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Erectile Dysfunction
Ptx 2 Week 3
56
Other
Professional
09/24/2011

Additional Other Flashcards

 


 

Cards

Term
T/F: Erectile Dysfunction(ED) is a decrease in sexual drive/desire.
Definition

False; that is the definition of a decreased libido.

 

ED = Failure to acheive and maintain an erection

Term
There will be ___________________ cases of ED by 2025
Definition
322 million
Term
What study done in the late 80s showed 52% of men surveyed reported some type of ED?
Definition
Massachusetts Male Aging Study (MMAS)
Term
What did the MMAS results show that ED was associated with?
Definition

1. Increase in Age

2. DM

3. HTN

4. Heart Disease

5. Poor education

Term
List the 5 components of normal sexual function
Definition

1. Libido

2. Arousal

3. Orgasm

4. Ejaculation

5. Resolution

Term
What does an erection depend on?
Definition
GOood vascular function
Term
_______________, _______________, _____________ allow for smooth muscle relaxation.
Definition

NO

Prostaglandin (PGE-1)

cGMP

Term
What causes ED?
Definition

1. Rx (Antihypertensives, antidepressants)

2. Endocrine disorders (DM, Testosterone deficiency)

3. Peripheral Vascular Disease (PVD)

4. Neurological dysfunction

5. Injury/disease

6. Psychological disorders

7. Lifestyle

Term
What are the 2 most common causes for ED?
Definition

1. Vascular - 40%

2. DM  - 30%

Term
The four types of dsyfunction associated with ED are:
Definition

1. Arterial

2. Venous

3. Nerve

4. Psychogenic

Term
How is ED diagnosed?
Definition

1. A thorough Hx of sexual, medical and psychosocial

 

2. Physical Exam

Term
When assessing the sexual history of a patient what can be used to determine the severity of ED?
Definition

The International Index of Erectile Function

(IIEF)

Term
A sexual history for ED includes finding info about the patients what?
Definition

1. Altered libido

2. orgasm

3. pain

 

Even there partners history of altered libido

Term
What information do you want to find out/ know in a Medical Hx?
Definition

1. Rx

2. Recreational drug use

3. Surgery

4. DM, HTN, or Hyperlipidemia

5. Trauma

6. Spinal cord injury

Term
What score in the IIEF is indicative of having ED?
Definition
A score with < 30
Term
What are the 6 questions to ask to assess physchological risk factors in ED?
Definition

1. Were you ever molested/

2. Have you been depressed about sex?

3. Do you sex make you feel guilty

4. Do you get morning wood?

5. Any partner conflicts?

6. Are you anxious about sex?

 

Term
Will Viagra work in a patient with psychological problems associated with there ED?
Definition

Nope

 

These patients need to be referred to a sex counselor

Term
What does the physical exam include?
Definition

Genito-urinary, neurologic and vascular exam

 

Lab results

Term
What lifestyle factors contribute to ED?
Definition

1. EtOH

2. Tobacco

3. Illegal drugs

4. Physical inactivity

Term
What is the goal of Tx in ED patients?
Definition
To improve the quality and quantity of an erection
Term
List the 3 types of nonpharmacological tx options for ED?
Definition

1. Sexual Counseling

2. Vacuum Erection Device (VED)

3. Penile implant

Term
Which VEDs should be used?
Definition
Those with a vacuum limiter
Term
What can you counsel a patient on who is on an anticoag and using a VED?
Definition
It may cause bruising and be very painful
Term
How effective is a VED and what kind of pressure does it cause?
Definition

90-95%

 

Negative pressure

Term
What are the 2 different penile implants that a patient can get?
Definition

1. Semi-rigid rods

2. Inflatable implant

Term
How long can a penile implant last?
Definition
15-20 years
Term
Why are penile implants considered a last resort?
Definition
Because it is a surgerical procedure there is an increase risk for infection, a patient needs to be on anesthia and have tissue removed.
Term
What are 2 local pharmacotherapy options to tx ED?
Definition

1. Prostaglandin in a suppository

2. Penile injection therapy

Term
What is MUSE?
Definition
A synthetic prostaglandin urethral suppository (aka Alprostadil)
Term
How effective is MUSE and what % of patients experience aching?
Definition

30-60% effective

 

25% experience aching

Term
Why is the first dose of MUSE done in a clinic setting?
Definition
Because it can lead to hypotension. We want to monitor that
Term
What are some things that we want to counsel our patients who are taking MUSE to Tx there ED?
Definition
That body position, EtOH and stress can affect the response
Term
What is the onset of action for MUSE and how long does it last for?
Definition

Onset is w/in 5 mins

and lasts about 30-60 minutes

Term
For penile injection therapy use ______________ which is alprostadil in an prefilled syringe form.
Definition
Caverject
Term
Where is Caverject injected inot?
Definition

The base of the penis

and into the erection chamber

Term
What are some side effects associated with Caverject?
Definition

Prolonged erections

Bruising

Scar tissue formation

Term
What happens if you experience an erection for longer than 4 hrs?
Definition
Seek medical attention this is an emergency
Term
Which patients are high risk patients for oral Rx for the tx of ED?
Definition

Those who are/have:

 

1. > 65 yro

2. Hepatic or renal impairment

3. CV risk

4. Retinal disorders

5. Spinal cord injury

6. Penile problems like deformities

Term
Why can some oral Rx for treating ED cause permanent eye loss?
Definition
They are PDE5 inhibitors and can overlap to inhibit PDE6 which is found in the rods and cones
Term
Which patients are not a candidate for sildenafil, tadalafil or vardenafil?
Definition

1. Taking nitrates

2. Unstable angina

3. Uncontrolled HTN
4. Class 2 HF
5. Stroke/ MI w/in the last 2 weeks

6. High risk arrhythmia

7. Cardiomyopathy

8. Moderate/severe valve disease

Term
What is the brand name for Sildenafil?
Definition
Viagra
Term
What is the MOA of Sildenafil?
Definition
Enhances the effect of NO through inhibition of PDE-5. That way more cGMP is around longer to cause an erection
Term
What is the normal pathophysiology of an erection?
Definition

Arousal signal-----> NO-----> cGMP = Erection

 

cGMP is then broken down by PDE-5

Term
What is the dosing on Sildenafil?
Definition

Take 25-100 mg as needed once a day (start low then titrate up)

 

Take 30-60 minutes before sex

Term
Vardenafil is aka _____________ whereas Tadalafil is aka _______________.
Definition

Levitra

Cialis

Term
Which CYP enzymes metabolize each Rx for ED tx?
Definition

Viagra = 80% 3A4, 20% 2C9

Levitra = Mostly 3A4 a little 2C9

Cialis = Solely 3A4

 

Term
What Drug interaction occurs with Nitrates and ED Rx?
Definition
Nitrates and ED Rx can cause an excess amount of cGMP and lead to alot of vasodilation. This causes severe Hypotension.
Term
What type of food interaction occurs in both Sildenfail and Vardenafil?
Definition
Fatty meals reduce its absorption
Term
What are some adverse events that occur with Viagra?
Definition

Headache

Flushing

 

Higher doses produce dyspepsia

 

 

Term
What do you want to pay attention to if taking a PDE5i?
Definition

Vision or hearing changes

and priapism

Term
If all the PDE5i all have the same MOA what is the differenc between them?
Definition

Levitra is more specific for PDE5 and has the fastest onset of action.

 

Cialis has the longest duration of action

Term
What is the dose of Verdanfil? What about if you have liver disease?
Definition

5-20 mg a day as needed

 

If liver disease then 10 mg a day

Term
Why caution with EtOH and Cialis?
Definition
Can decrease BP and cause hypotension
Term
T/F: Viagra is better to use to Tx ED than Cialis.
Definition
False; Meta analysis in 2009 concluded not one agent is better than the other
Term
What is Papaverine?
Definition
A muscle relaxant that is sometimes injected with alprostadil. (Trimix)
Term
What is Testosterone used for in ED?
Definition
No effect on ED but does influence libido
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