Term
| If ED is caused by beta blockers, clonidine, or methyldopa: |
|
Definition
Use:
- ACEIs
- ARBs
- Postsynaptic Alpha-1 Antagonists
|
|
|
Term
| If ED is caused by Verapamil: |
|
Definition
Use:
- Diltiazem
- Dihydropyridines
|
|
|
Term
| If ED is caused by TCAs/SSRIs: |
|
Definition
|
|
Term
| If ED is caused by diphenhydramine: |
|
Definition
| Use 2nd Gen Antihistamines (Loratadine, Cetirizine) |
|
|
Term
| If ED is caused by Phenothiazines: |
|
Definition
| Use Atypical Antipsychotics |
|
|
Term
| If ED is caused by metoclopramide: |
|
Definition
|
|
Term
| If ED is caused Cimetidine: |
|
Definition
|
|
Term
| Treatment Options for ED: 1st Line |
|
Definition
- PDE-5 Inhibitors
- Vacuum Erection Device
- Testosterone Replacement
|
|
|
Term
| Treatment Options for ED: 2nd Line |
|
Definition
|
|
Term
| Treatment Options for ED: 3rd Line |
|
Definition
|
|
Term
| Treatment Options for ED: 4th Line |
|
Definition
- Penile Prosthesis
- Vascular Surgery
|
|
|
Term
| PDE-5 Inhibitors are Contraindicated in: |
|
Definition
- Uncontrolled hypertension
- Unstable or symptomatic agina
- Recent MI (< 2 weeks)
- Morderate-Severe Valvular Disease
- Congestive Heart Failure (NYHA Class III or IV)
- High-Risk Arrhythmia
- Obstructive Hypertrophic Cardiomyopathy
|
|
|
Term
|
Definition
- HA
- Flushing
- Rhinitis
- Dyspepsia
- Dizziness
- Back/Limb Pain (Tadalafil)
|
|
|
Term
| Disease States that result in ED |
|
Definition
- HTN
- Atherosclerosis
- Peripheral Vascular Disease
- Stroke
- Spinal Cord Injury
- Cigarette smoking
- Excessive Ethanol Intake
- Diabetes
- Hypogonadism
- Depression/Anxiety
- Alzheimer's Disease
- Hypothyroidism
- Chronic Renal Failure
- Pituitary Tumors
|
|
|
Term
| Anticholinergic Agents and their effects on ED |
|
Definition
Blocks the normal physiological processes that result in erection
- Antihistamines
- Antiparkinsonian agents (cholinesterase inhibitors, levodopa)
- Tricyclic antidepressants
- Phenothiazines (clozapine, 1st gen antipsychotics, promethazine)
|
|
|
Term
| Dopamine Receptor Inhibitors and their effects on ED |
|
Definition
Inhibit prolactin inhibitory factor --> this increases prolactin levels and may inhibit testosterone production
- Metoclopramide
- Phenothiazines
|
|
|
Term
| Estrogens, Anti-Androgens and their effects on ED |
|
Definition
Suppress testosterone-mediated stimulation of libido
- LH-releasing hormone agonists
- Digoxin
- Spironolactone
- Ketoconazole
- Cimetidine
|
|
|
Term
| CNS Depressants and their effects on ED |
|
Definition
Suppress psychogenic stimuli
- Barbiturates
- Narcotics
- BZDs
- Excessive alcohol consumption, short term
|
|
|
Term
| Diuretics and their effects on ED |
|
Definition
| Reduce arteriolar flow to corpora |
|
|
Term
| Peripheral Beta Blockers and their effects on ED |
|
Definition
| Reduce arteriolar flow to corpora |
|
|
Term
| Central Sympatholytics and their effects on ED |
|
Definition
Reduce arteriolar flow to corpora
|
|
|
Term
| PDE 5 Inhibitors: Contraindications |
|
Definition
- High CV Risk (based on Second Princeton Consensus Conference)
- Pt on nitrates
|
|
|
Term
| According to the Second Princeton Consensus Conference, Patients with high CV risk have: |
|
Definition
- Unstable or symptomatic angina
- Uncontrolled HTN
- Severe CHF (NYHA Class III/IV)
- MI or stroke < 2 weeks ago
- Moderate/severe valvular heart disease
- High risk cardiac arrhythmia
- Obstructive Hypertrophic Cardiomyopathy
|
|
|
Term
|
Definition
- HA
- Facial Flushing
- Dizziness
- Dyspepsia
- Nasal congestion
- Lower back/limb pain (Tadalafil)
|
|
|
Term
| Do not administer nitrates within _____ hrs of sildenafil/vardenafil and ______ hrs of tadalafil use |
|
Definition
24 hrs of sildenafil/vardenafil
48 hrs of tadalafil |
|
|
Term
| According to the Second Princeton Consensus Conference, Patients with low CV risk have: |
|
Definition
- Asymptomatic/undiagnosed CV disease
- < 3 risk factors for CV disease
- Well-controlled HTN
- Mild, stable angina
- Mild CHF (NYHA Class I)
- Mild valvular heart disease
- Myocardial infarction > 6 weeks ago
These patients can use PDE5 Inhibitors |
|
|
Term
| Take PDE5 inhibitors at least ______ min prior to anticipated sexual activity, with the exception of tadalafil which should be taken _____ hrs prior |
|
Definition
30-60 min
2 hrs for tadalafil |
|
|
Term
| For PDE5 inhibitors, how many doses can you take in one day? |
|
Definition
No more than 1
Time between doses may be extended for tadalafil |
|
|
Term
|
Definition
Prostaglandin E1 Analogue
- Stimulates Adenylyl Cyclase which increases levels of cAMP
- This stimulates smooth muscle relaxation and enhances blood flow in penile sinuses
|
|
|
Term
| Which route of administration for Alprostadil is preferred for patients with DM on insulin/injectable therapy or with peripheral neuropathy? |
|
Definition
| Intracavernosal Injections |
|
|
Term
|
Definition
- Penile/urethral pain
- Injection site complications (bruising, scarring, infection)
- Vaginal itching, burning, pain in partner (intraurethral route)
- Priapism (dose related)
- Dizziness/hypotension (dose related)
|
|
|
Term
| When should patients take Alprostadil? |
|
Definition
| Immediately before sexual activity |
|
|
Term
| What is the max number of doses for Alprostadil? |
|
Definition
No more than 1 intracavernosal injection per day
OR
3 injections per week
No more than 2 doses of intraurethral pellets per day |
|
|
Term
| Testosterone Replacement for ED: Contraindications |
|
Definition
|
|
Term
| Testosterone Replacement for ED: Monitoring |
|
Definition
- Serum testosterone levels baseline; q 6-12 months for chronic therapy
- Lipid panel baseline; q 6-12 months for chronic therapy
- Hematocrit baseline; q 6-12 months for chronic therapy
- LFTs baseline (for PO Meds only)
- PSA baseline; yearly for chronic therapy -- screening for BPH indicated for pts > 40
- Digital rectal exam baseline; yearly for chronic therapy
|
|
|
Term
| Testosterone Replacement for ED: SE |
|
Definition
- Mood swings
- Weight gain
- Edema
- Sodium retention
- Dyslipidemia
- Gynecomastia
- Contact dermatitis
- Gynecomastia
- Hepatotoxicity (PO/alkylated formulations)
|
|
|
Term
| When should serum testosterone levels be taken for Testosterone replacement product? |
|
Definition
| in the morning, prior to use of any testosterone product |
|
|
Term
| Do not shower within ________ hrs of administration of Testosterone replacement product |
|
Definition
|
|
Term
| Vacuum Erection Device: First line treatment for |
|
Definition
| Older adults in stable sexual relationships |
|
|
Term
| Vacuum Erection Device: SE |
|
Definition
- Penis is cool/numb to touch
- Discolored appearance
|
|
|
Term
| Vacuum Erection Device: Contraindication |
|
Definition
| Sickle Cell Disease (high risk of priapism) |
|
|
Term
| Vacuum Erection Devices should be used cautiously in patients taking what medication? |
|
Definition
|
|
Term
| Penile Prosthesis: Place in therapy |
|
Definition
| Last line treatment for patients that do not respond to or are not candidates for other therapies |
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