Sex And Drugs

Front 1

Aspects of sexuality affected by drugs

Back 1

Libido (sex drive)
Sensation
Performance
-men (erections, orgasm, ejaculation)
-females (lubrication, orgasm)

Front 2

Libido - effect of hormones
-which hormones increase libido?
-which decrease?

Back 2

Increase
-testosterone (both sexes)
-estrogen (females)

Decrease
-prolactin (both sexes)
-estrogen (males)

Front 3

Libido - effect of CNS NTs
-DA
-ACh
-NE
-Serotonin

Back 3

DA increases sex drive (antagonists would decrease)

Muscarinic antagonists decrease libido

alpha-2 block increases libido; beta-antagonists, alpha-2 agonists decrease libido

Increased serotonin decreases libido

Front 4

Role of peripheral NS in sexual response
-Parasympathetic
-Sympathetic
-Somatic nerves

Back 4

Males
-parasympathetic --> erection
-sympathetic --> ejaculation
-somatic --> ejaculation/orgasm
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Females
-parasympathetic --> clitoris erection, lubrication
-sympathetic --> contraction of uterus, fallopian tubes, vagina
-somatic --> orgasm

Front 5

Effects of Antihypertensive Drugs
-ganglionic blockers
-beta blockers
-alpha-1 blockers
-clonidine, methyldopa

Back 5

Affects men only

Ganglionic blockers
-complete failure of erection, orgasm

Beta blockers
-ED, loss of libido

Alpha-1 blockers
-can get erection but have ejaculatory failure

Clonidine, methyldopa
-interfere with orgasm, ED

Front 6

Effects of Antihypertensive Drugs Cont'd
-thiazides
-spironolactone
-ca-channel blockers
-ACE inhibitors

Back 6

Thiazides
-impotence (ED)

Spironolactone
-decreased libido (increased prolactin, decreased testosterone)

Few problems w/ Ca-channel blockers and ACE inhibitors

Front 7

Antipsychotics

Back 7

Decreased libido due to:
-DA receptor blockade
-CNS anticholinergic effects
-CNS sedative effects

ED - peripheral anticholinergic

Orgasm problems - peripheral alpha-1 block

Front 8

Tricyclics (TCAs)

SSRIs

MAOIs

Levodopa

Back 8

impotence, decreased lubrication (anticholinergic), impaired orgasm (alpha-1)
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decreased libido, difficulty w/ orgasm
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orgasm difficulty, ejaculatory failure
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enhanced libido

Front 9

Alcohol/CNS depressants
-acute and chronic

Back 9

Acute
-disinhibiting, increased libido, impotence, delayed/less orgasm

Chronic
-impotence, decreased testosterone --> lower libido and loss of secondary sex characteristics

Front 10

Marijuana
-acute and chronic

Back 10

Acute
-enhanced sensory, disinhibition (lower doses), impotence/anxiety (higher doses)

Chronic
-decreased spermatogenesis, testosterone (libido, ED)
-irregular menstruation

Front 11

Cocaine and Amphetamines
-acute and chronic

Back 11

Acute
-enhanced libido (DA), delayed orgasm (lower doses); high doses stimulate erection, ejaculation, anxiety

Chronic
-loss of libido, depression, ejaculatory failure

Front 12

Opioids
-acute and chronic

Back 12

Acute
-increased sexual activity (disinhibition)

Chronic
-decrease in sexual activity

Front 13

Psychedelics
-LSD, mescaline
-MDA/MMDA
-PCP

Back 13

LSD/mescaline
-enhance sensory

MDA/MMDA
-enhance sexual feelings

PCP
-can inhibit sensation
-depression and psychosis w/ chronic use

Front 14

Prostaglandin E1
-use and MOA
-forms (admin)
-side effects

Back 14

Use for ED

PG binds receptors on surface of corpora cavernosa smooth muscle cell --> increase cAMP --> increase PKA --> decrease Ca2+ --> smooth muscle relaxation --> vasodilation
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drug of choice before Viagra

injectable and urethral suppository forms

Side effects - hypotension, mild penile pain, priaprism

Front 15

Sildenafil (Viagra)
-use
-MOA
-kinetics
-adverse effects

Back 15

Use for ED, NOT libido

NO increases guanylate cyclase --> increases cGMP --> smooth muscle relaxation
-sildenafil inhibits PDE-5 which breaks down cGMP --> elevated cGMP
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Peak plasma concentrations at 1 hr, 4 hr 1/2 life = effective duration
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Hypotension, headache, flushing

Visual disturbance - non-arteritic ischemic optic neuropathy

Hearing loss (and vestibular dysfunction)

Dangerous synergy w/ nitrates - caution in pts w/ CV disease