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16 Cards in this Set
- Front
- Back
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Erectile dysfunction |
Common cause- peripheral neuropathy, atherosclerosis, HTN Also spinal injury, depression, stroke |
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Drugs that cause ED |
Alcohol Anticancer (leuprolide, flutamide, busulfan, cyclophosphamide) Anticholinergics Antidepressants-SSRI, SNRI Antihypertensive- beta blockers, clonidine, methyldopa Antipsychotics- haloperidol, chlorpromazine, fluphenazine, thioridazine BPH- finasteride, dutasteride, silodosin Digoxin H2RA- cimetidine, nizatidine, ranitidine Nicotine Opioids (chronic)- methadone |
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Non- drug Tx |
Lifestyle Vacuum devices, implant/surgery Yohimbe(not good, has ADR), L-arginine, panax ginseng |
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Drug tx |
1st line- PDE-5 inhibitors- eg. tadalafil 2nd- Alprostadil(inj/urethral supp) Alt uses for PDE-5: sildenafil (viagra and revatio): viagra=ED, Revatio= PAH/ tadalafil(Cialis and Adcirca): cialis=ED and BPH, Adcirca= PAH |
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PDE-5 inhibitors |
Local release of nitric oxide -> more cGMP and muscle relaxation-> more blood flow CI- nitrate or riociguat use Warning- impaired color discrimination, hearing/vision loss, hypotension, priapism (>4hr; get help) Sx- HA, flush, dyspepsia, muscle/back pain (tadalafil, lasts <2days) Best on empty stomach (tadalafil doesnt matter) No more than 1 dose/day |
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Sildenafil |
Viagra, revatio (PAH) 50mg 1hr before sex Revatio- 5-20mg TID |
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Tadalafil |
Cialis(bph and ed), adcirca (PAH) 10mg 30min. Before sex The weekend pill Adcirca- 40mg qd |
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Vardenafil |
Levitra, staxyn odt 10mg before sex |
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Avanafil |
Stendra 100mg 15min. Before sex |
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Conditions that require lower dose |
3A4 inhibitors Alpha blockers Hepatic impairment Renal impairment (except viagra) Lower by half |
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Alprostadil |
Prostaglandin E1- vasodilation Inj or urethral suppository Invasive and painful, doesnt last as long as PDE-5 inhibitors |
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Caverject, Edex |
Alprostadil injection Inj 1.25-2.5mg into base of penis and titrate for effect(5-10min. For 1 hr) CI- sickle cell anemia, multiple myeloma, leukemia, penile implant, deformation Sx- pain, priapism, scarring Refrigerate, recon before use |
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Muse |
Alprostadil urethral pellet Insert 125-250mcg into urethra CI- Urethral stricture, hypospadias and curvature Sx- pain, priapism Urinate before insertion Refrigerate |
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Hypoactive sexual desire disorder |
Low sexual desire that causes marked distress or interpersonal difficulty, not due to drug or health condition |
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5-HT1a agonist and 5-HT2a antagonist |
For hypoactive sexual desire disorderFlibanserin- AddyiREMS avoid if pregnant100mg qhs, dc if no benefit 8wkBoxed- hypotension, alcohol, 3A4 inhibitors, hepatic impairmentCI- same as boxed |
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Flibanserin |
5-HT1A agonist and 5-HT2A antagonist Premenopausal women only Addyi 100mg qhs, dc if no benefit 8wks Boxed- severe hypotension risk with alcohol, mod/sev 3A4 inhibitor, or hepatic impairment CI- same as boxed Warning- hypotension, CNS depression Sx- dizziness, nausea, insomnia, dry mouth, somnolence |
