ED

Question 1

sexual dysfunction may be a precurser to what other health condition?

Answer 1

cardiovascular disease

Question 2

risk factors for ED

Answer 2

heart disease, depression, diabetes, HTN

Question 3

pathophysiology of ED

Answer 3

increased oxidants lead to endothelial cell injury

Question 4

physical causes of ED

Answer 4

vascular dz, diabetes (neuropathy), medications, spinal injury, low testosterone, Peyronie’s dz, cancer surgery (removal of prostate, bladder, colon, rectum)

Question 5

what medications can cause ED?

Answer 5

diuretics, beta blockers, certain supplements

Question 6

what parts of the CNS are involved in erection?

Answer 6

hypothalamus and hippocampus

Question 7

how is flaccid state maintained?

Answer 7

intrinsic myogenic activity (endothelins and SNS)

Question 8

physiology of erection

Answer 8

PNS releases NO, which increases cGMP, which results in decreased intracellular calcium, smooth muscle relaxation, and blood entry into shaft of penis (which is trapped by tunica albuginea)

Question 9

physiology of detumescence

Answer 9

adrenergic release of norepi, opening of calcium channels, smooth muscle contraction

Question 10

evaluation of ED

Answer 10

vitals, neurovascular, genital exams; lab tests = test for diabetes, lipid profile, testosterone levels; questionnaire

Question 11

current tx options for ED

Answer 11

testosterone tx if low levels, PDE-5 inhibitors (first line), intracavernosal injection, intraurethral suppository, penile prosthesis

Question 12

PDE-5 inhibitors work by?

Answer 12

preventing breakdown of cGMP, thus increasing erectile rigidity in normal physiologic response (doesn’t produce an erection)

Question 13

PDE-5 inhibitors should not be given if the patient is taking?

Answer 13

nitrates for chest pain

Question 14

side effects of PDE-5 inhibitors

Answer 14

flushing, blue vision, HA, back pain (cialis)

Question 15

be cautious in prescribing PDE-5 inhibitors to patients with?

Answer 15

hypotension (or taking alpha blocker) b/c double dilation

Question 16

major difference between sildenafil and tadalafil

Answer 16

tadalafil is longer acting

Question 17

injection tx and suppositories contain ____ as the active ingredient and have the common side effect of _____ (which is more effective?)

Answer 17

alprostadil (prostaglandin); penile pain; injection much more effective

Question 18

vacuum erection devices are effective in patients with?

Answer 18

prostatectomy

Question 19

patient satisfaction is greatest with ____ tx for ED

Answer 19

inflatable penile prosthesis

Question 20

diagnosis of hypogonadism

Answer 20

low serum testosterone (less than 350) + symptoms

Question 21

causes of extremely low testosterone (<100)

Answer 21

anabolic steroids, pituitary adenoma, neoplasm

Question 22

high risk conditions for TRT

Answer 22

metastatic or active prostate cancer, male breast cancer, erythrocytosis, possible prostate cancer, uncompensated heart failure

Question 23

cheapest TRT is ____; most common and most expensive TRT is _____

Answer 23

injection; transdermal gel