drugs in sexual medicine
DESCRIPTION
Masterclass in University of Barcelona´s School of Medicine about Drugs in Sexual Medicine (erectile dysfunction, premature ejaculation and testosterone deficiency).TRANSCRIPT
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FARMACOLOGÍA EN MEDICINA SEXUAL MASCULINA.
Eduard García CruzUrología
Hospital Clínic de [email protected]
www.reisho.com
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1. Inhibidores de la fosfodiesterasa-5.
2. Dapoxetina.
3. Testosterona.
4. Pycnogenol
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1. Inhibidores de la fosfodiesterasa-5.
2. Dapoxetina.
3. Testosterona.
4. Pycnogenol
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“Erection is a neurovascular phenomenon under hormonal control.”1ª opción DE
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Contra: N
O e CF >1
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Udenafil Avanafil
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75.000.000.000 USD 2010.
1% de los fármacos de los países del 1er mundo.10-30% de los fármacos de los países del 3er mundo.
+ 800% 2000-2005+384% 2005-2006+51% 2007
35.800.000 comprimidos de Sildenafil incautados en Europa 2004-2008.600.000-2.500.000 varones en Europa puede estar usando sildenafil-fake.
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1. Inhibidores de la fosfodiesterasa-5.
2. Dapoxetina.
3. Testosterona.
4. Pycnogenol
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Tiempo, control, stress
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Treatment:Psychological/Behavioural strategies:
Start-stop.Squeeze.
Topical anesthetic agents:Lidocaine-prilocaine gel.SS cream.
Selective serotonine reuptake inhibitorDapoxetine
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Se administra entre 1,5-3h antes.
Multiplica x2 o x3 el IELT.
Contraindicaciones: uso de otros antidepresivos
Placebo Priligy 30mg Priligy 60mg
Nausea 1,9% 8,7% 20,1%
Cefalea 1,4% 3,9% 6,8%
Diarrea 4% 5,9% 6,8%
Mareo 0,8% 3% 6,2%
Somnolencia 0,2% 3,2% 2,8%
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1. Inhibidores de la fosfodiesterasa-5.
2. Dapoxetina.
3. Testosterona.
4. Pycnogenol
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Morley JE. Metabolism 46(4) 1997:410-3
Harman SM J Clin Endocrinol Metab 86 (2) 2000: 724-731 Leifke Clin Endocrinol 53 2000: 689-695
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Estado de ánimo (mood)Libido
Masa grasa/Masa magra
Vellosidad/Gl seborreicas
ProducciónEPO
Sterm Cells
Producciónproteínas
séricas
ErecciónPróstata
Espermatogénesis
MetabolismoÓseo
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TDS: definición, clínica y diagnóstico
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Testosterona > 346 ng/dL
Testosterona 231 – 346 ng/dL
Testosterona < 231 ng/dL
Total TestosteroneFree TestosteroneSHBGLHProlactin
Total Testosterone >346ng/dLLow calculated testosterone
Total Testosterone 231-346ng/dL
Total Testosterone <231ng/dL
Total Testosterone >346ng/dLNormal calculated testostosterone
Confirm results:
Total TestosteroneFree TestosteroneSHBG 2nd low free testosterone
2nd total T 231-346
TESTOSTERONETREATMENT
NO TESTOSTERONE
TREATMENT
García-Cruz E. Diagnosing testosterone deficiency syndrome: What to do and what to consider. ESSM Newsletter 20 (2010) 12
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“Tempus irrefutabile fugit” Virgilio
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Regulación de eNOS, PDE5.
Metabolismo del tejido conjuntivo del pene.
↓cél musculares lisas ↓ elasticidad ↑colágeno III ↓ colágeno I
Traish A J Sex Med 2006; 3: 382-407
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• El nivel de deseo sexual (IIEF-12) se asocia con elnivel de testosterona sérica.
• Los pacientes con testosterona sérica baja tienen menor nivel de deseo sexual.
• El tratamiento con testosterona aumenta el nivel de deseo sexual, las erecciones nocturnas y la frecuencia de las relaciones sexuales.
Ansong KS J Urol. 1999;162:719-21 Zitzmann M J Clin Endorinol Metab. 2006;91:4335-43 Wang C J Clin Endocrinol Metab. 2004;89:2085-98Seftel AD J Androl. 2004;25:963-72.
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Iniciar tratamiento tópico. Pasar a tratamiento parenteral.
Control trimestral (Hematocrito/perfil hepático/PSA-PSA libre/TR).
Objetivo: niveles de testosterona normales.
Objetivo: mejoría clínica.
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1. Inhibidores de la fosfodiesterasa-5.
2. Dapoxetina.
3. Testosterona.
4. Pycnogenol
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1. Inhibidores de la fosfodiesterasa-5.
2. Dapoxetina.
3. Testosterona.
4. Pycnogenol
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FARMACOLOGÍA EN MEDICINA SEXUAL MASCULINA.
Eduard García CruzUrología
Hospital Clínic de [email protected]
www.reisho.com