ED, BPH, Urinary Incontinence Flashcards
what is the most common cause of ED
decreased blood flow
diseases: DM, HTN, Heart Dz
what are other causes of ED
Hormone- low testosterone
Psychological-Stress, anxiety,depression
what meds cause sexual dysfunction
BP Med Antipsychotics Antidepressants BPH Opiods Nicotine Excess alcohol
What is the #1 reason people stop SSRI or SNRI?
sexual dysfunction
what is the goal of therapy with ED tx?
increase quantity and quality of sex
Tx should not be used for pt’s without ED!!!
What are physical Tx for ED?
lifestyle modifications if no effect then use devices or meds
How do you Tx psychological ED?
psychotherapy or Behavioral therapy
How do you tx drug ED?
D/C offending agent or reduce dose of offending agent
Patient with organic ED was prescribed oral PDEi and has been ineffective, what is the next treatment option?
Intracavernosal therapy
What are the 2 tx options for Organic ED
Oral PDEi & Vacuum erection device
What is the onset of:
Sildenafil, Vardenafil, Tadalafil
Sildenafil: 30min- 1hr
Vardenafil: 1hr
Tadalafil: 2hr
If patient’s current tx of intracavernosal therapy is not working, what can be considered next?
intraurethral alprostadil
Which drug is a PDE-6 inhibitor
Sildenafil, Vardenafil, Tadalafil?
Sildenafil (Viagra)
Vardenafil (Levitra)-minimally
What is the onset of:
Sildenafil, Vardenafil, Tadalafil
Sildenafil: 30min- 1hr
Vardenafil: 1hr
Tadalafil: 2hr
What is the MOA of PDEi?
they inhibit PDE enzymes which slows the breakdown of cGMP, allowing for the depression of Ca++ which results in smooth muscle relaxation leading to an erection
What is the Duration of:
Sildenafil, Vardenafil, Tadalafil
Sildenafil: 4hr
Vardenafil: 4hr
Tadalafil: 24-36hr
What are some Rx unapproved agents used in the treatment of ED?
Phentolamine
Papaverine
Trazodone
What does the depression of Ca++ cause?
Smooth muscle relaxation resulting in an erection
What are the 2 drug to drug interactions for PDEi’s?
ETOH and Nitrates
What are the 2 rare, yet serious ADRs?
Non-arteritic anterior optic neuropathy (NAION) & priaprism
What are some Rx unapproved agents used in ED?
Phentolamine
Papaverine
Trazodone
what is the MOA of alprostadil?
increase cAMP
At what age does BPH affect most men?
over the age of 60
what are ADR of alprostadil?
injection site rxn
fibrous deposits
curvature of penis
what are the two types of alprostadil used in ED?
Intracavernous injections (caverject or Edex) Intraurethral (MUSE)
what is the MOA of alprostadil?
increase cAMP
what type of receptor is in the stromal and capsule layer?
α 1 receptors
What is the onset and duration of alprostadil?
onset: 5-15min
Duration: related to dose
14-44min
what are ADR of alprostadil?
injection site rxn
fibrous deposits
curvature of penis
what is the difference between Static vs. Dynamic
Static- physical block- permanent enlargement of tissue
Dynamic- muscle contaction- effect urethral lumen
what are complications of untreated BPH?
AKI Gross hematuria Overflow urinary incontinence UTI Bladder diverticula bladder stones long standing obstruction lead to renal failure
What are some PE findings that correlates with a clinical presentation of BPH?
elevated PSA (>1.4 ng/mL) elevated BUN, SCr (w/ obstruction) increased PVRV (>25-50 mL) decreased urine flow rate (<10 mL/s)
Name the 2 5-ARI’s
Finasteride & Dutasteride