As the population of older adults and life expectancy continue to grow, there is information about sex therapy but it is often not easily accepted. Cultural and sexual roles are always changing throughout the life-course. As people age, they are often viewed as asexual or as incapable of possessing sexual desires. The presence of sexual dysfunction during old age can be impacted by health problems. There are many endocrine, vascular and neurological disorders that may interfere in sexual function, along with some medications and surgeries. Older men experience changes that occur in sexual physiology and affect both erectile function and ejaculation. While older women experience physiological effects of aging after menopause, resulting in the decreased production of estrogen. This leads to increased vaginal dryness, general atrophy of vaginal tissue, and genital changes (reduced size of clitoral, vulvar, and labial tissue). Cognitive changes and decline is another factor that influences sexual activity. Dementia, Alzheimers and mental health disorders may have an effect on sexual behavior, producing disinhibition or relationship difficulties with subsequent effects on couples sexual relationships.Sex therapy with older adults looks at factors which influence sexuality in older adults, including sexual desire, sexual activity, the value of sexuality, and health. It can include sensate focus, communication, and fantasy exercises as well as psychodynamic therapy.Sex therapy for older adults is similar to sex therapy with other populations. It includes the use of water-based personal lubricants (for decreased vaginal lubrication), hormone therapy, and medications. Sex therapists working with older adults should know about sexuality and aging.
It is unknown if amiloride can be dialyzed off, and no specific antidote against it exists. Treatment is generally supportive, though hyperkalemia can be treated. Interactions
Amiloride may have important drug-drug interactions when combined with other medications that also increase potassium levels in the blood, leading to hyperkalemia. For example, the combination of amiloride with angiotensin-converting enzyme (ACE) inhibitors like lisinopril, or angiotensin II receptor type 1 (AT1) antagonists like losartan, may lead to high levels of potassium in the blood, requiring frequent monitoring. Pharmacology
Mechanism of action
Diuresis
Amiloride works by directly blocking the epithelial sodium channel (ENaC) with an IC50 around 0.1 μM, indicating potent blockade. Antagonism of ENaC thereby inhibits sodium reabsorption in the late distal convoluted tubules, connecting tubules, and collecting ducts in the nephron. This promotes the loss of sodium and water from the body, and reduces potassium excretion. The drug is often used in conjunction with a thiazide diuretic to counteract with a potassium-losing effect. Due to its potassium-sparing capacities, hyperkalemia (elevated potassium concentration in the blood) can occur. The risk of developing hyperkalemia is increased in patients who are also taking ACE inhibitors, angiotensin II receptor antagonists, other potassium-sparing diuretics, or any potassium-containing supplements. Miscellaneous
A fraction of the effects of amiloride is inhibition of cyclic GMP-gated cation channels in the inner medullary collecting duct.Amiloride has a second action on the heart, blocking Na+/H+ exchangers sodium–hydrogen antiporter 1 or NHE-1.