Term
| to make an erection cGMP and cAMP do what? |
|
Definition
| decrease intracellular Ca- muscle relaxes- more blood flow |
|
|
Term
| 2 mechanisms of detumescence |
|
Definition
PDE5->break down cGMP-> more cystolic Ca
sympathetic (NE, EPi)-> more cystolic Ca |
|
|
Term
| what type of ED is not as receptive to sexual stimuli |
|
Definition
|
|
Term
| different causes of psychogenic ED |
|
Definition
general unresponsive
situational
psychological distress |
|
|
Term
| what are the 4 types of organic ED |
|
Definition
neurogenic
vascular
hormonal
drug induced |
|
|
Term
| neurogenic ED can be due to? -3 |
|
Definition
brain injury
peripheral neruopathy
spinal cord injury |
|
|
Term
|
Definition
decreased testoserone production
hyperprolactinemia
hypothyroidism
hyperthyroidism |
|
|
Term
| Hyperprolacinemia inhbiits _ which decreases what hormone? |
|
Definition
|
|
Term
| hypothyroidism leads to ED how? -2 |
|
Definition
| decreased testosterone->increased prolactin |
|
|
Term
| hyperthyroidism causes ED how |
|
Definition
| decreased libido due to increased estrogen |
|
|
Term
| 5 drug classes that cause ED |
|
Definition
anticholinergics
antidepressents/psychotics
dopamine antagonists
estrogens/antiandrogen
CNS depressants
antihypertensive agents |
|
|
Term
how does cigarette smoking cause ED?
alcohol? |
|
Definition
vasoconstriction;
organic and psychogenic |
|
|
Term
| what lab tests do you do for ED -4 |
|
Definition
| lipids, glucose, testosterone, thyroid |
|
|
Term
what is first line management for ED?
for what type of ED would it not work for? |
|
Definition
PDE5 inhibitors
-if libido problem- it requries NO and cGMP |
|
|
Term
| how do the PDE5 inhibitors work? |
|
Definition
| inhibit break down of cGMP- keep cystolic Ca low |
|
|
Term
|
Definition
| genital tissue, tracheal smooth muscle, platelets |
|
|
Term
PDE6 selective inhibitor might cause? -3
why? |
|
Definition
light sensitivty, blurry vision, loss blue-green color
bc has recpt in retina |
|
|
Term
PDE 11 selective might cause?
why? |
|
Definition
back pain
bc recpt in skeletal muscle |
|
|
Term
what is contraindicated for PDE inhibitors?
why?
if still use how long to wait inbtwn? |
|
Definition
use of nitrates
creates hypotension by increase NO
24-48 hrs of seperation |
|
|
Term
| precautions for PDE5 inhibitors-3 |
|
Definition
priapism
CAD
vasodilation conditions (hypotension) |
|
|
Term
| common side effects of PDE5 inhibitors-4 |
|
Definition
| headache, dizzy, face flush, dyspepsia |
|
|
Term
| rare side effects of PDE 5 inhibitors -5 |
|
Definition
priapism
hearing imparied
vision imparied
back pain
NAION |
|
|
Term
CYP 3A4 inhibitors should not be coadmin with?
what are ex of thesE? |
|
Definition
PDE 5 inhibitors
macrolides, azoles |
|
|
Term
| how long do you seperate alpha1 blockers from PDE 5 inhibiors |
|
Definition
|
|
Term
| medications that if coadministered with PDE5 inhibitors could cause hypotension |
|
Definition
|
|
Term
| counseling tips for PDE5 inhibitor meds-3 |
|
Definition
-foreplay
-take on empty stomach
-onset of action |
|
|
Term
| what should you avoid while taking PDE5 inhibitors? |
|
Definition
|
|
Term
| which medication is synthetic prostaglandin E? |
|
Definition
|
|
Term
| what is the MOA of alprostadil? |
|
Definition
| increase cAMP-> decerase Ca->increase blood flow |
|
|
Term
| which type of alprostadil administration has better efficacy |
|
Definition
| intracavernosal injection |
|
|
Term
| which type of ED therapy is good for multiple ED etiologies |
|
Definition
|
|
Term
| what is the dosing schedule for the intracavernosa injection? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| duration of erection for alprostadil is directly related to? |
|
Definition
|
|
Term
| contraindications for alprostadil-3 |
|
Definition
penile deformity/priapism
penile implant
-preggo partner w/o condom |
|
|
Term
| Precautions for alprostadil-3 |
|
Definition
bleeding disorder
other vasoactive agents
cardiac health |
|
|
Term
what drug therapy with ED do you not need hepatic and renal adjustments?
which doesnt have drug interactions? |
|
Definition
|
|
Term
| side affects from alprostadil -5 |
|
Definition
| dizziness, hypotension, pain, priapisim, bleeding |
|
|
Term
for intracavernosal injection:
storage-
do you reconstitute?
when do you inject?
how long does erection last? |
|
Definition
room temp
yes
5-10 minutes before want erection
lasts 1 hr |
|
|
Term
| what patients do you caution use of the injection alprostadil |
|
Definition
|
|
Term
for MUSE:
storage-
suggest what before use?
what should you do to help blood flow? |
|
Definition
fridge
empty bladder
sit, stand, walk for 10 minutes after |
|
|
Term
| counseling points for alprostadil-4 |
|
Definition
-needs good vision
-rotate sites to avoid hematomas
-low risk of priapism
-can use with VEDs |
|
|
Term
| what is not recommended therapy for secondary ED |
|
Definition
|
|
Term
| this is indicated fro primary and secodnary hypogonadism |
|
Definition
|
|
Term
| signs of low testosterone/ secodnary ED |
|
Definition
| decreased libido, decreased muscle, depression |
|
|
Term
| secondary ED treatment doesnt directly act on ED- its acts to do what? |
|
Definition
|
|
Term
| Goals of secodnary ED treatment-4 |
|
Definition
restore muscle
restore sex drive
mood
return testosterone to normal level |
|
|
Term
| what type of testosterone therapy wont be of use for ED? |
|
Definition
|
|
Term
| caution use of testosterone therapy for 2nd ED for - 2 |
|
Definition
|
|
Term
| when using testosterone therapy what do you monitor? |
|
Definition
|
|
Term
| stop testosterone treatment if not working after how long? |
|
Definition
|
|
Term
| cardio effects of testosterone-3 |
|
Definition
|
|
Term
| endocrine efects of testosterone-4 |
|
Definition
hypoglycemia
weight gain
Na retention
gynecomastia |
|
|
Term
| what testosterone admin bypasses 1st pass metab |
|
Definition
|
|
Term
| what testosterone admin has less frequent dosing? |
|
Definition
|
|
Term
| this testosterone patch has good absorption but falls off easily? |
|
Definition
|
|
Term
| this testosterone patch increases risk of dermatitis |
|
Definition
|
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