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vardenafil
Levitra, Staxyn
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intracavernisal
Caverject, Edex
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gel
Androgel, Fortesta, Testim, Vogelxo
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injection
Depo-testosterone, Delatestryl
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transdermal patch
Androderm
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transdermal solution
Axiron
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Name all 4 PDE Inhibitors
- 1. avanafil - Stendra
- 2. sildenafil - Viagra
- 3. tadalafil - Cialis
- 4. vardenafil - Levitra, Staxyn
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Name 2 PGE1's (Alprostadil)
- 1. intracavernosal - Caverject, Edex
- 2. intraurethral - Muse
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Name 5 Testosterone
- 1. buccal system - Striant
- 2. gel - Androgel, Fortesta, Testim, Vogelxo
- 3. injection - Depo-testosterone, Delatestry
- 4. transdermal patch - Androderm
- 5. transdermal solution - Axiron
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What are potentially correctible co-morbid conditions of erectile dysfunction?
- 1. Diabetes
- 2. Tobacco Use
- 3. Alcohol Use
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What medications may be potentially correctable causes of erectile dysfunction? (there are 7 classes)
- 1. Anticholinergics
- 2. anti-androgen drugs
- 3. CNS depressants
- 4. antidepressants
- 5. diuretics
- 6. beta-blockers
- 7. 5alpha reductase inhibitors
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How does PDE1 (prostaglandin-1; Alprostadil) work in erectile dysfunction?
PDE (prostaglandin-1; Alprostadil) works as a vasodilator. Muse is a penile suppository that is inserted into the urethra, while Caverject and Edex are injected by syringe directly into the corpus cavernosum. This opens blood vessels by relaxing smooth muscle.
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Which PGE1 is more effective?
Intracavernosal (Caverject, Edex)
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What medication group of "non-responders" does PGE-1 have a HIGH response in?
PDE-5 (Phosphodiesterase-5 inhibitors)
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What population of patients have a lower response to PDE5 inhibitors?
- 1. diabetics
- 2. those w/ vascular disease
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How are patients on PDE5 inhibitors who are categorized as "non-responders" assessed?
- 1. adherence
- 2. if doses have been correctly titrated
- 3. if at least 7-8 doses have been given for prn drugs; if daily, should be on it for a month
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Class of erectile dysfunction (ED) medication that has a a response in patients regardless of ED etiology, including "low T".
PDE-5 inhibitors
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What is the only PDE-5 inhibitor that can be used under ANY hepatic condition?
Sildenafil (Viagra)
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Which PDE-5 inhibitors are prohibited from use when a patient is on dialysis?
Vardenafil (Levitra) and Vardenafil ODT (Staxyn)
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List STRONG CYP inhibitors of PDE-5 inhibitors.
- CYPE3A4
- atazanavir, clarithromycin, indanavir, itraconazole, ketoconazole, nefazodone, nelfinavir, saquinavir, ritonavir, and telithromycin
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List MODERATE inhibitors of PDE-5 inhibitors
- CYP3A4
- amprenavir, aprepitant, diltiazem, erythromycin, fluconazole, fosamprenavir, verapamil
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What are the dose related side effects of PDE-5 inhibitors?
- 1. headache
- 2. facial flushing
- 3. dyspepsia
- 4. dizziness
- 5. visual changes (not seen in tadalafil)
- 6. lower back and limb muscle pain (tadalafil only)
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What are special considerations when using tadalafil (Cialis) not seen with other PDE-5 inhibiotrs?
- 1. Will NOT have "visual changes" as with others in its class
- 2. Will NOT decreae blood pressure by 8-10mmHG/5-6 mmHG like other PDE-5 inhibitors
- 3. The ONLY PDE-5 inhibitor to cause lower back and limb muscle pain
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What class of medications used in erectile dysfunction should be reviewed for STOPP criteria in people over the age of 65? What condition and monitoring parameter should these meds be avoided?
- 1. PDE-5 inhibitors
- 2. Severe heart failure when SBP <90 mmHg
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What is the safety profile for testosterone?
- 1. Sodium and fluid retention
- 2. increased Hct
- 3. Gynecomastia
- 4. Class III - potential for abuse
- 5. Cardiovascular (heart attack/stroke) NNH-71
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Which formulation of testosterone alters mood and/or libido?
Injection
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Which formulation(s) of testosterone poses the possibility for transfer from person to person?
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What monitoring parameters are important to watch for with testosterone use and why?
- 1. Hct - if >54% stop therapy
- 2. PSA - if >4ng/L or an increase by 1.4ng/L
- 3. LFT's
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