ED 2 Flashcards
1
Q
Phosphodiesterase 5 Inhibitors
- ____ are contraindicated
- _____: give lowet dose of each and separate doses 6 hours apart
A
- Nitrates
- Alpha blockers
- tamsilosin in AM
- viagra in PM
2
Q
8 SE of PDE-5-I
A
- Nasal congestion
- Facial flushing
- HA
- Dyspepsia
- back pain/myalgia
- Visual changes* (blue halo)
- Loss of vision (non-arteritic anterior ischemic optic neuropathy, NAION)
- Priapism
3
Q
What are the 4 PDE-5-I drug names and which causes back pain and lasts 36 hours?
A
- Sildenafil
- Tadalafil ** 36 hr / back pain
- Vardenafil
- Avanafil
4
Q
PDE-5-Inhibitors
- __ - __ mins before sexual activity
- Avoid taking after ____
- _____ needed
- Allows erection to be sustained. DOES NOT initiate erection
A
- 30-60
- meals (except for Tadalafil)
- Physical stimulation
5
Q
Which PDE-5-I?
- Approved for daily dosing for BPH & ED
Has longer half life - When used as PRN, med stays in system for ___
- More likely to have _____ as a SE
A
Tadalafil
- 36
- back pain
6
Q
Which med is NOT significantly better than a placebo?
A
Yohimbine
7
Q
Vacuum Erection Device (VED)
- Cylinder placed over penis
- Vacuum created
- Increased arterial blood flow into _____ (against lowered resistance)
- Constricting ring placed _____
- Intercourse
- Remove ____ (DO NOT ____)
A
- corpora cavernosa
- at base of penis
- constricting ring / fall asleep w/ ring on
8
Q
Medicated Urethral System for Erection (MUSE)
- Urethral suppository
- Name of med?
- Increases intra-cellular ____ –> decreased intracellular ___ –> cavernosal artery vasodilation
- Onset __ - __ mins after dosing
- 1st done under medical supervision (3% hypotension)
A
- Alprostadil
- c-AMP –> Calcium
- 5 - 20 mins
9
Q
A
10
Q
Penile Injection
- Injection of vasodilatory medication directly into ______
- Inject shaft on ____ side(s) prior to sexual activity
- 3 combo?
- Instruction/1st dose done under medical supervision. ____ dose at home
- Not to exceed __ doses / week
A
- corpus cavernosum
- one
- Prostaglandin E1 + Phentolamine + Papaverine = vasodilation
- titrate
- 3
11
Q
5 risks of penile injection
A
- pain
- infection
- bleeding
- fibrosis –> curvature (alternate sides)
- Priapism
12
Q
A true urologic emergency as a result of penile injection
- pain
- stasis
- hypoxia to cavernosal tissues
- acidosis
- fibrosis
- ED
A
Priapism
13
Q
Tx for priapism after penile injection (4 steps)
- What are the 3 goals?
A
- Placement of 18-19 gauge needle into corpus cavernosum
- Aspiration of cavernosal blood
- Infusion of saline
- Injection of phenylephrine (vasoconstrictor)
(May require surgery to create a shunt)
- Goal: prevent fibrosis, prevent loss of cavernosal tissue, prevent recurrent priapism
14
Q
Which tx?
- Tx for venous leakage
- Adjustable size
- Should be easily removed
A
constriction ring
15
Q
Which tx?
- Circumferential ring placed at base of glans (corona)
- Attaches to ridid bar going along underside (____) of penile shaft
- Bar attaches to a circumferential ring at penile base
- Sized to pt
- ____ state not required
A
Penile Splint
- anterior
- tumescent (erect / engorged)
