09-30-2008, 12:55 PM
3. Phosphodiesterase-5 inhibitors are contraindicated in patients taking anti-hypertensive drugs.
False. Interactions of PDE-5 inhibitors with anti-hypertensive drugs in men with HT have not been associated with an increased incidence of adverse events. Vasodilator effects of the major classes of anti-hypertensive agents have mechanisms of action that do not involve the nitric oxide-cGMP pathway. Nonetheless, PDE-5 inhibitors should still be used with caution in patients taking multiple anti-hypertensive drugs.
4. Long term use of phosphodiesterase-5 inhibitors in patients with coronary heart disease is associated with more myocardial infarction and deaths.
False. Data from prospective clinical trials, retrospective metanalyses and epidemiologic studies have shown no evidence that administration of a PDE-5 inhibitor in accord with published guidelines (including absence of nitrate therapy) would increase morbidity and mortality in men with co-existing erectile dysfunction and stable ischemic heart disease.
5. Cardiac assessment is mandatory before starting phosphodiesterase-5 inhibitors for erectile dysfunction.
True. Patients who wish to start PDE-5 inhibitors therapy should receive a cardiac assessment beforehand, particularly for hypertension, congestive heart failure and ischemic heart disease. Interactions between nitrate and PDE-5 inhibitors should be clearly informed. Although firm data are lacking, pre-therapy treadmill tests to assess for the presence of stress-induced ischemia in patients with overt and covert coronary artery disease can guide the patient and physician to the risk of cardiac ischemia during sexual intercourse. If the patient can achieve 5 to 6 METS on a treadmill stress test without demonstrating ischemia, the risk of ischemia during coitus with a familiar partner, in familiar settings, without the added stress of a heavy meal or alcohol ingestion, is probably low. However, the physical and emotional stresses of sexual intercourse can be excessive in some people, particularly those who have not performed this activity in some time and who are not in good condition. These stresses themselves may produce acute ischemia or precipitate myocardial infarction. Such patients should be advised to use common sense and to moderate their physical exertion and their emotional expectations as they start PDE-5 inhibitors.
References:
1. Feldman et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 151 (1994), 54-61.
2. ACC/AHA Expert Consensus Document. Use of Sildenail in patients with cardiovascular disease. Circulation 1999;99:168-177.
False. Interactions of PDE-5 inhibitors with anti-hypertensive drugs in men with HT have not been associated with an increased incidence of adverse events. Vasodilator effects of the major classes of anti-hypertensive agents have mechanisms of action that do not involve the nitric oxide-cGMP pathway. Nonetheless, PDE-5 inhibitors should still be used with caution in patients taking multiple anti-hypertensive drugs.
4. Long term use of phosphodiesterase-5 inhibitors in patients with coronary heart disease is associated with more myocardial infarction and deaths.
False. Data from prospective clinical trials, retrospective metanalyses and epidemiologic studies have shown no evidence that administration of a PDE-5 inhibitor in accord with published guidelines (including absence of nitrate therapy) would increase morbidity and mortality in men with co-existing erectile dysfunction and stable ischemic heart disease.
5. Cardiac assessment is mandatory before starting phosphodiesterase-5 inhibitors for erectile dysfunction.
True. Patients who wish to start PDE-5 inhibitors therapy should receive a cardiac assessment beforehand, particularly for hypertension, congestive heart failure and ischemic heart disease. Interactions between nitrate and PDE-5 inhibitors should be clearly informed. Although firm data are lacking, pre-therapy treadmill tests to assess for the presence of stress-induced ischemia in patients with overt and covert coronary artery disease can guide the patient and physician to the risk of cardiac ischemia during sexual intercourse. If the patient can achieve 5 to 6 METS on a treadmill stress test without demonstrating ischemia, the risk of ischemia during coitus with a familiar partner, in familiar settings, without the added stress of a heavy meal or alcohol ingestion, is probably low. However, the physical and emotional stresses of sexual intercourse can be excessive in some people, particularly those who have not performed this activity in some time and who are not in good condition. These stresses themselves may produce acute ischemia or precipitate myocardial infarction. Such patients should be advised to use common sense and to moderate their physical exertion and their emotional expectations as they start PDE-5 inhibitors.
References:
1. Feldman et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 151 (1994), 54-61.
2. ACC/AHA Expert Consensus Document. Use of Sildenail in patients with cardiovascular disease. Circulation 1999;99:168-177.
) just kiddin