Term
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Definition
| Damage to tissue components associated with the process of erection including nerves, endothelial lining of vessels, vascular smooth muscle. ex: trauma, surgery |
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Term
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Definition
Advancing age
Smoking
Diabetes*
Hypertension
Atherosclerosis
Heart disease
Kidney
Illicit drug use (cocaine , methamphetamine)
Neurological disorders (Parkinson’s, MS, stroke, AD, SCI)
Hormonal abnormality
Psychological conditions |
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Term
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Definition
Antihypertensives
Psych Meds
Antidysrhythmics and other hert meds
Hormones/antiandrogens
Antihistamines (H1 & H2)
Some NSAIDS
Muscle Relaxers
Chemo, recreational |
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Term
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Definition
Identify comorbidies, potential psychosocial etiologies, potential drug adverse effects and treat or eliminate.
Lifestyle changes
Phosphodiesterase-5 (PDE5) inhibitors
-First line drug treatment
Devices and surgery |
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Term
ED Medication PDE-5 Inhibitors MOA & Ex
requires arousal signal, 70% improved function |
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Definition
inhibits PDE5 and thereby inhibits the degradation of cGMP in VSMCs of penis resulting in maintenance of smooth muscle relaxation, vasodilation, and inflow of blood.
Sildenafil (Viagra, Revatio)
Duration 4 hours
Vardenafil (Levitra)
Duration 4 hours
Tadalafil (Cialis)
Duration 36 hours |
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Term
| ED Medication PDE-5 Inhibitors Pharmacokinetics |
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Definition
Absorption – well absorbed
Delayed after fatty meal (peak 2 hr)
Bioavailability
40%
Highly protein bound
Peak – 1 hour
Metabolized P450
CYP3A4
Active metabolite
Clearance delayed in men > 65 y.o.
Response is dose-dependent |
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Term
| ED Medication PDE-5 Inhibitors Adverse Effects |
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Definition
Hypotension particularly if other drugs are being taken for HTN
-Contraindicated in those taking nitrates
Headache, dizziness, flushing, nasal decongestion
Visual disturbances
Blue color, light sensitivity, blurring
-Optic neuropathy ( rare)
-Blockage of blood flow to optic nerve
Irreversible blurring or loss of vision
Priapism
Sudden hearing loss |
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Term
| Sildenafil as Revatio for PAH 2005 |
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Definition
Pulmonary HTN
selective inhibition of PDE5→ preserves cGMP and enhances vasodilation mediated by NO
20mg 3 times/day |
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Term
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Definition
Etiology unknown
Hyperplasia
DHT-induced growth factors cause proliferation of prostatic stromal cells & decreasing death of epithelial cells
Hyperplasia of epithelial & smooth muscle resulting in obstruction of the urethra
-Mechanical or static
-Dynamic |
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Term
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Definition
Urinary urgency, frequency; nocturia
Dysuria; hesitancy; straining to void; dribbling
Decreased force and caliber of urine stream
Incomplete bladder emptying
toruous ureter, dilated renal pelvlis |
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Term
| ED Medication PDE-5 Inhibitors Pharmacokinetics |
|
Definition
Absorption – well absorbed
Delayed after fatty meal (peak 2 hr)
Bioavailability
40%
Highly protein bound
Peak – 1 hour
Metabolized P450
CYP3A4
Active metabolite
Clearance delayed in men > 65 y.o.
Response is dose-dependent |
|
|
Term
| ED Medication PDE-5 Inhibitors Pharmacokinetics |
|
Definition
Absorption – well absorbed
Delayed after fatty meal (peak 2 hr)
Bioavailability
40%
Highly protein bound
Peak – 1 hour
Metabolized P450
CYP3A4
Active metabolite
Clearance delayed in men > 65 y.o.
Response is dose-dependent |
|
|
Term
| ED Medication PDE-5 Inhibitors Adverse Effects |
|
Definition
Hypotension particularly if other drugs are being taken for HTN
-Contraindicated in those taking nitrates
Headache, dizziness, flushing, nasal decongestion
Visual disturbances
Blue color, light sensitivity, blurring
-Optic neuropathy ( rare)
-Blockage of blood flow to optic nerve
Irreversible blurring or loss of vision
Priapism
Sudden hearing loss |
|
|
Term
| ED Medication PDE-5 Inhibitors Adverse Effects |
|
Definition
Hypotension particularly if other drugs are being taken for HTN
-Contraindicated in those taking nitrates
Headache, dizziness, flushing, nasal decongestion
Visual disturbances
Blue color, light sensitivity, blurring
-Optic neuropathy ( rare)
-Blockage of blood flow to optic nerve
Irreversible blurring or loss of vision
Priapism
Sudden hearing loss |
|
|
Term
| Sildenafil as Revatio for PAH 2005 |
|
Definition
Pulmonary HTN
selective inhibition of PDE5→ preserves cGMP and enhances vasodilation mediated by NO
20mg 3 times/day |
|
|
Term
| Sildenafil as Revatio for PAH 2005 |
|
Definition
Pulmonary HTN
selective inhibition of PDE5→ preserves cGMP and enhances vasodilation mediated by NO
20mg 3 times/day |
|
|
Term
|
Definition
Etiology unknown
Hyperplasia
DHT-induced growth factors cause proliferation of prostatic stromal cells & decreasing death of epithelial cells
Hyperplasia of epithelial & smooth muscle resulting in obstruction of the urethra
-Mechanical or static
-Dynamic |
|
|
Term
|
Definition
Etiology unknown
Hyperplasia
DHT-induced growth factors cause proliferation of prostatic stromal cells & decreasing death of epithelial cells
Hyperplasia of epithelial & smooth muscle resulting in obstruction of the urethra
-Mechanical or static
-Dynamic |
|
|
Term
|
Definition
Urinary urgency, frequency; nocturia
Dysuria; hesitancy; straining to void; dribbling
Decreased force and caliber of urine stream
Incomplete bladder emptying
toruous ureter, dilated renal pelvlis |
|
|
Term
|
Definition
Urinary urgency, frequency; nocturia
Dysuria; hesitancy; straining to void; dribbling
Decreased force and caliber of urine stream
Incomplete bladder emptying
toruous ureter, dilated renal pelvlis |
|
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Term
|
Definition
Severe: surgical or invasive
Moderate: drugs
-5 alpha reductase inhibitors (mechanical or static)
-Alpha 1-adrenergic antagonists (dynamic)
-Antimuscarinic agents
Minimal: watchful waiting |
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Term
| 5-alpha reductase converts testosterone into DHT |
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Definition
| 2 different androgenic hormones: testosterone, which mediates overt masculinization in the adult male, and dihydrotestosterone (DHT), which mediates prostatic growth, acne, facial beard, and male pattern baldness. Inhibition of DHT in adults results in prostatic shrinkage and symptomatic relief in many men, without the side effects seen with conventional androgen-deprivation therapy |
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Term
| BPH Medication 5-alpha reductase inhibitors MOA & EX |
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Definition
MOA: Acts in reproductive tissues to inhibit 5-α reductase (enzyme that converts testosterone to DHT )
finasteride (Proscar) & dutastide (Avodart)
ben: 6 - 12 mo; gynecomast; highly enlarged; mech/stat obst |
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Term
| BPH Medication alpha-1 adrenergic antagonists MOA & EX |
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Definition
MOA: alpha 1 receptors relaxes smooth muscle in the bladder neck (trigone & sphincter), prostate capsule, prostatic urethra
Improves symptoms
mild, non-selective or Silodosin & tamulosin are selective for alpha 1 receptors in the prostate |
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Term
| BPH alpha-1 adrenergic antagonists cautions |
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Definition
Caution combining nonselective alpha blockers with vasodilators, nitrates, PDE5 inhibitors Why?
CYP3A4 inhibitors can increase levels of alpha blockers
combination therapy |
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Term
|
Definition
Absence or suppression of menstruation
Causes
Hormonal disturbances (GnRH deficiency; thyroid; pituitary)
Stress (Anorexia nervosa)
Exercise
Neoplasms (ovarian, adrenal, or pituitary tumors) |
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Term
|
Definition
Absence of menstruation for 3 or more cycles or 6 months
Hypothalamus
Pituitary
Thyroid
Adrenal
Ovary
Uterine (pregnancy)
Extrauterine |
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Term
| Dysmenorrhea (painful menstruation) |
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Definition
Develops 1-2 years after menarche
Results from increase prostaglandin that promotes uterine contractions and ischemia of endometrial capillaries
Sharp, suprapubic cramping severe enough to limit activity, nausea, vomiting, diarrhea |
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Term
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Definition
Growth & development
reproductive processes
metabolic effects |
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