PDE5 Inhibitors: Contraindications and Adverse Effects (Nursing)

00:01 Okay now, this is life threatening. Okay? I want you to remember that you need to educate all your patients if they're on a PDE5 that they can have a drop in their blood pressure and if it's combined with a nitrate or another vasodilator might be a slight drop, might be a really big drop. So, PDE5 should not be combined with other nitrates. So if they've got a cardiac history and they're taking nitrates or some other vasodilators you want to use real caution with that and discuss that in depth with the healthcare provider. Now if you've got nitroglycerin, now it's a life threatening issue. Right? This could be a drop in blood pressure that could put them at severe risk for really poor perfusion. So, PDE5s and nitroglycerin are an absolute no, no, no.

00:51 Let's go back to the previous slide where you have PDE5s with a vasodilator could be a problem absolutely for nitroglycerin, it's going to be a life threatening risk for hypotension. Now, what if you have just a history of heart disease and PDE5? If you've got coronary heart disease, they need to be evaluated like we talked about. You need to talk to your health care provider, they need to have a very in-depth conversation about safety of sexual activity and physical activity and the use of these medications. So, sexual activity is of course an intense physical activity.

01:29 You want to make sure that your patient's heart status, their coronary heart disease allows for that and that just includes sexual activity. Okay, so use with caution. Let's go to review a quick checklist of things if you have coronary heart disease and PDE5s. So, if they've had an event like a stroke, an MI, or they've had some pretty serious dysrhythmias in the past 6 months, this is probably not going to be a drug that we're going to start. Now, if they already have low blood pressure like below 90/50 mmHg, this is obviously not a good choice for them because it will cause a drop in the rest of their blood pressure. Now if they have high blood pressure, high as in 170/110, this is also not a good choice; or CHF or if they have unstable chest pain. If you have unstable chest pain, sexual activity is not your best choice anyway let alone combining that with a PDE5.

02:26 Now, let's go back over and look at the adverse effects of this PDE5. We've already talked about hypotension or low blood pressure. That's why if a patient has already has low blood pressure and we give them nitroglycerin, that can be a real risk for them. Now, priapism is, wow, this is something nobody wants to experience. These are painful erections that last more than 4 hours. Most people you would hope to know to get treatment for that but you want to educate your patient like "Hey if you experience this let us know, contact your healthcare provider, this is worth a visit to the ER." Because if you let this go on too long you could actually have permanent damage to their penis. Okay, so let's talk about the most common adverse effects of PDE5. It can cause a headache, it can cause flushing, it can upset their stomach but really what oral medications don't sometimes but it can also intensify sleep apnea. Okay, stop and back up. Think about the population particularly our aging population takes PDE5s. So sleep apnea can really become a significant problem. These are all things that you can rectify, that you can overcome but you need to let them know "Hey if your partner notices that your sleep apnea is getting worse, they see more periods of time when you're stopping breathing, maybe you're not on a CPAP, or if you are on a CPAP maybe some adjustments need to be made. But they need to know to watch for those signs so they can have an open discussion with their healthcare provider and you can problem solve with them so they can have safe sleep and use the PDE5.