Term
| What conditions are included in the definition ED? |
|
Definition
inability to get an erection
erection that does not allow for penetration
erection does not last until orgasm |
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Term
| What disorders are NOT included in the definition of ED? |
|
Definition
decreased libido
ejaculatory disorders
infertility |
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Term
| What is a psychogenic erection? |
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Definition
| an erection triggered by fantasy or visual stimulation |
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Term
| What type of input is involved in a psychogenic erection? |
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Definition
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Term
| Where does the sympathetic input for psychogenic erections come from? |
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Definition
|
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Term
| What is a reflex erection? |
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Definition
| an erection triggered by tactile stimulation |
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Term
| What type of input is involved in a reflex erection? |
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Definition
|
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Term
| Where does the parasympathetic input for reflex erections come from? |
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Definition
|
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Term
| What do parasympathetic signals control? |
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Definition
|
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Term
| What do sympathetic signals control? |
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Definition
|
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Term
| How do PDE-5 inhibitors work to treat ED? |
|
Definition
| they block the breakdown of cGMP which is then able to causes smooth muscle relaxation and an erection |
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Term
| What neurotransmitter is involved in parasympathetic signals? |
|
Definition
|
|
Term
| How do parasympathetic signals cause an erection? |
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Definition
| Acetylcholine release causes endothelial cells and nerve terminals to release nitric oxide (NO). NO promotes the conversion of GTP to cGMP. This causes the relaxation of arterial and cavernosa smooth muscles which allows increased blood flow in. The blood flow into the corpora causes compression of emissary veins and a decrease in venous return, thus causing an erection. |
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Term
|
Definition
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Term
T/F
Relatively high levels of PDE-5 are found in the human corporus cavernosum. |
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Definition
|
|
Term
|
Definition
| brain, kidney, and smooth muscle |
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Term
|
Definition
|
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Term
|
Definition
| smooth muscles, platelets, and cardiac tissue |
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Term
|
Definition
| brain and lung lymphocytes |
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Term
|
Definition
| photoreceptors of the human retina |
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Term
|
Definition
| involved in regulation of cardiac contractility |
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Term
| Name 4 medications for right ventricular heart failure due to pulmonary hypertension. |
|
Definition
milrinone
vesnarinone
enoximone
sildenafil |
|
|
Term
| What problems can ED by a sign of? |
|
Definition
cardiovascular disease
diabetes
depression
alcoholism
smoking
recreational drug use |
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Term
| What other forms of sexual dysfunction does ED need to be differentiated from? |
|
Definition
decreased libido
anatomical abnormalities
ejaculatory dysfunction |
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Term
| What are the signs and symptoms of Peyronie's Disease? |
|
Definition
| penile curvature, plaque formation impaired sexual activity, and pain on erection |
|
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Term
|
Definition
| transdermal electromotive administration |
|
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Term
| What type of therapy has proven effective in treatment of Peyronie's Disease? |
|
Definition
TEA of verpamil and dexamethasone - requires several sessions
surgical procedures may be required |
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Term
| What types of effects does blocking PDE-3 have? |
|
Definition
ionotropic agent
vasodilator |
|
|
Term
| For a patient that complains of ED, what should be included in the PE? |
|
Definition
1. abdomen - circulation
2. genitalia - STDs, secondary sexual characteristics
3. neurologic
4. rectal exam to r/o prostate CA |
|
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Term
| What labs should be drawn up on an ED patient? |
|
Definition
1. PSA
2. Total and free testosterone levels
3. fasting serum glucose and lipid panel
4. TSH |
|
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Term
| How do we help our patients prevent development of ED? |
|
Definition
Manage co-morbid conditions - diabetes, HTN, heart disease
Maintain ideal body weight
No smoking
Regular exercise |
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|
Term
| Ed may be the first sign of _______. |
|
Definition
|
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Term
| How do you manage ED initially? |
|
Definition
1. Educate - non pharm therapy - healthy diet, regular activity, weight loss, stop smoking
2. Be supportive
3. Reassure the patient
4. Involve the spouse |
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Term
| What does the AUA recommend as the DOC for treatment of ED? |
|
Definition
|
|
Term
T/F
Taking PDE-5 inhibitors will give you an erection whether you are in the mood to have sex or not. |
|
Definition
| False - Nitric oxide must be generated to convert GTP to cGMP |
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|
Term
| How does an erection begin when on PDE-5 inhibitors? |
|
Definition
| parasympathetic response begins with tactile stimulation |
|
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Term
| What drugs have interactions with PDE-5 inhibitors? |
|
Definition
alpha blocker
anti-virals used for AIDS
antibiotics - macrolides
oral antifungals - "azoles" |
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|
Term
| What dosing is suggested for PDE-5 inhibitors? |
|
Definition
|
|
Term
| Which of the PDE-5 inhibitors should be taken on an empty stomach? |
|
Definition
sildenafil (Viagra) - less effective
avoid fatty foods |
|
|
Term
| Which PDE-5 inhibitor lasts the longest? |
|
Definition
|
|
Term
| Which of the PDE-5 inhibitors has the longest half-life? |
|
Definition
|
|
Term
|
Definition
Viagra
starting 50 mg
onset 14-60 min
duration 4 hours |
|
|
Term
|
Definition
Levitra
starting 10 mg
onset 25 min
duration 4 hours |
|
|
Term
|
Definition
Cialis
starting 10 mg
onset 16-45 min
duration 36 hours |
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Term
T/F
Sildenafil has a lower selectivity between PDE-5 and PDE-6 which is why it affects color vision. |
|
Definition
| True - blue-tinged vision when on the medication |
|
|
Term
| Where is sildenafil metabolized? |
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Definition
|
|
Term
| By what % is the metabolism of sildenafil decreased after age 65? |
|
Definition
| 40% - start low and go slow |
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Term
| What is a contraindication for PDE-5 inhibitors? |
|
Definition
| severe hypotension with nitrate use |
|
|
Term
| What % of patients will get a headache with PDE-5 inhibitor use? |
|
Definition
|
|
Term
| What are the possible side effects of PDE-5 use? |
|
Definition
| headache, dyspepsia, facial flushing, nasal congestions, priapism |
|
|
Term
| Name 3 side effects of sildenafil not shared among all PDE-5 inhibitors. |
|
Definition
| visual abnormalities, back pain, and prolongation of the QT interval |
|
|
Term
| For which drug is concurrent use of an alpha-1 blocker a contraindication? |
|
Definition
|
|
Term
| How far apart should doses of sildenafil (> 25 mg) and alpha-1 blockers be? |
|
Definition
|
|
Term
| Which alpha-1 blocker can you take with tadalafil (Cialis)? |
|
Definition
| only tamsulosin (Flomax) at 0.4 mg dose |
|
|
Term
|
Definition
| Non-arteritic ischemic optic neuropathy |
|
|
Term
| What should you check about family history before prescribing PDE-5 inhibitors? |
|
Definition
| family history of eye disease |
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Term
T/F
NAION is more common in persons with heart disease, diabetes, hypertension, smokers, and/or are >50 years of age. |
|
Definition
|
|
Term
| What is the success rate of vacuum erection devices? |
|
Definition
|
|
Term
| What are some patient concerns with vacuum erection devices? |
|
Definition
| cold, discolored, lifeless penis with hinged like feel |
|
|
Term
| What are the contraindications for vacuum erection devices? |
|
Definition
| sickle cell disease, bleeding disorders, or on oral anticoagulants |
|
|
Term
| When should the MUSE system not be used? |
|
Definition
| sexual intercourse with a pregnant woman unless the couple uses a condom barrier |
|
|
Term
| How long does it take for an erection to begin using the MUSE system? |
|
Definition
|
|
Term
| How long does an erection from the MUSE system last? |
|
Definition
|
|
Term
T/F
The MUSE system is more effective than PDE-5 inhibitors because it relies on NO. |
|
Definition
| False - it is more effective because it doesn't rely on NO |
|
|
Term
| What is the starting dose for alprostadil (Muse)? |
|
Definition
|
|
Term
T/F
Alaprostadil is more effective when used with vacuum constrictive device. |
|
Definition
|
|
Term
| What are the side effects of alaprostadil (Muse)? |
|
Definition
| penile pain, urethral burning, testicular pain, HA, priapism, and hypotension |
|
|
Term
T/F
The penile NO pathway is testosterone dependent. |
|
Definition
|
|
Term
| What should the testosterone levels be before trying testosterone therapy? |
|
Definition
| less than 200 on 2 separate occasions |
|
|
Term
| How many days should you wait until you reassess testosterone levels? |
|
Definition
|
|
Term
T/F
Testosterone has a bigger effect on sexual dysfunction and a smaller effect on libido. |
|
Definition
| False - bigger effect on libido |
|
|
Term
| What are the methods of testosterone delivery and which method is more effective? |
|
Definition
skin patch, topical gel, injection, or buccal oral tablets
transdermal is more effective |
|
|
Term
| What are the side effects of testosterone use? |
|
Definition
| increase risk of prostate cancer, hepatic neoplasms and fulminant hepititis, erythropoietin-mediated polycythemia, gynecomastia, decreased HDL, edema, sleep apnea, HTN, infertility, BPH |
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Term
T/F
Topical therapies are not approved by the FDA. |
|
Definition
|
|
Term
| Name 3 common therapies that are not recommended by the AUA. |
|
Definition
| Yohimbine, herbals, and trazodone (Desyrel) |
|
|
Term
| What drug does Super-X contain? |
|
Definition
|
|
Term
| What drug does Stamina-Rx contain? |
|
Definition
|
|
Term
T/F
The FDA regulates internet formulations for ED. |
|
Definition
|
|
Term
T/F
AYA recommends vascular surgery for ED. |
|
Definition
|
|
Term
T/F
Surgical treatment for ED includes prosthesis. |
|
Definition
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