Androgens and Treatment of Impotence

What class of drugs bind cytosolic receptors, leading to dimerization, nuclear entry, and gene expression modulation?

Androgens

What class of drugs are responsible for the development of male puberty, increased muscle mass/bone density, increased RBC production, male, pattern, baldness, and maintenance of libido and fertility?

Androgens

What is the first line treatment for symptomatic hypogonadism (testicular or pituitary dysfunction)?

Testosterone replacement therapy

What is the first line treatment for hypo pituitarism prior to adolescence?

Testosterone replacement therapy

What drug is used to treat endometriosis-related pain and is a weak androgen with anti-estrogenic activity?

Danazol

What class of drugs is used with estrogen to treat postpartum breast engorgement and menopause?

Androgens

What drugs are oral agents that should not be used due to increased risk of hepatotoxicity?

Methyltestosterone and fluoxymesterone

Which formulation of testosterone has a boxed warning for pulmonary oil microembolism reactions and increased blood pressure?

Undecanoate

Which formulation of testosterone has fluctuations in mood/libido, "roller coaster" pharmacokinetics, and injection site pain?

Undecanoate

Which formulation of testosterone has a higher cardiovascular risk and box warning for increased blood pressure?

Enanthate

Which formulation of testosterone only has the disadvantage of higher cardiovascular risk

Cypionate

Which formulation of testosterone has a boxed warning for cross exposure to others?

Gels/solutions

Which formulation of testosterone is long acting (q3-6 months) but has unpredictable pharmacokinetics and requires a small incision?

Pellet

Which treatment is contraindicated in patient with male breast, cancer, prostate cancer, PSA greater than four, pregnancy, planning, fertility, or MI/stroke within the past six months?

Testosterone replacement therapy

Which treatment has a box warning for increased blood pressure leading to increased major adverse cardiac event (MACE), and adverse effects of increased risk of heart failure, sleep apnea, acne, gynecomastia, hair loss/balding, infertility, and increased LDL/decreased HDL?

Testosterone replacement therapy

What treatment has a boxed warning for secondary exposure leading to virilization in children?

Transdermal testosterone replacement therapy

What treatment has the adverse effect of polycythemia?

Parenteral testosterone replacement therapy

What drug should be reassessed at 1-3 months and given for 3-6 months for a trial before determining the full response?

Testosterone replacement therapy

Which drugs are anti-androgens that may cause erectile dysfunction?

Leuprolide, goserelin, ketoconazole

Which drugs are 5-alpha reductase inhibitors that may cause erectile dysfunction?

Finasteride, dutasteride

Which drugs are antiarrhythmics that may cause erectile dysfunction?

Digoxin, amiodarone, disopyramide

Which drugs are antidepressants that may cause erectile dysfunction?

TCAs, SSRIs

Which drugs are anti-hypertensive that may cause erectile dysfunction?

Thiazide diuretics, beta blockers, calcium channel blockers

Which drugs are recreational substances that may cause erectile dysfunction?

Marijuana, cocaine, nicotine, alcohol

What is first line pharmacotherapy for men with erectile dysfunction?

Avanafil, sildenafil, tadalafil, vardenafil

What drug is a synthetic PGE1, thought to increase cAMP to promote smooth muscle relaxation in the corpus cavernosum, and should be used if PDE5I is ineffective/cannot be used and can be injected or inserted as a pellet?

Alprostadil

What degrades CGMP leading to termination of an erection?

PDE-5

What promotes relaxation of smooth muscle of the corpus cavernosum during an erection?

PGE-1

What drug promotes relaxation of smooth muscle in the corpus cavernosum by increasing the levels of PGE-1?

Alprostadil

Which drugs are phosphodiesterase-5 inhibitors?

Avanafil, sildenafil, tadalafil, vardenafil

What drug indicated in the treatment of a erectile dysfunction can also be used to treat BPH?

Tadalafil

What drugs used in the treatment of erectile dysfunction can also be used to treat pulmonary hypertension?

Sildenafil and tadalafil

What drugs are contraindicated with nitrate therapy and alpha-1 blockers due to hypotension risk, with guanylate cyclase stimulators (riociguat), and should not be used more than once daily?

Avanafil, sildenafil, tadalafil, vardenafil

What drugs have the adverse effects of nasal congestion, loss of blue/green discrimination, priapism, headache, flushing, and dyspepsia, and are metabolized by CYP3A4?

Avanafil, sildenafil, tadalafil, vardenafil

Which PDE-5 inhibitor has the longest half-life and time to peak concentration?

Tadalafil

What class of drugs have interactions with nitrates, guanylate cyclase stimulators (riociguat), and alpha-1 blockers that leads to hypotension?

Avanafil, sildenafil, tadalafil, vardenafil

What drug is contraindicated for use in women, children, people with a predisposition to priapism (sickle cell, thrombocytopenia, polycythemia, leukemia, and multiple myeloma), and abnormal penile anatomy?

Alprostadil

What drug formulation is contraindicated in fibrotic conditions of the penis (cavernosal fibrosis/Peyronie disease), or a penile implant?

Alprostadil intracavernosa injections

What drug formulation is contraindicated in patient with a pregnant sexual partner?

Alprostadil intraurethral suppository

What drug other than PDE-5 inhibitors has adverse effects of penile pain, priapism, hypertension/headache, and has interactions with hypertension medications that may lead to hypotension?

Alprostadil

What is the first line treatment of erectile dysfunction after you have treated underlying diseases, discontinued contributing medication, removed the risk factors, and given testosterone supplementation if hypogonadism is present?

Avanafil, sildenafil, tadalafil, vardenafil

If PDE-5 inhibitors are contraindicated, what alternative treatment can be given if a vacuum erection device is not preferred?

Alprostadil