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ED is not a disease, but rather a [blank_start]symptom[blank_end] of a physical or psychological problem, or a mixture of both. It is significantly associated with reduced [blank_start]quality of life[blank_end] and emotional stress, and can damage [blank_start]relationships[blank_end] between partners.
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symptom
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quality of life
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relationships
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Smooth muscles contracted > vasoconstriction > low blood flow = ?
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Flaccid penis
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Erect penis
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Smooth muscles relaxed > vasodilation > high bloodflow = ?
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Risk factors/Causes of erectile dysfunction:
• Vascular – [blank_start]arterial[blank_end] (cholesterol, diabetes, [blank_start]hyper[blank_end]tension, trauma/surgery)
• Neurogenic - [blank_start]surgery/trauma, MS, diabetes[blank_end]
• Psychologic [blank_start]- depression, anxiety, substance abuse[blank_end]
• Hormonal - [blank_start]low testosterone, thyroid, prolactin[blank_end]
• Anatomical - [blank_start]Peyronie’s disease, phimosis[blank_end]
• Medications – e.g. antihypertensives, [blank_start]antidepressants[blank_end] (SSRIs), antihistamines, anti-psychotics, digoxin
• Chronic condition – [blank_start]COPD, Alzheimer's, renal/liver[blank_end]
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arterial
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hyper
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surgery/trauma, MS, diabetes
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- depression, anxiety, substance abuse
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low testosterone, thyroid, prolactin
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Peyronie’s disease, phimosis
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antidepressants
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COPD, Alzheimer's, renal/liver
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ED shares many risk factors for heart disease and warrants a cardiac risk assessment in most patients.
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Delay in treatment for ED?
Despite increased awareness of ED there is often a delay between the onset of symptoms and seeking help, with a mean delay of 1-3.5 [blank_start]years[blank_end]. [blank_start]Pharmacists[blank_end] are in a unique position to be able to raise awareness and [blank_start]check-in[blank_end] with men about ED.
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years
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months
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check-in
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Pharmacists
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Which of these is not a lifestyle modification recommended for ED?
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Medicines for ED:
1st line: Phosphodiesterase type-5 [blank_start]inhibitors[blank_end] (PDE5i). [blank_start]Sildenafil[blank_end], tadalafil and vardenafil.
2nd and 3rd line: Hormonal ([blank_start]local[blank_end], inserted), [blank_start]Intracavernosal Injection[blank_end] (ICI) Therapy, Pumps, Implants. If [blank_start]priapism[blank_end] (persistent and painful erection of the penis) occurs with alprostadil, [blank_start]treatment[blank_end] shouldn’t be delayed more than [blank_start]6[blank_end] hours.
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PDE5 inhibitors relax [blank_start]smooth[blank_end] muscle and increase [blank_start]blood[blank_end] flow which allows an erection to occur in response to sexual stimulation.
- Effective in [blank_start]80[blank_end]% of patients with ED
- MoA: NO ([blank_start]nitric oxide[blank_end]) passes into the smooth muscle cells of the blood vessel [blank_start]walls[blank_end], this produces cGMP; cGMP then leads to a decrease in [blank_start]calcium[blank_end] levels. [blank_start]Decreased[blank_end] calcium level causes the muscle cells to [blank_start]relax[blank_end] and allow high blood flow for an erection.
- PK: Sildenafil 100 mg on empty stomach has a Tmax of 70 minutes, and a half life of 4. Vardenafil 20 mg on empty stomach has a Tmax of [blank_start]48[blank_end] minutes, and a half life of 4-5. Tadalafil 20 mg on empty stomach has a Tmax of 120 minutes, and a half life of [blank_start]17.5[blank_end]
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smooth
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blood
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80
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nitric oxide
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walls
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calcium
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Decreased
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relax
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48
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17.5
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Which of these is not a Common Side Effect of PDE5is?
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Sildenafil is metabolised predominantly by the cytochrome P450 [blank_start]3A4 and 2C9[blank_end] enzymes, and interacts with cimetidine, [blank_start]erythromycin[blank_end] (inhibitor) [blank_start]rifampicin[blank_end] (inducer).
Keys to PDE-5i Success:
- doing/checking [blank_start]CVD[blank_end] risk assesment
- take approximately [blank_start]one[blank_end] hour before sexual activity.
- for patients who anticipate sexual activity at least [blank_start]twice[blank_end] weekly, 5 mg [blank_start]Taladafil[blank_end] once daily can be taken, reduced to [blank_start]2.5[blank_end] mg once daily according to response (not subsidised).
- may take longer to take effect if taken with [blank_start]food[blank_end].
- mental and physical stimulation [blank_start]required[blank_end], Anxiety can [blank_start]counteract[blank_end] effects
- efficacy of the 3 drugs [blank_start]varies[blank_end] from patient to patient - try at least [blank_start]4[blank_end] attempts, with [blank_start]2[blank_end] different PDE5i, in the absence of contraindications before declaring failure.
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3A4 and 2C9
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erythromycin
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rifampicin
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CVD
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one
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twice
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Taladafil
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2.5
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food
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required
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counteract
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varies
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4
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2
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Pharmacist Only/Restricted Medicine – Sildenafil (and analogues). Rules:
- Tablets containing [blank_start]100 milligrams[blank_end] or less per dose unit when sold in the manufacturer's original pack...
- Containing no more than [blank_start]12[blank_end] solid dosage units...
- For Tx of [blank_start]erectile dysfunction[blank_end] in males aged [blank_start]35-70[blank_end] years.
- By a registered pharmacist who has successfully completed a [blank_start]training programme[blank_end].
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100 milligrams
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12
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erectile dysfunction
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35-70
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training programme