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 |
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Term
| There will be ___________________ cases of ED by 2025 |
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Definition
|
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Term
| What study done in the late 80s showed 52% of men surveyed reported some type of ED? |
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Definition
| Massachusetts Male Aging Study (MMAS) |
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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 |
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Term
| List the 5 components of normal sexual function |
|
Definition
1. Libido
2. Arousal
3. Orgasm
4. Ejaculation
5. Resolution |
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Term
| What does an erection depend on? |
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Definition
|
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Term
| _______________, _______________, _____________ allow for smooth muscle relaxation. |
|
Definition
NO
Prostaglandin (PGE-1)
cGMP |
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Term
|
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% |
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Term
| The four types of dsyfunction associated with ED are: |
|
Definition
1. Arterial
2. Venous
3. Nerve
4. Psychogenic |
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|
Term
|
Definition
1. A thorough Hx of sexual, medical and psychosocial
2. Physical Exam |
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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) |
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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 |
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Term
| What information do you want to find out/ know in a Medical Hx? |
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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
|
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Term
| What are the 6 questions to ask to assess physchological risk factors in ED? |
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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?
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Term
| Will Viagra work in a patient with psychological problems associated with there ED? |
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Definition
Nope
These patients need to be referred to a sex counselor |
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Term
| What does the physical exam include? |
|
Definition
Genito-urinary, neurologic and vascular exam
Lab results |
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Term
| What lifestyle factors contribute to ED? |
|
Definition
1. EtOH
2. Tobacco
3. Illegal drugs
4. Physical inactivity |
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|
Term
| What is the goal of Tx in ED patients? |
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Definition
| To improve the quality and quantity of an erection |
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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 |
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|
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 |
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Term
| How effective is a VED and what kind of pressure does it cause? |
|
Definition
|
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Term
| What are the 2 different penile implants that a patient can get? |
|
Definition
1. Semi-rigid rods
2. Inflatable implant |
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|
Term
| How long can a penile implant last? |
|
Definition
|
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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. |
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Term
| What are 2 local pharmacotherapy options to tx ED? |
|
Definition
1. Prostaglandin in a suppository
2. Penile injection therapy |
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|
Term
|
Definition
| A synthetic prostaglandin urethral suppository (aka Alprostadil) |
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|
Term
| How effective is MUSE and what % of patients experience aching? |
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Definition
30-60% effective
25% experience aching |
|
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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 |
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Term
| What are some things that we want to counsel our patients who are taking MUSE to Tx there ED? |
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Definition
| That body position, EtOH and stress can affect the response |
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|
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
|
|
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 |
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|
Term
| What happens if you experience an erection for longer than 4 hrs? |
|
Definition
| Seek medical attention this is an emergency |
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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? |
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Definition
| They are PDE5 inhibitors and can overlap to inhibit PDE6 which is found in the rods and cones |
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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
|
|
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 |
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Term
| Vardenafil is aka _____________ whereas Tadalafil is aka _______________. |
|
Definition
|
|
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
|
|
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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. |
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|
Term
| What type of food interaction occurs in both Sildenfail and Vardenafil? |
|
Definition
| Fatty meals reduce its absorption |
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|
Term
| What are some adverse events that occur with Viagra? |
|
Definition
Headache
Flushing
Higher doses produce dyspepsia
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|
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Term
| What do you want to pay attention to if taking a PDE5i? |
|
Definition
Vision or hearing changes
and priapism |
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Term
| If all the PDE5i all have the same MOA what is the differenc between them? |
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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 |
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Term
| T/F: Viagra is better to use to Tx ED than Cialis. |
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Definition
| False; Meta analysis in 2009 concluded not one agent is better than the other |
|
|
Term
|
Definition
| A muscle relaxant that is sometimes injected with alprostadil. (Trimix) |
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|
Term
| What is Testosterone used for in ED? |
|
Definition
| No effect on ED but does influence libido |
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