Term
| Requirements for Penile Erection |
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Definition
psychogenic factors;
testosterone;
good vascular flow to erectile tissue;
neurologic control of erectile tissue (ACh-controlled release of NO); |
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Term
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Definition
| failure to achieve an erection suitable for satisfactory sexual intercourse |
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Term
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Definition
male pts >50 yrs old;
stroke, mental disorders;
DM, HTN, CAD;
Drugs: anticholinergics, TCAs, antihistamines, estrogens, CNS depressants, diuretics, dopamine antagonists |
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Term
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Definition
| improve level of sexual function to satisfaction of pt & sexual partner w/ cost-effective agent w/ minimal adverse effects |
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Term
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Definition
D/C smoking, recreational drug use, and excessive EtOH intake;
D/C drugs which could cause ED;
Control underlying diseases;
Initiate psychosocial counseling PRN |
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Term
| Vacuum Erection Device (VED) |
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Definition
cylindrical chamber that fits over penis, hand- or battery-operated pump which forms vacuum suction pressure draws blood into corporal bodies, producing an erection, use rubber rings places around penile shaft to sustain erection;
Takes 15-30 min to onset;
68-93% efficacy;
Indications: pts in stable sexual relationship;
ADRs: penile pain & discoloration due to failure to remove penile rings, penile shaft becomes cold to touch, failure to ejaculate; |
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Term
| Phosphodiesterase Inhibitors |
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Definition
MoA: competitively inhibits PDE-5 in corporal tissue --> decreased breakdown of cGMP;
Pt MUST be sexually stimulated to work;
Indications: pts w/ ED due to any cause;
Efficacy: 60-80%;
Dose must be titrated;
Caution: bleeding disorders, PUD, retinitis pigmentosa; |
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Term
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Definition
Inhibits types 5 & 6 PDE-5 inhibitor;
Tx of ED due to any cause;
Dose: 50 mg one hr before coitus;
Half-life: 3.7 hrs;
Onset is delayed by high fat meals;
Duration: 4-6 hrs;
Reduce dose to 25 mg/d in pts w/ CrCl < 30 ml/min;
Reduce dose in hepatic failure & if pts on CYP 3A4 inhibitors;
ADRs: HA, flushing, hypotension, CYANOPSIA |
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Term
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Definition
Inhibits types 5 & 6 PDE;
Half-life: 4.5 hrs;
Dose: 10 mg one hour coitus;
Onset is affected by high fat meals;
Duration: 4-6 hrs;
NO dose adjustment in renal failure;
Dose adjustment in hepatic dysfunction;
Dose adjustment in pts on CYP 3A4 inhibitors;
ADRs: HA, flushing, hypotension, CYANOPSIA |
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Term
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Definition
Inhibits 5 & 11 PDE;
Half life: 17.5 hrs;
Onset is NOT affected by high fat meals;
Duration: 24-36 hrs;
Starting Dose: 10 mg prior to sexual activity OR 2.5 - 5 mg once daily;
Limit to 5 mg/day for renal failure pts;
Dose reduced in hepatic failure and in pts on CYP 3A4 inhibitors;
ADRs: HA, flushing, hypotension, muscle pain |
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Term
| Reasons for Treatment Failure with PDE Inhibitors |
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Definition
NO sexual foreplay;
Pt does not allow adequate time after drug administration for drug to work;
Pt may not be titrated up to effective dose;
Pt not coordinating time of drug administration with meals & coitus; |
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Term
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Definition
Cardiac mortality;
cyanopsia;
HA;
Flushing;
Hypotension;
Nasal Congestion;
Priapism;
GERD;
muscle pain;
nonarteritic anterior ischemic optic neuropathy (NAION); |
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Term
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Definition
CAN use PDE inhibitors without ANY special precautions;
Reassess pts every 6-12 months;
Pts who are asymptomatic of CAD have less than 3 risk factors for CAD;
Class I CHF, mild valvular dx, uncomplicated past MI, post-successful coronary revascularization, mild stable angina, controlled HTN; |
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Term
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Definition
pts should NOT receive PDE inhibitor & should ABSTAIN from all sexual activity;
Pts include:
- uncontrolled HTN, unstable angina, Class 3-4 CHF, recent MI, recent CVA, high-risk arrhythmias, cardiomyopathy, moderate/severe valvular dx; |
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Term
| Intermediate Risk Cardiac Pts |
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Definition
Pts should undergo cardiac evaluation to determine if they should be treated w/ PDE Inhibitors;
Pts w/ >= 3 risk factors for CAD, moderate stable angina, recent MI or CVA, Class 2 CHF, arrhythmia of unknown cause |
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Term
| Contraindications for PDE Inhibitors |
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Definition
| retinitis pigmentosa, severe cardiac disease, use of any nitrates |
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Term
| Drug Interactions with PDE Inhibitors |
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Definition
nitrates --> fainting, syncope, angina;
CYP 3A4 inhibitors (cimetidine, erythromycin, ketoconazole, clarithromycin) --> increase blood levels;
Protease inhibitors (ritonavir) --> increased drug levels;
Alpha-adrenergic antagonists (terazosin, doxazosin, alfuzosin, tamsulosin) --> risk of hypotension |
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