Pharmacological Sexual Function and drug of abuse quiz

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Questions and Answers

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?

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?

Antidepressants

Testosterone

Ethanol (correct)

Antipsychotics

What can interrupt the genital-sacral-spinal reflex and decrease sexual desire?

Antidepressants Signup and view all the answers

What decreases libido by blocking dopaminergic signaling pathways?

Antipsychotics Signup and view all the answers

What occurs when relaxation of vascular smooth muscle allows blood to flow into the sinusoidal spaces?

Swelling of erectile tissue Signup and view all the answers

What should treatment of sexual dysfunction involve?

A multidisciplinary approach Signup and view all the answers

What is the pharmacological action of flibanserin?

Serotonin 5-HT1A receptor agonist; 5-HT2A antagonist; and a dopamine D4 receptor partial agonist Signup and view all the answers

How long must flibanserin be taken to show an effect?

At least four weeks Signup and view all the answers

What was the initial cost of flibanserin per month?

~$800.00 Signup and view all the answers

What was the increase in 'satisfying sexual events' per month with flibanserin?

0.7 Signup and view all the answers

What was the reason for not approving flibanserin in 2010 and 2013?

Marginal clinical benefit and potentially life-threatening risks Signup and view all the answers

Who pressured Congress and the FDA for the approval of flibanserin in 2015?

A 'women's advocacy group' called Even the Score Signup and view all the answers

What are the four major neurobiological phases of the human sexual response according to Masters & Johnson (1966)?

Sexual desire, arousal, sexual intercourse, resolution Signup and view all the answers

What was the outcome two days after the FDA approved flibanserin?

Sprout Pharmaceuticals was acquired by Valeant Pharmaceuticals for ~$1 billion in cash Signup and view all the answers

How did Masters & Johnson's model differ from the phases mentioned in the text above?

It did not include 'sexual desire' as a specific phase and split 'sexual intercourse/orgasm' into separate phases: 'plateau' and 'orgasm' Signup and view all the answers

What is the pharmacological action of bremelanotide?

Nonselective melanocortin receptor agonist Signup and view all the answers

What are some physiological changes that occur during the arousal phase of the human sexual response?

Erectile tissues swell, increased heart rate and respiration, enhanced tactile sensitivity Signup and view all the answers

What percentage of patients receiving Vyleesi had an increase in their 'sexual desire score'?

25% Signup and view all the answers

What is the general feeling associated with the resolution phase of the human sexual response?

Return to pre-excited state Signup and view all the answers

In the model by Masters & Johnson, what is the phase that involves involuntary muscle contractions and possible orgasm?

Sexual intercourse Signup and view all the answers

According to the text, what are the 'Active' phases of the human sexual response distinguished by?

Their neurobiological underpinnings Signup and view all the answers

In contrast to the phases mentioned in the text, how did Masters & Johnson's model differ in the inclusion of 'sexual desire'?

It was not included as a specific phase Signup and view all the answers

Which of the following is not a potential treatment for Female Sexual Dysfunction (FSD) mentioned in the text?

Intra-penile injections of papaverine Signup and view all the answers

What is a common side effect of PDE-5 inhibitors mentioned in the text?

Impaired color vision Signup and view all the answers

Which PDE-5 inhibitor is mentioned to be more selective for PDE-5 over PDE-6?

Sildenafil Signup and view all the answers

What can contribute to Female Sexual Dysfunction (FSD) according to the text?

Untreated anxiety and depression Signup and view all the answers

Which class of drugs can interfere with sexual function by affecting ejaculation, arousal, and sexual desire?

Antipsychotics Signup and view all the answers

Which medication was approved by the FDA in 2019 as a treatment for Female Sexual Dysfunction (FSD)?

Bremelanotide Signup and view all the answers

What were the pharmacological approaches for erectile dysfunction prior to PDE-5 inhibitors, according to the text?

Intra-penile injections of papaverine Signup and view all the answers

What is the approximate number of deaths in 2021 from opiates, as mentioned in the text?

71,000 Signup and view all the answers

How many Americans were estimated to be affected by substance use disorders in 2006, as per the text?

20 million Signup and view all the answers

What is the main distinguishing factor of substance use disorders, as per the text?

Use of a substance in a manner not intended Signup and view all the answers

What was the number of deaths in 2021 from methamphetamine, as mentioned in the text?

33,000 Signup and view all the answers

What is the main factor that does not necessarily imply the presence of substance use disorder, according to the text?

Off label drug use Signup and view all the answers

What is the approximate percentage of deaths from guns in 2021 that were due to suicide, as per the text?

60% Signup and view all the answers

Which of the following individuals were mentioned in the text in relation to multiple prescription drugs and substance use disorders?

Both Heath Ledger and Michael Jackson Signup and view all the answers

Which of the following best represents unconditioned stimuli in addiction?

The rewarding activities themselves Signup and view all the answers

What gives rise to 'wanting' and motivation to obtain the reward in addiction?

Expectation of the reward Signup and view all the answers

What do virtually all addictive drugs activate in the brain?

DA/Glu reward pathways Signup and view all the answers

How are drugs classified based on, according to the text?

General pharmacological effects, drug class, physical/chemical class, and context or situation of use Signup and view all the answers

What is the relative addiction potential rated from, according to the text?

1 to 5 Signup and view all the answers

How are substance use disorders generally managed, according to the text?

Therapeutic agents to minimize withdrawal symptoms and psychological counseling/behavior modification Signup and view all the answers

What plays an essential role in the success of treating substance use disorders?

Support groups Signup and view all the answers

Which drug inhibits acetaldehyde dehydrogenase and causes accumulation of acetaldehyde resulting in hangover-like symptoms?

Disulfiram (Antabuse®) Signup and view all the answers

Which drug is a structural analogue of GABA with unclear exact mechanism and no established efficacy for alcohol use disorder?

Acamprosate (Campral®) Signup and view all the answers

Which drug is a long-acting mu-opioid receptor agonist used for maintenance therapy/long term detox for opiate use disorder?

Methadone (Dolophine®) Signup and view all the answers

Which drug is a mixed partial agonist (mu); antagonist (kappa) used for maintenance therapy/long term detox for opiate use disorder?

Buprenorphine (Subutex®) Signup and view all the answers

Which drug is a selective partial agonist of the a4b2 nicotinic cholinergic receptor with side effects including nausea, headache, and disturbed sleep?

Varenicline (Chantex®) Signup and view all the answers

Which drug is an opiate receptor antagonist used as an adjunct to psycho-social therapy for opiate use disorder?

Naltrexone (Revia) Signup and view all the answers

Which drug is an NDRI class anti-depressant with nicotinic cholinergic receptor antagonist activity and modest efficacy as monotherapy for nicotine use disorder?

Bupropion (Zyban®) Signup and view all the answers

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?

Nicotine Replacement Therapy (NRT) Signup and view all the answers

What is the prevalence of substance use disorders in the general public?

10-15% Signup and view all the answers

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?

Naltrexone (Revia®, Vivitrol®) Signup and view all the answers

What is the role of the mesolimbic dopamine pathway in addiction?

Influences cognitive control and decision-making Signup and view all the answers

Which neurotransmitter acts on the NMDA, AMPA, and kainate receptor subtypes?

Glutamate Signup and view all the answers

What is the central aspect of the neuroadaptation that occurs during learning?

Involvement of the dopamine and glutamate pathways Signup and view all the answers

What is addiction considered to be?

A form of maladaptive learned behavior Signup and view all the answers

What underscores the intricate nature of addiction?

Interplay between environmental cues, neuroadaptation, and reward pathways Signup and view all the answers

What is crucial for developing effective treatments and interventions for substance use disorders and addiction?

Understanding the psychological and physiological aspects Signup and view all the answers

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.