Notes

Slide Show

Outline

1	Erectile Dysfunction: Focus on Sildenafil and Newer PDE-5 Inhibitors Richard F. Spark, M.D. F.A.C.E. Beth Israel Deaconess Medical Center Boston, MA
2	Male Sexual Chemistry
3	Understanding Male Sexuality
4	The Impulses for Sexual Potency
5
6	The Nitric Oxide Cascade
7	Reports of Erections With Placebo and Viagra
8	Efficacy of Sildenafil
9	Given Sildenafil corrects ED in most but not all men Some men do not sustain their initial positive sildenafil response Is sildenafil tachyphylaxis the cause? Are coexistent risk factors responsible? Does risk factor modification improve the response to sildenafil ?
10	ED- Risk Factors 2002 To date: RF a. identification b. segregation c. differentiate response RF modification-limited data
11	ED-At Risk Populations Diabetes Mellitus Hyperlipidemia Testosterone deficiency HBP-Antihypertensive meds Depression-Antidepressant Rx. Neuropathy Tobacco EtOH Radical Prostatectomy Age
12
13	RF control- sildenafil efficacy Proven Increase serum testosterone levels Normalize lipid levels DC Smoking/ EtOH Unproven Improved glycemic control Adjust anti hypertensive therapy Alleviate depression
14	Just Say “NO” - Nitric Oxide and penile erection
15	ED in Diabetes-Baseline Response at +12 Wk.
16	Q.4 Sildenafil Response by DM Subgroup
17	ED in Diabetes-Sildenadil Q.4 Response By Age
18	ED in Diabetes-12 Week Response
19	Glycemia-ED- Sildenafil
20	Low Testosterone
21	Normal Testosterone
22	“Drink provokes the desire but taketh away the performance”*
23	Lipids and Rigi-Scan
24	Atorvastatin Effect on Penile Erections
25	ED Risk Factors
26	Tadalafil (Cialis)and Vardenafil (Nuviva) in Diabetic Men With ED
27	Structure of PDE5 inhibitors
28	Overall Selectivity of Tadalafil
29
30	Tadalafil-Treatment Effect on Successful Intercourse: SEP Q3†
31	Intercourse Success Rate With Tadalafil as a Function of Time†‡
32	Diabetes Tadalafil- Treatment Effect on Successful Intercourse: SEP Question 3†‡
33	Vardenafil Diabetes Study Diary Questions -Penetration & Maintenance
34	Percent Response in Diabetic Men with ED
35	PDE-5 Inhibitors and ED in Diabetic Men 1. The PDE-5 inhibitors can reverse ED in diabetic men 2. PDE-5 responsiveness not yet linked to Diabetic control 3. Differences in AE profiles and period of responsiveness may exist 4. The new PDE-5 inhibitors expand medical options for men with ED
36	Prospective Studies