CHAPTER 72 SEXUAL DYSFUNCTION ● Drugs that can lead to ED/Sexual Dysfunction: ○ Antidepressants especially SSRIs and SNRIs (dec libido) ○ AntiHTNs such as BB, clonidine, and others ○ APs: first generation, prolactin raising second gen ○ BPH meds such as finasteride, dutasteride, and silodosin ● Natural products: ○ Yohimbe ○ L-arginine ○ Panax ginseng PDE-5 INHIBITORS: cause a local release of NO which inc cGMP and causes smooth muscle relaxation which inc blood flow to penis ● CI: do not use with nitrates or riociguat ● May cause impaired color discrimination (dose related,) hearing loss, vision loss, hypotension, priapism, and CVD ● SE: HA, flushing, dizziness, dyspepsia ● No more than one dose/day is needed ● Stendra can be taken closest to sexual activity ● Reduce dose if: ○ > 65 YO ○ Using an alpha blocker ○ Using a 3A4 inhibitor ○ Severe renal/liver disease ● Sildenafil: (Viagra) 25-100 mg daily ○ Start at 50 mg; take 1 hour before sexual activity ○ Revatio is used for PAH ● Vardenafil: (Levitra or Staxyn ODT) 5-20 mg daily or
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- Spring '17
- vision loss, PAH, ALPHA BLOCKER, Clonidine, 5HT1