Erectile dysfunction treatment

Erectile dysfunction Treatment of erectile dysfunction caused by neurogenic, vasculogenic, psychogenic, or mixed etiology. 

Alprostadil is used in erectile dysfunction. Alprostadil relaxes smooth muscle of ductus arteriosus. It produces vasodilation, inhibits platelet aggregation, and stimulates intestinal and uterine smooth muscle. Alprostadil induces erection by relaxation of trabecular smooth muscle and by dilation of cavemosal arteries (see Erectile Dysfunction— Treatment of). 

Epileptic seizures treatment of Erectile dysfunction treatment of Ergot alkaloids Estrogenic preparations... 

Therapeutic opportunities for NO synthons include angina, for which nitroglycerin is effectively used, as well as penile erectile dysfunction. NOS inhibitors have demonstrated some protection in cerebral ischemia models and may be potentially beneficial in alleviating cell death associated with cerebral ischemia. l-NMA is under clinical study for treatment of sepsis. 

TABLE 48-3. Common Drug Treatment Regimens for Erectile Dysfunction... 

Erectile dysfunction is common, and initial treatment should include one of the oral medications currently available (e.g., sildenafil, vardenafil,tadalafil). 

Very often, drugs are discovered through persistent work and continual optimization and many tests and trials. This is exemplified by the history behind the discovery of sildenafil (Viagra, Pfizer), a drug for the treatment of erectile dysfunction, and the AIDS drug zidovidine (Retrovir, GlaxoSmithKline) (Exhibits 3.18 and 3.19). 

At clinical trials, sildenafil did not work well as a treatment for angina. Instead, it was observed that it overcomes erectile dysfunction. Later, it was found that cyclic GMP also increases the level of nitric oxide, which is needed in penile erections. 

Hence, we can see how the focus of treatment for sildenafil changed from antihypertensive to angina treatment to overcoming erectile dysfunction, giving rise to the drug called Viagra. 

In some diseases a simple ordinal scale or a VAS scale cannot describe the full spectrum of the disease. There are many examples of this including depression and erectile dysfunction. Measurement in such circumstances involves the use of multiple ordinal rating scales, often termed items. A patient is scored on each item and the summation of the scores on the individual items represents an overall assessment of the severity of the patient s disease status at the time of measurement. Considerable amoimts of work have to be done to ensure the vahdity of these complex scales, including investigations of their reprodu-cibihty and sensitivity to measuring treatment effects. It may also be important in international trials to assess to what extent there is cross-cultural imiformity in the use and imderstand-ing of the scales. Complex statistical techniques such as principal components analysis and factor analysis are used as part of this process and one of the issues that need to be addressed is whether the individual items should be given equal weighting. 

Absorption - For treatment of erectile dysfunction, alprostadil is administered by injection into the corpora cavernosa or inserted intraurethrally. 

Cardiovascular effects Treatments for erectile dysfunction, including these agents, generally should not be used in men for whom sexual activity is inadvisable because of their underlying cardiovascular status. 

Erectiie dysfunction Undertake thorough medical history and physical examination to diagnose erectile dysfunction, determine potential underlying causes, and identify appropriate treatment. 

The safety and efficacy of combinations of sildenafil or vardenafil with other treatments for erectile dysfunction have not been studied. Therefore, the use of such combinations is not recommended. 

Deformation of penis Use agents for the treatment of erectile dysfunction with caution in patients with anatomical deformation of the penis or in patients who have conditions that may predispose them to priapism. 

The moderately selective PDE type V-inhibitor sildenafil (Viagra ) has been introduced in the treatment of erectile dysfunction. On the basis of cyclic GMP accumulation sildenafil is claimed to be a selective vasodilator in erectile tissues in the penis because of the high concentration of PDE type V in this region. Several of its adverse reactions (headache, flush, hypotension) reflect its vasodilator actions in other vascular beds than that of the penis. The drug will not be further discussed here. 

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