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

ED is not a disease, but rather a ❌ of a physical or psychological problem, or a mixture of both. It is significantly associated with reduced ❌ and emotional stress, and can damage ❌ between partners.

Risk factors/Causes of erectile dysfunction:
• Vascular – ❌ (cholesterol, diabetes, ❌tension, trauma/surgery)
• Neurogenic - ❌
• Psychologic ❌
• Hormonal - ❌
• Anatomical - ❌
• Medications – e.g. antihypertensives, ❌ (SSRIs), antihistamines, anti-psychotics, digoxin
• Chronic condition – ❌

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 ❌. ❌ are in a unique position to be able to raise awareness and ❌ with men about ED.

Medicines for ED:
1st line: Phosphodiesterase type-5 ❌ (PDE5i). ❌, tadalafil and vardenafil.
2nd and 3rd line: Hormonal (❌, inserted), ❌ (ICI) Therapy, Pumps, Implants. If ❌ (persistent and painful erection of the penis) occurs with alprostadil, ❌ shouldn’t be delayed more than ❌ hours.

PDE5 inhibitors relax ❌ muscle and increase ❌ flow which allows an erection to occur in response to sexual stimulation.
- Effective in ❌% of patients with ED
- MoA: NO (❌) passes into the smooth muscle cells of the blood vessel ❌, this produces cGMP; cGMP then leads to a decrease in ❌ levels. ❌ calcium level causes the muscle cells to ❌ 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 ❌ 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 ❌

Sildenafil is metabolised predominantly by the cytochrome P450 ❌ enzymes, and interacts with cimetidine, ❌ (inhibitor) ❌ (inducer).
Keys to PDE-5i Success:
- doing/checking ❌ risk assesment
- take approximately ❌ hour before sexual activity.
- for patients who anticipate sexual activity at least ❌ weekly, 5 mg ❌ once daily can be taken, reduced to ❌ mg once daily according to response (not subsidised).
- may take longer to take effect if taken with ❌.
- mental and physical stimulation ❌, Anxiety can ❌ effects
- efficacy of the 3 drugs ❌ from patient to patient - try at least ❌ attempts, with ❌ different PDE5i, in the absence of contraindications before declaring failure.

Pharmacist Only/Restricted Medicine – Sildenafil (and analogues). Rules:
- Tablets containing ❌ or less per dose unit when sold in the manufacturer's original pack...
- Containing no more than ❌ solid dosage units...
- For Tx of ❌ in males aged ❌ years.
- By a registered pharmacist who has successfully completed a ❌.