NAPLEX: Male & Female Health - Sexual Dysfunction

disease states erectile dysfunction is common in

HTN

atherosclerosis

DM

drugs that can cause / contribute to erectile dysfunction

Alcohol

Antidepressants: SSRI, SNRI

Anti hypertensives: beta blockers, clonidine, thiazides

Antipsychotics: first generation (chlorpromazine), prolactin raising second gen (risperidone, paliperidone)

BPH: finasteride, dutasteride, silodosin

Anticancer drugs: leuprolide, flutamide

Anticholingerics

Atomoxetine

Digoxin

H2RA: cimetidine, ranitidine

Nicotine

Opioids (chronic use especially methadone)

natural products that can be used for erectile dysfunction

Yohimbe - insufficient evidence

L-arginine - possibly effective

Panax ginseng - possibly effective

erectile dysfunction treatment

1st line = PDE-5 inhibitors

alt = alprostadil

what can cause treatment failure with PDE-5 inhibitors

sexual stimulation

timing of dose

eating large meal with dose

PDE-5 inhibitor DDIs

nitrates, riociguat

caution in pts that cause HoTN: alpha blockers, antihypertensive drugs

- pt should be stable on A1 before starting PDE-5

moderate/strong cyp450 3a4 inhibitors increase drug levesl of PDE-5 inhibiors

- lower starting doses or extend dosing intervals

strong cyp3a4 inducers decrease drug levels - monitor effectiveness

alprostadil form

iv injection or urethral pellets injected into penis

true or false

alprostadil lasts longer than PDE-5 inhibitors

false

treatment is painful, invasive, and does not last as long as PDE-5 inhibitors

PDE-5 inhibitor SE

Difficulty with color discrimination (blue green)

Potential vision loss

Headache

Flushing

Dizziness

Dyspepsia

Increased sensitivity to light

Epistaxis

Diarrhea

Myalgia

Muscle / back pain (mostly with tadalafil)

HoTN

Priapsim

which PDE-5 inhibitors have decreased efficacy if taken with a high fat or large meal

sildenafil, vardenafil

what conditions will qualify for a pt to start a PDE-5 inhibitor at a reduced dose

- >65 y/o

- using an alpha blocker

- using a cyp3a4 inhibitor

- severe renal or liver disease

when should sildenafil, vardenafil be taken

1 hr before sexual activity

when should tadalafil be taken

30 min before sexual activity

when should avenafil be taken

15-30 min before sexual activity

alprostadil SE

Penile pain

Priapsim

Headache

Dizziness

Urethral pellets: urethral burning or bleeding

alprostadil CI

Conditions that predispose pt to priapism (sickle cell anemia, multiple myeloma, leukemia)

alprostadil storage / administration instructions

caverject: reconstitute before use

muse: refrigerate

hypoactive sexual desire disorder treatment

flibanserin

bremelanotide

flibanserin, bremelanotide SE

↑BP ↓HR after each dose

Skin hyperpigmentation

Nausea

Delayed gastric emptying

flibanserin, bremelanotide CI

Pregnancy

Uncontrolled HTN

Known CV disease

Alcohol

how long should flibanserin, bremelanotide be used

Discontinue if no benefit after 8 wks

flibanserin DDIs

Use with CNS depressants increases risk of HoTN, syncope

Major substrate of CYP3A4 and inhibits P-gp

Concurrent moderate-strong CYP3A4 inhibitors CI

lifestyle treatment

weight loss

quitting tobacco

reducing alcohol

tadalafil (cialis) indication

can be used for BPH at 5 mg daily, which can treat concurrent ED

which PDE-5 inhibitors are used for PAH

sildenafil (revatio)

tadalafil (adcirca)

tadalafil (cialis) half life

48 hours

sildenafil (viagra), vardenafil (levitra) half life

long enough for 1 erection (1 round of intercourse)

sildenafil (viagra)

- starting dose

- reduced dose

starting dose: 50 mg

reduced dose: 25 mg

tadalafil (cialis), vardenafil (levitra)

- starting dose

- reduced dose

starting dose: 10 mg

reduced dose: 5 mg

avanafil (stendra)

- starting dose

- reduced dose

starting dose: 100 mg

reduced dose: 50 mg

tadalafil (cialis) daily dosing

2.5-5 mg daily

start at 2.5 mg

do not use daily dosing w severe renal or liver failure

addyi indication

FDA approved for hypersexual desire disorder

increases # of satisfying sexual events per month by 0.5-1 compared to placebo

dose: 100 mg qHS, discontinue if no benefit at 8 wks

addyi CI

- alcohol d/t severe HoTN and syncope (REMS program)

- combo w moderate-strong CYP3A4 inhibitors

- hepatic impairment

addyi SE

warnings:

- HoTN

- syncope

- CNS depression

SE:

- dizziness

- somnolence

- nausea

- fatigue

- insomnia

- dry mouth