sexual dysfunction (NAPLEX)

Meds causing sexual dysfunction (studygal) *

Alcohol

Antidepressants (SSRI/SNRI)

Antihypertensives (Beta blockers, clonidine, thiazides)

Antipsychotics (FGA, prolactin raising SGA)

BPH (finasteride, dutasteride, silodosin)

What conditions can contribute to ED? (5)

DM

Depression

Stress

Spinal cord injuries

Stroke

Natural products for ED

Yohimbe

L-arginine

Panax ginseng

PDE-5 inhibitors MOA

Block PDE-5 from degrading cGMP

Normally during stimulation there is a release of NO, which increases cGMP causing smooth muscle relaxation permetting blood to flow in, causing an erection

Reduce PDE5 dosing if (4) *

>65 yo

Using an alpha blocker

Using a CYP3A4 inhibitor

Severe renal/liver dx

Typical PDE starting dose (4) *

50mg (S)

10mg (V, T)

100mg (A)

Sildenafil brand

Viagra

Revatio (PAH)

Tadalafil brand

Cialis

Adcirca (PAH)

Tadalafil indications (3)

BPH, ED, PAH

PDE5 taken in regards to sex

avanafil: 15-30 minutes prior

tadalafil: 30 minutes prior

sildenafil: 1 hour prior

vardenafil: 1 hour prior

PDE5 warnings (5)

hearing loss

hypotension

impaired color discrimination

priapism

vision loss (NAION)

PDE5 adverse effects

Back pain (tadalafil mostly)

Dizziness

Dyspepsia

Flushing

Headache

Seek ER if priapism >____ hrs

4

Can you take more than 1 dose of PDE5 per day?

Not recommended

Which 2 PDE5's can have decreased efficacy if taken with high fat or large meal?

Sildenafil

Vardenafil

PDE5 inhibitors DDI (4)

Alpha blockers

Antihypertensives

CYP3A4 inhibitors

Nitrates (severe hypo)

Alprostadil MOA

Prostaglandin E1 vasodilator injected pellets

Aloprastadil administration

Injected into the base of the penis or a pellet is inserted through the urethra

T/F: urethral pellets must be refridgerated

True

Hypoactive sexual disorder TX

Filbanserin (Addyi) only in premenopausal females

Filbanserin MOA

5HT1A agonist and 5HT2A antagonist

Premenopause hypoactive sexual disorder TX (2)

Filbanserin (Addyi) PO

Bremelanotide injection

Filbanserin BW/REMS (3)

REMS for severe hypotension/syncope when taken with alcohol

Contraindicated with CYP3A4 inhibitors

Contraindicated in hepatic impairment