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  #1  
Old 01-24-2011
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Drug Old man with erectile dysfunction?

man 60 year old complain of decrease erection you diagnose him with erectile dysfunction problem. he also hypertensive and on anti angina medication. You decide not to give him sildenafil because of nitroglycerin treatment for angina. So if you want to treat his erectile dysfunction and take in consideration his heart disease you will give him a drug act on which receptor:

A - alpha 1
B - alpha 2
C- beta 1
D- beta 2
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  #2  
Old 01-27-2011
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hey guys where are you ???
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  #3  
Old 01-27-2011
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Default B.

B. alpha 2 receptors

I'm thinking of phentolamine and yohimbine
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  #4  
Old 01-27-2011
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option A is right.

Alpha 1 is found on vascular smooth muscle.
- blockers like prazosin will lead to vascular smooth muscle relaxation, hence treating hypertension, and improving erection. in fact one of the side effects of prazosin is priapism (a fact that this question seem to be testing).

B) Alpha 2 is found centrally or peripherally(presynaptic),
-Agonists(e.g: methyldopa) : decreased sympathetic outflow,hence decreased NE = antihypertensive. but its absent on vascular smooth muscle hence no effect on erection, in fact its side effect is reduced sexual drive.
-Antagonists (yohimbine,mirtazapan) : increased sympathetic outflow, hence increased NE = Hypertension. The increased central NE increases sexual drive (does not improve erection), but it will worsen the hypertension in this man.
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  #5  
Old 02-09-2011
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alpha 1 blockers cause retrograde ejaculation .although we help him with his impotence-erectile dysfunction-but we add a new problem for his sexual activity.
how about givinh him a selective BETA 1 blocker?
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  #6  
Old 02-09-2011
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Quote:
Originally Posted by hana View Post
alpha 1 blockers cause retrograde ejaculation .although we help him with his impotence-erectile dysfunction-but we add a new problem for his sexual activity.
how about givinh him a selective BETA 1 blocker?
B1 only have actions on Heart & Kidney, not vascular smooth muscle.

The other choice could be a B2 Blocker, Propronalol (non selective)
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Old 02-09-2011
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Quote:
Originally Posted by patelMD View Post
B1 only have actions on Heart & Kidney, not vascular smooth muscle.

The other choice could be a B2 Blocker, Propronalol (non selective)
i am thinking;
B1 blocker although does not work on vessels directly but decrease systolic BP by lowering COP. and patient is already on nitroglycerine which should take care of vessles.
b2 blockers forsure cause erectile dysfunction andn decrease libido.
i am jut know b1 blocker has LESS sexual dysfunction .
@kemoo;btw,what is the source of this q?
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  #8  
Old 02-09-2011
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I think it's alpha 1 beta 1
b/c their will be the potential side effect of alpha blockers which is reflex tachycardia , so will also compromise his cardiac function
so basically am gonna go with A
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  #9  
Old 02-09-2011
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Default best choice for HTN+SEXUAL DYSFUNCTION

WHAT WOULD BE BEST CHOICE IF WE HAVE ALL OPTIONS FOR MANAGING HTN- AND LETS ASSUME PATIENT ONLY HAS HTN AND NOT OTHER CVD- and he is complaining of sexual dysfunction?
it is ACEI.ARBs,hydrolozine,nitroprusside? or what ?
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Old 02-09-2011
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Quote:
Originally Posted by hana View Post
WHAT WOULD BE BEST CHOICE IF WE HAVE ALL OPTIONS FOR MANAGING HTN- AND LETS ASSUME PATIENT ONLY HAS HTN AND NOT OTHER CVD- and he is complaining of sexual dysfunction?
it is ACEI.ARBs,hydrolozine,nitroprusside? or what ?
1st line drugs in Tx of HTN is ACEI, than 2nd line would be adding drugs from other groups (B Blockers etc.)

So if no other Hx of CVD (Angina specifically), than I guess Sildenafil can be given
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Old 02-09-2011
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Quote:
Originally Posted by zaiody View Post
I think it's alpha 1 beta 1
b/c their will be the potential side effect of alpha blockers which is reflex tachycardia , so will also compromise his cardiac function
so basically am gonna go with A
you think it is alpha1 or beta 1?
if you choose alpha 1 blocker you should know that they CAUSE reflex takycardia
the HTN RX, w/o reflex takycardia are;b1 blocker,ganglion blockers,alpha2 agonists,guanitine,reserpine and i think also CCB,not sure about the last one.
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Old 02-09-2011
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hey guys i would go also for A - alpha 1

because alpha blocker will reduce the hypertension and also help with erctile dysfunction
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  #13  
Old 02-10-2011
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Quote:
Originally Posted by kemoo1985 View Post
hey guys i would go also for A - alpha 1

because alpha blocker will reduce the hypertension and also help with erctile dysfunction

IS IT BETTER TO HAVE ERECTION BUT NO EJACULATION OR JUST NOT HAVING ERECTION?

AND WHY B1 BLOCKER IS not good? comsidering the fact that there is no reflex takycardia with b blocker but with aloha 1 blockers.
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  #14  
Old 02-10-2011
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I just believe this is a bad question. Without an answer or an explanation, theres no way any of us could be sure what the test writer had in mind, and whether he took into consideration all the other factors.
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Old 03-15-2011
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Quote:
Originally Posted by Mondoshawan View Post
B. alpha 2 receptors

I'm thinking of phentolamine and yohimbine
I agree with Mondoshawan.
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  #16  
Old 02-25-2012
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Quote:
Originally Posted by hana View Post
IS IT BETTER TO HAVE ERECTION BUT NO EJACULATION OR JUST NOT HAVING ERECTION?

AND WHY B1 BLOCKER IS not good? comsidering the fact that there is no reflex takycardia with b blocker but with aloha 1 blockers.
id rather have an erection and no ejaculation than no erection, and i think the ladies would agree haha

but seriously, i think its A.
maybe an alpha1-blocker? nothing else really makes sense to me, maybe b2-agonist?
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  #17  
Old 05-04-2016
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Default Old man with erectile dysfunction

Hi,
Generally it has seen that when men gets old then their strength level decreases and they are unable to perform other activities properly. Then its obvious that their body cannot perform the sexual activity and they have a chance of erectile dysfunction. However treatment is there which can help to get out of such situation. Well here you will get to know about erectile dysfunction and its treatment.
erectiledysfunctioninmen.jimdo.com/
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  #18  
Old 09-23-2016
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When a man gets older he loses his sex drive and will gradually lose the stamina to have prolonged sex. That is quite natural. Now there is a wide range of erectile dysfunction treatment options. A friend of mine had undergone this treatment in Canadian men's clinic Toronto and is very much satisfied with the procedure. There are also people who live their whole life with erectile dysfunction without undergoing any treatment. It is better to identify the problem and get it treated as soon as possible.
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