-life = 17 hours No interaction with alcohol |
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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** |
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How are PGE-5 inhibitors metabolized?
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Metabolized by CYP3A4
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***Premature Ejaculation***
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***Premature Ejaculation***
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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 |
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PE drug therapy:
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Paroxetine
Sertraline Fluoxetine Clomipramine (S/E is low libido) |
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What is Yohimbine’s MOA?
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Yohimbine is an alpha-2 receptor antagonist → enhances penile erections by inhibiting penile venous outflow
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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 |
