Aug31 M1-Erectile dysfunction

Question 1

5 forms of sexual dysfunction

Answer 1

• erectile dysfunction (ED)
• hypogonadism (andropause = low testo)
• ejaculatory disorders (premature, delayed, painful)
• psychosocial issues
• Peyronie’s disease (anatomical deformity, bending bc of scarring in tunica albugenia)

Question 2

most important nerve for erection

Answer 2

cavernous nerves (S2 to S4)

Question 3

main thing for erection to occur

Answer 3

SM relaxation in the corpora cavernosa (2 of these. note spongiosum with urethra). vessels are in cavernous bodies and blood goes in sinusoid levels.

Question 4

(important) main ntr for erection

Answer 4

nitric oxide

Question 5

cells releasing NO

Answer 5

• NANC nerves (non adrenergic non cholinergic)
• endothelial cells
• NO goes to SM cells

Question 6

how NO causes SM relaxation around corpora cavernosa

Answer 6

• 2nd messenger (cGMP) is increased
• this decreases IC Ca
• SM relaxes

Question 7

how to get rid of erection (molecularly)

Answer 7

phosphodiesterase enzyme hydrolyzes cGMP, IC Ca back up, SM contracts

Question 8

approach to ED management

Answer 8

• Hx and PE
• assess CV risk
• if good CV status, start meds

Question 9

why assess CV risk in ED

Answer 9

same risk factors for ED and CVD

Question 10

5 forms on sexual dysfunction

Answer 10

• ED
• psychosocial
• andropause
• ejaculatory disorders (like premature)
• Peyronie

Question 11

how to qt ED

Answer 11

questionnaires give scores

Question 12

right name for andropause (hypogonadism), can still have good erection

Answer 12

androgen deficiency in aging male (ADAM)

Question 13

lab tests specific for ED

Answer 13

• testo (bc low testo can cause ED, so this is the link between ADAM and ED)
• FSH
• LH
• HbA1c (poorly controlled diabetes is assoc with ats and bad erectile fct)

Question 14

link between hypogonadism and ED

Answer 14

two diff things but the low testo can cause ED

Question 15

symptoms, signs of low testo

Answer 15

• less desire and arousal
• less frequency of sexual activity
• lower semen level
• ED

Question 16

why not give exogenous testo to cure ED

Answer 16

negatively feedbacks on pit and less FSH and LH are produced so less sperm prod and less testo

Question 17

risk factors for ED (same as CVD)

Answer 17

• lifestyle
• smoking
• BMI
• stress
• lipids
• htn
• glycemic control
• FHx
• Age
• Gender

Question 18

(imp?) 2 conditions most assoc with ED

Answer 18

1. heart disease

2. diabetes

Question 19

(imp) categories of cardiac risk + approach for if can have sex or not + if can get ED meds

Answer 19

• low = stable angina, controlled htn, no sx
• interm = mild SOB or angina, mild sx
• high = unstable angina, uncontrolled htn
• can have sex + can get ED meds if no symptoms in activities of MET>5 (metabolic index)*

Question 20

3 ED meds

Answer 20

• sildenafil (viagra)
• tadalafil (cialis)
• vardenafil (levitra)

Question 21

ED meds do what

Answer 21

inhibitors of PDE5 enzyme which hydrolyzes cGMP in SM

Question 22

(imp) most imp contraindication for ED meds

Answer 22

nitroglycerine (can’t take if on nitro) (bc nitro lowers BP and PDE5i will lower it even more)

Question 23

diff between ED meds

Answer 23

tadalafil (cialis) much higher half life than sildenafil (viagra) but therefore sildenafil peaks (effect) before

Question 24

how to mix nitro and ED meds

Answer 24

• can take nitro 24 hrs after sildenafil and vardenafil

- can take nitro 48 hrs after tadalafil

Question 25

other ways of reducing ED if meds don’t work (PDE5i)

Answer 25

1. control modifiable risk factors
   - stop smoking
   - exercise
   - control DM, lipids, CV status
   - control depression
   - control weight
2. patient educ on best time to take the drugs
3. optimize dose
4. switch med (placebo)