L18 Men’s Health – ED, Prostate health and baldness

Prevalence of ED:

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.

Smooth muscles contracted > vasoconstriction > low blood flow = ?

Smooth muscles relaxed > vasodilation > high bloodflow = ?

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]

ED shares many risk factors for heart disease and warrants a cardiac risk assessment in most patients.

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.

Which of these is not a lifestyle modification recommended for ED?

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.

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]

Which of these is not a Common Side Effect of PDE5is?

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.

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].