Podcast
Questions and Answers
What plays a 'permissive' role in sexual desire for both men and women?
What plays a 'permissive' role in sexual desire for both men and women?
- Cerebral cortex
- Dopaminergic signaling pathways
- Cultural/social factors
- Testosterone (correct)
What is involved in sexual arousal?
What is involved in sexual arousal?
- Interplay between the autonomic nervous system, peripheral sensory nerves, and the cerebral cortex (correct)
- Peripheral sensory nerves only
- Cerebral cortex only
- Autonomic nervous system only
What can provoke desire but take away performance?
What can provoke desire but take away performance?
- Antidepressants
- Testosterone
- Ethanol (correct)
- Antipsychotics
What can interrupt the genital-sacral-spinal reflex and decrease sexual desire?
What can interrupt the genital-sacral-spinal reflex and decrease sexual desire?
What decreases libido by blocking dopaminergic signaling pathways?
What decreases libido by blocking dopaminergic signaling pathways?
What occurs when relaxation of vascular smooth muscle allows blood to flow into the sinusoidal spaces?
What occurs when relaxation of vascular smooth muscle allows blood to flow into the sinusoidal spaces?
What should treatment of sexual dysfunction involve?
What should treatment of sexual dysfunction involve?
What is the pharmacological action of flibanserin?
What is the pharmacological action of flibanserin?
How long must flibanserin be taken to show an effect?
How long must flibanserin be taken to show an effect?
What was the initial cost of flibanserin per month?
What was the initial cost of flibanserin per month?
What was the increase in 'satisfying sexual events' per month with flibanserin?
What was the increase in 'satisfying sexual events' per month with flibanserin?
What was the reason for not approving flibanserin in 2010 and 2013?
What was the reason for not approving flibanserin in 2010 and 2013?
Who pressured Congress and the FDA for the approval of flibanserin in 2015?
Who pressured Congress and the FDA for the approval of flibanserin in 2015?
What are the four major neurobiological phases of the human sexual response according to Masters & Johnson (1966)?
What are the four major neurobiological phases of the human sexual response according to Masters & Johnson (1966)?
What was the outcome two days after the FDA approved flibanserin?
What was the outcome two days after the FDA approved flibanserin?
How did Masters & Johnson's model differ from the phases mentioned in the text above?
How did Masters & Johnson's model differ from the phases mentioned in the text above?
What is the pharmacological action of bremelanotide?
What is the pharmacological action of bremelanotide?
What are some physiological changes that occur during the arousal phase of the human sexual response?
What are some physiological changes that occur during the arousal phase of the human sexual response?
What percentage of patients receiving Vyleesi had an increase in their 'sexual desire score'?
What percentage of patients receiving Vyleesi had an increase in their 'sexual desire score'?
What is the general feeling associated with the resolution phase of the human sexual response?
What is the general feeling associated with the resolution phase of the human sexual response?
In the model by Masters & Johnson, what is the phase that involves involuntary muscle contractions and possible orgasm?
In the model by Masters & Johnson, what is the phase that involves involuntary muscle contractions and possible orgasm?
According to the text, what are the 'Active' phases of the human sexual response distinguished by?
According to the text, what are the 'Active' phases of the human sexual response distinguished by?
In contrast to the phases mentioned in the text, how did Masters & Johnson's model differ in the inclusion of 'sexual desire'?
In contrast to the phases mentioned in the text, how did Masters & Johnson's model differ in the inclusion of 'sexual desire'?
Which of the following is not a potential treatment for Female Sexual Dysfunction (FSD) mentioned in the text?
Which of the following is not a potential treatment for Female Sexual Dysfunction (FSD) mentioned in the text?
What is a common side effect of PDE-5 inhibitors mentioned in the text?
What is a common side effect of PDE-5 inhibitors mentioned in the text?
Which PDE-5 inhibitor is mentioned to be more selective for PDE-5 over PDE-6?
Which PDE-5 inhibitor is mentioned to be more selective for PDE-5 over PDE-6?
What can contribute to Female Sexual Dysfunction (FSD) according to the text?
What can contribute to Female Sexual Dysfunction (FSD) according to the text?
Which class of drugs can interfere with sexual function by affecting ejaculation, arousal, and sexual desire?
Which class of drugs can interfere with sexual function by affecting ejaculation, arousal, and sexual desire?
Which medication was approved by the FDA in 2019 as a treatment for Female Sexual Dysfunction (FSD)?
Which medication was approved by the FDA in 2019 as a treatment for Female Sexual Dysfunction (FSD)?
What were the pharmacological approaches for erectile dysfunction prior to PDE-5 inhibitors, according to the text?
What were the pharmacological approaches for erectile dysfunction prior to PDE-5 inhibitors, according to the text?
What is the approximate number of deaths in 2021 from opiates, as mentioned in the text?
What is the approximate number of deaths in 2021 from opiates, as mentioned in the text?
How many Americans were estimated to be affected by substance use disorders in 2006, as per the text?
How many Americans were estimated to be affected by substance use disorders in 2006, as per the text?
What is the main distinguishing factor of substance use disorders, as per the text?
What is the main distinguishing factor of substance use disorders, as per the text?
What was the number of deaths in 2021 from methamphetamine, as mentioned in the text?
What was the number of deaths in 2021 from methamphetamine, as mentioned in the text?
What is the main factor that does not necessarily imply the presence of substance use disorder, according to the text?
What is the main factor that does not necessarily imply the presence of substance use disorder, according to the text?
What is the approximate percentage of deaths from guns in 2021 that were due to suicide, as per the text?
What is the approximate percentage of deaths from guns in 2021 that were due to suicide, as per the text?
Which of the following individuals were mentioned in the text in relation to multiple prescription drugs and substance use disorders?
Which of the following individuals were mentioned in the text in relation to multiple prescription drugs and substance use disorders?
Which of the following best represents unconditioned stimuli in addiction?
Which of the following best represents unconditioned stimuli in addiction?
What gives rise to 'wanting' and motivation to obtain the reward in addiction?
What gives rise to 'wanting' and motivation to obtain the reward in addiction?
What do virtually all addictive drugs activate in the brain?
What do virtually all addictive drugs activate in the brain?
How are drugs classified based on, according to the text?
How are drugs classified based on, according to the text?
What is the relative addiction potential rated from, according to the text?
What is the relative addiction potential rated from, according to the text?
How are substance use disorders generally managed, according to the text?
How are substance use disorders generally managed, according to the text?
What plays an essential role in the success of treating substance use disorders?
What plays an essential role in the success of treating substance use disorders?
Which drug inhibits acetaldehyde dehydrogenase and causes accumulation of acetaldehyde resulting in hangover-like symptoms?
Which drug inhibits acetaldehyde dehydrogenase and causes accumulation of acetaldehyde resulting in hangover-like symptoms?
Which drug is a structural analogue of GABA with unclear exact mechanism and no established efficacy for alcohol use disorder?
Which drug is a structural analogue of GABA with unclear exact mechanism and no established efficacy for alcohol use disorder?
Which drug is a long-acting mu-opioid receptor agonist used for maintenance therapy/long term detox for opiate use disorder?
Which drug is a long-acting mu-opioid receptor agonist used for maintenance therapy/long term detox for opiate use disorder?
Which drug is a mixed partial agonist (mu); antagonist (kappa) used for maintenance therapy/long term detox for opiate use disorder?
Which drug is a mixed partial agonist (mu); antagonist (kappa) used for maintenance therapy/long term detox for opiate use disorder?
Which drug is a selective partial agonist of the a4b2 nicotinic cholinergic receptor with side effects including nausea, headache, and disturbed sleep?
Which drug is a selective partial agonist of the a4b2 nicotinic cholinergic receptor with side effects including nausea, headache, and disturbed sleep?
Which drug is an opiate receptor antagonist used as an adjunct to psycho-social therapy for opiate use disorder?
Which drug is an opiate receptor antagonist used as an adjunct to psycho-social therapy for opiate use disorder?
Which drug is an NDRI class anti-depressant with nicotinic cholinergic receptor antagonist activity and modest efficacy as monotherapy for nicotine use disorder?
Which drug is an NDRI class anti-depressant with nicotinic cholinergic receptor antagonist activity and modest efficacy as monotherapy for nicotine use disorder?
Which drug is a replacement for tobacco smoking with various forms such as gums, transdermal patches, lozenges, and nasal sprays, and is known to alleviate craving but may lead to substitution of one addiction for another?
Which drug is a replacement for tobacco smoking with various forms such as gums, transdermal patches, lozenges, and nasal sprays, and is known to alleviate craving but may lead to substitution of one addiction for another?
What is the prevalence of substance use disorders in the general public?
What is the prevalence of substance use disorders in the general public?
Which drug is an opiate receptor antagonist used in 'rapid detox' done under general anesthesia/heavy sedation and is promoted as a 'one-step' cure with high rate of relapse?
Which drug is an opiate receptor antagonist used in 'rapid detox' done under general anesthesia/heavy sedation and is promoted as a 'one-step' cure with high rate of relapse?
What is the role of the mesolimbic dopamine pathway in addiction?
What is the role of the mesolimbic dopamine pathway in addiction?
Which neurotransmitter acts on the NMDA, AMPA, and kainate receptor subtypes?
Which neurotransmitter acts on the NMDA, AMPA, and kainate receptor subtypes?
What is the central aspect of the neuroadaptation that occurs during learning?
What is the central aspect of the neuroadaptation that occurs during learning?
What is addiction considered to be?
What is addiction considered to be?
What underscores the intricate nature of addiction?
What underscores the intricate nature of addiction?
What is crucial for developing effective treatments and interventions for substance use disorders and addiction?
What is crucial for developing effective treatments and interventions for substance use disorders and addiction?
Study Notes
Pharmacological Effects on Sexual Function
- Antipsychotics can adversely affect ejaculation and orgasm due to "off target" a1-AR antagonism and hyperprolactinemia, leading to decreased sexual desire and arousal.
- Antihypertensives like a1-AR blockers, centrally acting sympatholytics, and spironolactone can interfere with sexual function by affecting ejaculation, arousal, and sexual desire.
- Prior to PDE-5 inhibitors, pharmacological approaches for erectile dysfunction included intra-penile injections of papaverine, phentolamine, and alprostadil.
- PDE-5 inhibitors like sildenafil, vardenafil, tadalafil, and avanafil have varying selectivity for PDE isoforms, with sildenafil being more selective for PDE-5 over PDE-6.
- Common side effects of PDE-5 inhibitors include headache, flushing, dyspepsia, nasal congestion, orthostatic hypotension, impaired color vision, priapism, hearing loss, and rare cases of sudden death.
- PDE-5 inhibitors have other indications such as pulmonary arterial hypertension, benign prostatic hyperplasia, and off-label uses for conditions like vasospasm, Raynaud's phenomenon, and premature ejaculation.
- Female Sexual Dysfunction (FSD) encompasses low sexual desire, impaired arousal, absence of desire causing distress, difficulty with orgasm, and pain during sexual activity, with various potential physical, hormonal, psychological, and social causes.
- Potential treatments for FSD include estrogen replacement, testosterone replacement, sildenafil, lubricants, mechanical devices, and medications like flibanserin and bremelanotide.
- Flibanserin's efficacy and safety have been questioned, with results showing an increase in satisfying sexual events, but also a high incidence of adverse events, leading to discontinuation in some patients.
- Bremelanotide was approved by the FDA in 2019 as a treatment for FSD.
- Testosterone replacement and sildenafil have been tested as potential treatments for FSD, with testosterone patch (Intrinsa®) approved in Europe, and sildenafil showing some promise.
- Psychological and social factors, such as untreated anxiety and depression, life stress, and unresolved conflicts with a partner, can contribute to FSD, along with physical and hormonal causes.
Understanding Substance Use Disorders and Addiction
- Substance use disorders can affect anyone regardless of sex, age, religion, race, income, or profession, with a prevalence of 10-15% in the general public.
- Substance use disorders are characterized by criteria such as taking the substance in larger amounts than intended, unsuccessful attempts to quit, spending excessive time obtaining the substance, and continued use despite known problems.
- Substance use disorders do not necessarily require the development of tolerance or physical dependence, but they often involve psychological aspects like drug craving and loss of voluntary control, making treatment challenging.
- The psychological aspects of addictive behaviors are rooted in the dopamine reward pathway, particularly the mesolimbic dopamine pathway originating in the ventral tegmental area (VTA) of the midbrain and projecting to the nucleus accumbens.
- The mesolimbic dopamine pathway regulates "incentive salience" and is involved in the motivation to obtain a reward, associative learning, and encoding memories about a reward, rather than the subjective pleasure of the reward.
- Other pathways originating in the VTA, such as the mesocortical dopamine pathway to the prefrontal cortex and the pathway to the amygdala and hippocampus, are also part of the dopamine reward pathway, influencing cognitive control, motivation, emotional response, memory processing, decision-making, and emotional responses.
- Glutamate, the major excitatory neurotransmitter in the brain, acts on the NMDA, AMPA, and kainate receptor subtypes, and its activation from the nucleus accumbens to the prefrontal cortex and back leads to neuroadaptation related to environmental cues associated with drug rewards.
- The activation of dopamine and glutamate pathways is central to the neuroadaptation that occurs during learning, whether it involves beneficial behaviors like sex, food, and shelter or maladaptive behaviors like substance abuse that can lead to addiction.
- Addiction is considered a form of maladaptive learned behavior, where the acquisition of maladaptive behaviors is driven by the dopamine and glutamate reward pathways, potentially causing harm.
- The understanding of the psychological and physiological aspects of substance use disorders and addiction is crucial for developing effective treatments and interventions.
- The complexities of substance use disorders and addiction highlight the challenges in addressing these conditions and the importance of considering both the physical and psychological aspects in treatment approaches.
- The interplay between environmental cues, neuroadaptation, and reward pathways underscores the intricate nature of addiction and the need for comprehensive strategies to address it.
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Description
Test your knowledge of pharmacological effects on sexual function with this quiz. Explore topics such as the impact of antipsychotics and antihypertensives, the use of PDE-5 inhibitors for erectile dysfunction, and potential treatments for female sexual dysfunction. Dive into the complexities of sexual function and the pharmacological interventions available.
