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afsha Pre- Reg > ED not finished > Flashcards

ED not finished Flashcards

1
Q

erectile dysfunction may be a side effect of which drugs? (5)

A
  • ADs
  • Antihypertensives
  • Cytotoxic drugs
  • Recreational drugs (incl alcohol)
  • Antipsychotics
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2
Q

5 risk factors for ED

A
  • sedentary lifestyle
  • obesity
  • smoking
  • hypercholesterolaemia
  • metabolic syndrome
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3
Q

which of the following is NOT a risk factor for erectile dysfunction
- smoking
- alcohol and recreational drug use
- being underweight
- hypercholesterolaemia
- metabolic syndrome

A

being underweight

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4
Q

true or false - ED increases risk of CVD

A

true

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5
Q

If a man has unexplained ED, what should you do?

A

ED increases risk of CVD
if unexplained ED, evaluate pt for presence of CV RF and address any unidentified risk

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6
Q

4 lifestyle changes in pt with ED

A
  • smoking cessation
  • reduce alcohol
  • regular exercise
  • reduce BMI if obese/overweight
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7
Q

recommended approach in management of ED

A

combination of drug treatment and lifestyle changes e.g. smoking cessation, regular exercise, reduce BMI, reduce alcohol

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8
Q

this drug class is 1st line for ED, regardless of cause

A

phosphodiesterase type 5 inhibitor

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9
Q

MOA for PPD type 5 inhibitor for ED

A

increases blood flow to penis

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10
Q

true or false - mechanism of action of PPD type 5 inhibitors is that they increase blood flow to penis. this will initiate an erection

A

FALSE
MOA part is true however they DO NOT stimulate an erection; sexual stimulation is required

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11
Q

true or false - there is some short acting and some long acting PPD type 5 inhibitors. Choice depends on frequency of intercourse and response to treatment

A

True

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12
Q

The following are short acting PPD type 5 inhibitors and are suitable for occasional use as required (3)

A

avanafil
sildenafil
vardenafil

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13
Q

the following (1) is a longer acting PPD type 5 inhibitor and can be used as required, but also can be given as a regular lower daily dose to allow for spontaneous (rather than schedules) sexual activity, or in those who have frequent sex

A

tadalafil

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14
Q

true or false - tadalafil can be given as a regular low daily dose to allow for spontaneous sex, rather than scheduled. it is long acting

A

true

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15
Q

tadalafil - long or short acting

A

long

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16
Q

how many doses of a PPD type 5 inhibitor should a patient have at the max dose (WITH sexual stimulation) before being classified as a non-responder?

A

6 doses

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17
Q

What to do with a patient who fails to respond to the max dose of 2 different PPD type 5 inhibitors (at least 6 doses at max dose)?

A

refer to specialist

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18
Q

1st line for all ED regardless of cause is PPD type 5 inhibitors. What is 2nd line and when can it be given

A

under careful medical supervision only
intracavernosal, intraurethral or topical application of alprostadil (PG E1)

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19
Q

true or false - intracavernosal or intraurethral preparations of alprostadil can be used to aid DIAGNOSIS

A

true

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20
Q

what is priapism

A

prolonged erection

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21
Q

discuss priapism associated with alprostadil

A
  • seek medical help if prolonged erection lasting 4 or more hours
  • apply ice pack to upper inner thigh (alternating between R and L every 2 mins for up to 10 mins) can result in reflex opening of venous valves
  • if it has lasted for more than 6 hours, urgent treatment must be given; cannot be delayed
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22
Q

what type of drug is alprostadil

A

prostaglandin analogue

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23
Q

name the different steps in managing priapsim that has lasted >6 hours

(4 steps)

ALIS

A
  1. penile aspiration
  2. lavage if above unsuccessful
  3. intracavernosal injection of sympathomimetic with action on alpha adrenergic receptors can be given with continuous monitoring of BP and pulse (all unlicensed - adrenaline, phenylephrine etc) ((if necessary, the injections can be followed by further aspiration)
  4. if this is still unsuccessful, urgent referral for surgical management.
24
Q

cialis is brand name for which drug

A

tadalafil

25
Q

how long can cialis be effective for

A

tadalafil - long acting
can be effective for up to 36h

26
Q

when should you take cialis

A

at least 30 mins before hoping to get an erection

27
Q

avoid this whilst taking cialis as it affects how well it functions

A

alcohol

28
Q

how many tabs of cialis can you take in 24h

A

max 1
never combine with other ED meds

29
Q

cialis strengths available

A

10mg
20mg
cialis daily: 2.5mg, 5mg

30
Q

what is cialis daily, who is it a good option for, and how to take, and when should you notice the effect

A

lower strength (2.5mg,5mg) taken daily
- good option if sex at least 2x/week
- take at same time everyday
- max one tablet daily, do not combine with other ED meds
- should notice effect within 3-5 days

31
Q

common SE cialis

A

headache
flushing
lightheaded
stuffy nose
indigestion
pounding heartbeat

32
Q

True or false - a potentially serious, but uncommon side effect of cialis is chest pain

A

true

33
Q

what to do if chest pain with cialis

A

uncommon SE but can be potentially serious
if chest pain occurs, get in a semi-sitting position and try to relax by breathing deeply
- if still present >15mins, call 999

34
Q

important counselling with any DDP 4 inhibitors, including OTC - do not take with ..

A

grapefruit juice

35
Q

2 drug condraindications for DDPT5I (1 recreational)

A
  • poppers
  • nitrate based med e.g. isosorbide or GTN - could result in fatal drop in BP
36
Q

Do not take cialis if …

A

○ Allergy
○ Taking any form of nitrate - cialis increases the effects of these meds
○ Serious heart disease or recent heart attack within last 90 days
○ Stroke within last 6 months
○ Low BP or uncontrolled high BP
○ Ever had loss of vision due to NAION (aka stroke of the eye)
○ Taking riociguat (used to treat pulmonary arterial hypertension and chronnci TE pulmonary hypertension) - cialis increases the effect of these

37
Q

A patient has PHx stroke, 5 years ago. Can they take cialis?

A

Yes
Only contraindicated if recent stroke or serious heart disease or recent MI within 90 days

38
Q

Counselling point for PDD type 5 inhibitors - can make you

A

drowsy
caution machinery driving etc

39
Q

who can OTC viagra/cialis be sold to - age

A

18 and over only

40
Q

instructions on when to take viagra

A

one tablet 1h before sex, swallow whole with water

41
Q

how long does viagra take to work

A
  • Works within 30-60mins, can take it up to 4h before sex
42
Q

if taken after a meal high in this ….. it can take longer for viagra to work

A

fat

43
Q

avoid this juice with silfenafil/viagra

A

grapefruit

44
Q

when should avanafil be taken

A

15-30 min before sex

45
Q

max dose avanafil with concurrent use of moderate inhibitors of CYP3A4

A

Max 100mg once every 48h with concurrent use of moderate inhibitors of CYP3A4

46
Q

contraindications to avanfil

A

○ Systolic BP <90
○ BP >170/100
○ Hereditary retinal disorders
○ Hx NAION (aka stroke of eye)
○ Life threatening arrhythmia in previous 6 months
○ Mild to severe HF
○ Not advised to have sex/vasodilation
○ Recent Hx MI
○ Recent Hx stroke
Recent unstable angina

47
Q

can you take avanafil if on an alpha blocker

A

Alfuzosin, doxazosin, terazosin causes significant hypotensive effects when given with avanafil, stabilise on first drug then add second drug at llowest recommended dose

48
Q

can you take avanafil with potent inducers/inhibtiors

A

○ clarithromycin, itraconazole, ketoconazole, voriconazole, ritonavir predicted to increase exposure to avanafil, avoid
Carbamazepine, fosphenytoin, phenobarbital, phenytoin, primidone, rifampicin, predicte to decrease exposure to avanafil, avoid

49
Q

why should grapefruit juice be avoided

A

Caution or avoid grapefruit predicted to increase exposure

50
Q

Patient would like to be commenced on a PPD5 inhibitor. Their current medication list is as follows. October 2024 new rx for: Omeprazole 20, ramipril 5, clopidogrel 75, aspirin 75, atorvastatin 80, bisoprolol 2.5. Which one would you give?

A

CI in recent MI, stroke, or unstable angina. From his medication, seems as if he has recently had MI because of the 4 drugs for secondary prevention: BB, statin, DAT, ACE

51
Q

Avoid all PPD5 inhibitors if systolic BP

A

below 90

52
Q

onset of PPd4 inhibtors may be delayed if

A

taken with food

53
Q

when to take avanafil, sildenafil, tadalfil and vardenafil before sex

A

avanafil: 15-30mins
sildenafil: 1 hour
tadalafil: 30 mins
vardenafil: 25-60 mins

54
Q

common SE

A

vasodilation
flushing
headache
nasal congestion
hypotension
drowsiness
GI discomfort

55
Q

When to take before sex
A tiger vanished suddently

A

A = 15-30
T - 30
V and S = 60

afsha Pre- Reg (24 decks)

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