ED

Question 1

What are the 4 general causes of impaired erection?

Answer 1

• Vascular,
• Neurologic,
• Psychogenic,
• Hormonal

Loss of Libido = androgen deficiency

Question 2

•What are the 3 Drug Classes that lead to ED?**

Answer 2

• Anticholinergics
• Dopamine antagonists
• Estrogens, antiandrogens

Question 3

T/F CNS depresants cause ED

Answer 3

True

Question 4

What are some misc. meds that cause ED?

Answer 4

• Finasteride, Dutasteride
• Lithium
• MAOi
• Gemfibrozil (for HLD)
• Clofibrate
• INF
• Opioids

Question 5

What is “Dry Sex” & Retrograde Ejaculation

Answer 5

• Delayed or absent ejaculation

- Ejaculate passes retrograde into the bladder, instead of toward the anterior urethra

Question 6

What are 1st line Least Invasive ED tx? (4)

Answer 6

• Vaccum erection device (onset 30 mins)
• PED5i
• Intracavernosal injections/ intraurethral inserts
• Penile prosthetics

Question 7

What are the 4 PDE5s?

Answer 7

• Sildenafil (blue vision)
• Tadalafil (back pain)
• Vardenafil
• Avanafil

Question 8

What can you not give if your patient takes a PDE5?

* this is on the test*

Answer 8

Nitrates

Question 9

Where are PDE5 receptors found besides the genitals? (3)

Answer 9

• Peripheral vascular tissue
• Tracheal smooth muscle
• Platelets (flushing, HA, congestion, dyspepsia)

Question 10

Where are PDE6 found? * think vision*

Answer 10

• Rods and cones = blurred vision

* Cyanopsia (blue vision) from Sildenafil (blue pill)*

Question 11

Where are PDE11 found? * think muscles*

Answer 11

• Striated muscle

Question 12

Which PDE5 can be taken with food?

Answer 12

Tadalafil

Question 13

T/F should Sildenafil be reduced if taken with a CYP P450 inhibitor?

Answer 13

True - keeps the drug around longer

Question 14

What are the 4 most common side effects of PDE5s?

Answer 14

• HA
• Facial Flushing
• Dyspepsia
• Dizziness

Question 15

T/F Sudden unilateral, painless blindness is also known as Nonarteritic anterior ischemic optic neuropathy (NAION)?

Answer 15

True

Question 16

What is a Side Effect of Vardenafil?

Answer 16

• Prolonged QT interval

Question 17

Priapism is mostly associated with __________ and __________. What are risk factors? (SLIM)

Answer 17

• Sildenafil and vardenafil

- RF = Sickle cell anemia, Leukemia, Multiple myeloma, Increased PDE5 usage

Question 18

How do you treat Priapism? (5)

Answer 18

• Ice packs
• Have the patient walk up stairs (arterial steal phenomenon)
• Oral Pseudoephedrine (alpha agonist)
• Aspiration of cavernosum
• Phenylephrine, epinephrine, methylene blue injection into cavernosum

Question 19

What happens if your patient is on PDE5s and takes nitrates?

What can you treat the angina with?

Answer 19

• > Severe Hypotension is the SE
• Non-nitrate containing agents
• calcium channel blockers
• adrenergic antagonist
• morphine

Question 20

When is Testosterone replacement recommended?

Answer 20

• Any hypogonadism, low libido, or low T

Question 21

T/F: Testosterone replacement regiments do not directly correct ED.

Answer 21

• True

* improves libido = corrects for secondary ED*

Question 22

Methyltestosterone or Fluoxymesterone is not recommended because…

Answer 22

• Methyl: Hepatotoxicity (first pass hepatic catabolism)

- Fluoxy: Hepatoxicity

Question 23

When should you administer the testosterone patch

Answer 23

• at bedtime

Question 24

What drug’s side effects give you mood swings, gynecomastia, polycythemia, HLD?

Answer 24

• IM Testosterone (Cypionate or Enanthate)

Question 25

When do you use Alprostadil?

Answer 25

• Cavernosal injections and Intraurethral pellets

Question 26

How does Alprostadil treat ED?

Answer 26

Increase cAMP -> reduce intracellular calcium -> relaxes smooth muscle -> erection

Question 27

What is the most invasive ED treatment?

Answer 27

• Surgical prosthesis