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F3 E1 Shea > ED 2 > Flashcards

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
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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
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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
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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
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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
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6
Q

Which med is NOT significantly better than a placebo?

A

Yohimbine

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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
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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
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9
Q
A
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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
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11
Q

5 risks of penile injection

A
  • pain
  • infection
  • bleeding
  • fibrosis –> curvature (alternate sides)
  • Priapism
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12
Q

A true urologic emergency as a result of penile injection

  • pain
  • stasis
  • hypoxia to cavernosal tissues
  • acidosis
  • fibrosis
  • ED
A

Priapism

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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
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14
Q

Which tx?

  • Tx for venous leakage
  • Adjustable size
  • Should be easily removed
A

constriction ring

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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)
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17
Q

Penile prosthesis

  • Surgical implantation of rods into penile shaft to increase rigidity
  • 2 types?
A
  • Non-inflatable
  • inflatable
18
Q

Penile Prosthesis

  • Non-inflatable (malleable or semi-rigid)
    • __ rods, surgically implanted in L/R penile shaft
    • Can be ___ into and out of position (“_____”)
A
  • 2
  • bent
  • “goose-neck lamp”
19
Q

Penile Prosthesis

  • Inflatable penile prosthesis (IPP)
    • 2 rods
    • Reservoir placed in ____, behind ____
    • Pump placed in ____ to transfer fluid from reservoir to rods
    • All _____
    • 4 Complications?
A
  • abdomen / abd muscles
  • scrotum
  • internal
  • erosion, infection, auto-inflation, mechanical failure
20
Q

Penile Revascularization Surgery

  • Indicated for ______
  • _____ as arterial supply
  • Anastomosis of _____ to ______
A
  • focal arterial occlusion of cavernosal artery
  • inferior epigastric artery
  • inferior epigastric artery –> dorsal penile artery
21
Q

Office visit for ED is an opportunity to discuss what 2 things?

A
  • CV disease
  • Motivation for lifestyle changes

F3 E1 Shea (14 decks)

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