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F3 E1 Shea > ED 1 > Flashcards

ED 1 Flashcards

1
Q

Inability to attain/maintain penile erection sufficient for satisfactory sexual performance

A

ED

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2
Q

52% of men over __ y/o have some degree of ED

A

40

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3
Q

What are the 2 processes of normal erection?

A
  • Relaxation of smooth muscles of cavernosal artery –> increased inflow of blood to corpora cavernosa
  • Increased venous outflow resistance –> decreased outflow
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4
Q

Normal physiology of erections

  • Relaxation of smooth muscles of cavernosal arterial wall
    • ______ nerves release _____
    • Increased ____ and ____ in cells of smooth muscle surrounding cavernosal arteries
    • Decreased intracellular ____
    • Smooth muscle relaxation, vasodilation
    • Wider diameter of artery
    • Greater inflow of blood into _____ of penile shaft
A
  • Parasympathetic / nitric oxide (NO)
  • cyclic-GMP & cyclic-AMP
  • calcium
  • corpora cavernosa
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5
Q

Normal physiology of erections

  • Increased venous outflow resistance
    • High inflow into corpora cavernosa causes corpora cavernosa to expand & compress the _______
    • Decreased outflow of blood via the ____ from the penis –> erection occurs and is sustained
A
  • venous sinuses
  • venous system
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6
Q

6 etiologies of ED

A
  • Vasculogenic
  • Neurogenic
  • Psychogenic
  • Endocrine
  • Medication induced
  • Disease states
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7
Q

What are the 2 vasculogenic problems?

A
  • Arterial inflow problem
  • Venous outflow problem
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8
Q

Cause of neurogenic ED

A

Prostatectomy

(prostate removed, nerves are taken with it)

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9
Q

4 psychogenic causes of ED

A
  • Depression
  • Stress
  • Anxiety
  • Psychiatric disorders

“PADS” bc psychos need padded room

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10
Q

4 endocrine causes of ED

A
  • Hyperprolactinemia
  • thyroid disorder
  • SHBG (sex hormone binding globulin)
  • Hypogonadism
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11
Q

3 main types of meds which cause ED

A
  • antihypertensives
  • antidepressants & antipsychotics
  • meds which reduce testosterone
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12
Q

What are the 4 antihypertensives which cause ED?

A
  • Beta Blockers
  • Thiazides
  • Clonidine
  • Methyldopa
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13
Q

4 antidepressants/antipsychotics which cause ED

A
  • Tricyclic antidepressants
  • MAO-I
  • Lithium
  • Phenothiazines (thorazine, compazine)
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14
Q

6 meds that can reduce testosterone

A
  • Cimetidine
  • Spironolactone
  • Ketoconizole
  • LHRH agonists (leuprolide)
  • Non-steroidal anti-androgens (flutamide, bicalutamide)
  • Estrogens (DES) = Diethylstilbestrol
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15
Q

What are 5 “other meds/drugs” which cause ED?

A
  • Sedatives
  • Phenytoin
  • Anticholinergics
  • Alcohol
  • Tobacco smoking
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16
Q

3 disease states which cause ED

A
  • Medical
  • Surgical
  • Traumatic
17
Q

4 medical disease states causing ED

A
  • Chronic renal insufficiency
  • DM
  • Chronic hepatic disease
  • Neurologic, atherosclerotic disease, endocrine
18
Q

2 surgical disease states which cause ED

A
  • Prostatectomy & Cystectomy
19
Q

2 traumatic disease states which cause ED

A
  • Pelvic fx
  • Penile fx

(fascia tear)

20
Q

What scale is used?

A

International Index of Erectile Function

(IIEF Scale)

21
Q

5 PE components of ED

A
  • Circulation
  • Gynecomastia
  • Galactorrhea
  • Visual field defects (caused by prolactinoma)
  • External genitalia exam (penis & testes)
22
Q

3 ways to eval ED

A
  • Testosterone
    • if pt has decreased libido / physical findings
    • total testosterone
    • bioavailable testosterone
    • highest from 7a-11a
  • Prolactin
  • Nocturnal penile tumescence (postage stamp) if it falls off pt had a night time erection
23
Q

2 imaging studies for ED

A
  • Penile duplex dopper sonography
    • tests for arterial insufficiency
    • cavernosal injection w/ vasoactive med
    • Arterial flow measured
    • Arterial diameter measured
  • Cavernosometry / Cavernosography
    • tests for venous leak
    • cavernosal injection w/ vasoactive med
    • cavernosal needle for inflow of saline
    • measures rate of inflow of saline required to maintain erection
24
Q

Which test?

  • tests for venous leak
  • cavernosal injection w/ vasoactive med
  • cavernosal needle for inflow of saline
  • measures rate of inflow of saline required to maintain erection
A

Cavernsometry / Cavernosography

25
Q

Which test?

  • tests for arterial insufficiency
  • cavernosal injection w/ vasoactive med
  • Arterial flow measured
  • Arterial diameter measured
A

Penile duplex dopper sonography

26
Q

General Tx for ED

  • Determine if ____ is appropriate for sexual activity
  • Smoking cessation
  • Weight control
  • ETOH
  • Possible change of _____
  • Tx of _____
A
  • CV status
  • medication
  • medical conditions
27
Q

4 meds for ED

A
  • PDE-5-I
  • Yohimbine (doesn’t work)
  • Medicated Urethral System for Erection (MUSE)
  • Penile injection
28
Q

4 tools to tx ED

A
  • Vacuum Erection Device (VED)
  • Constriction ring
  • Penile splint
  • Penile prosthesis
29
Q

Surgery for ED

A

Penile revascularization

30
Q

ED tx contraindicated w/ Nitrate use

A

Phosphodiesterase-5 Inhibitors

(Sildenafil = viagra)

31
Q

What medication for ED also treats pulmonary HTN?

A

PDE-5-I (Sildenafil)

32
Q

Detumescence: ____ decreases amount of c-GMP, causing a decreased blood flow into penis

A

Phosphodiesterase-5

33
Q
  • PDE-5-Inhibitors block ____, permitting c-GMP to continue to exert its ____ effect
  • Prolongs _____
A
  • PDE-5 / vasodilatory
  • erection

F3 E1 Shea (14 decks)

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