Erectile dysfunction Flashcards
What are the risk factors for erectile dysfunction? (5)
Sedentary lifestyle Obesity Smoking Hypercholesterolaemia Metabolic syndrome
Erectile dysfunction increases the risk of (?) disease.
cardiovascular
All men with unexplained erectile dysfunction should be evaluated for the presence of (?) and any identified risk should be addressed.
cardiovascular risk factors
What is the first-line drug treatment for erectile dysfunction?
Oral phosphodiesterase type-5 inhibitor
In the treatment of erectile dysfunction, oral phosphodiesterase type-5 inhibitors act by …
increasing the blood flow to the penis
They do not initiate an erection—sexual stimulation is required.
Name 3 short-acting oral phosphodiesterase type-5 inhibitors
Avanafil
Sildenafil
Vardenafil
Avanafil, sildenafil and vardenafil are (?)-acting phosphodiesterase type-5 inhibitors
short
Name one longer-acting oral phosphodiesterase type-5 inhibitor
Tadalafil
Tadalafil is a (?)-acting phosphodiesterase type-5 inhibitor
longer
If a patient with erectile dysfunction would like to have spontaneous (rather than scheduled) sexual activity or has frequent sexual activity, which oral phosphodiesterase type-5 inhibitor would be preferred?
Tadalafil
Longer-acting drug that can be used as a regular lower daily dose
A patient with erectile dysfunction should receive (?) doses of an individual phosphodiesterase type-5 inhibitor at the maximum dose (with sexual stimulation) before being classified as a non-responder.
six
A patient with erectile dysfunction should receive six doses of an individual phosphodiesterase type-5 inhibitor at the maximum dose (with (?)) before being classified as a non-responder.
sexual stimulation
A patient with erectile dysfunction should receive six doses of an individual phosphodiesterase type-5 inhibitor at the maximum dose (with sexual stimulation) before being classified as a (?).
non-responder
What is a second-line therapy for erectile dysfunction?
Alprostadil (prostaglandin E1) by intracavernosal, intraurethral or topical application
Patients should be advised to seek medical help if a prolonged erection lasting (?) occur
4 or more hours
If a patient has a prolonged erection, what can they do at home that may help by opening the venous valves?
Apply an ice pack to the upper-inner thigh (alternating between left and right thighs every two minutes for up to 10 minutes)
If priapism has lasted more than 6 hours, treatment should not be delayed. What is the initial therapy?
Penile aspiration
Using aseptic technique, 20–50mL of blood should be aspirated using a 19–21 gauge butterfly needle inserted into the corpus cavernosum; if necessary the procedure may be repeated on the opposite side
Adrenaline/epinephrine:
Acts on both (?) and (?) receptors and increases both heart rate and contractility (beta1 effects); it can cause peripheral vasodilation (a beta2 effect) or vasoconstriction (an alpha effect).
alpha
beta
Adrenaline/epinephrine:
Acts on both alpha and beta receptors and increases both (?) and (?) (beta1 effects); it can cause peripheral vasodilation (a beta2 effect) or vasoconstriction (an alpha effect).
heart rate
contractility
Adrenaline/epinephrine:
Acts on both alpha and beta receptors and increases both heart rate and contractility ((?) effects); it can cause peripheral vasodilation (a beta2 effect) or vasoconstriction (an alpha effect).
beta-1
Adrenaline/epinephrine:
Acts on both alpha and beta receptors and increases both heart rate and contractility (beta1 effects); it can cause (?) (a beta2 effect) or vasoconstriction (an alpha effect).
peripheral vasodilation
Adrenaline/epinephrine:
Acts on both alpha and beta receptors and increases both heart rate and contractility (beta1 effects); it can cause peripheral vasodilation (a (?) effect) or vasoconstriction (an alpha effect).
beta-2
Adrenaline/epinephrine:
Acts on both alpha and beta receptors and increases both heart rate and contractility (beta1 effects); it can cause peripheral vasodilation (a beta2 effect) or (?) (an alpha effect).
vasoconstriction
Adrenaline/epinephrine:
Acts on both alpha and beta receptors and increases both heart rate and contractility (beta1 effects); it can cause peripheral vasodilation (a beta2 effect) or vasoconstriction (an (?) effect).
alpha
What is the indication for the use of alprostadil?
Erectile dysfunction
Name 3 conditions that have a predisposition to priapism
Sickle cell disease
Multiple myeloma
Leukaemia
CAUTION when prescribing phosphodiesterase type-5 inhibitors
When may phosphodiesterase type-5 inhibitor prescriptions be potentially potentially inappropriate in the elderly (STOPP criteria)? (2)
Severe heart failure characterised by hypotension (systolic BP < 90)
Concurrent nitrate therapy for angina (risk of cardiovascular collapse)
What are the two indications for the use of metaraminol?
Acute hypotension
Priapism
What three drugs given via intracavernosal injection can be used if penile aspiration and lavage are unsuccessful in treating priapism?
Phenylephine hydrochloride
Adrenaline/epinephrine
Metaraminol
All are unlicensed for this indication
What are the three indications for the use of phenylephrine hydrochloride?
Mydriasis
Acute hypotension
Priapism
What are the three indications for the use of sildenafil?
Pulmonary arterial hypertension Erectile dysfunction Digital ulcers (associated with systemic sclerosis)
What are the contraindications for the use of sildenafil? (8)
- Hereditary degenerative retinal disorders
- History of non-arteritic anterior ischaemic optic neuropathy
- Recent MI
- Recent stroke
When used for erectile dysfunction
- Systolic BP < 90
- If vasodilation or sexual activity are inadvisable
- Recent unstable angina
When used for pulmonary arterial hypertension
8. Sickle cell anaemia
What are the common side effects of sildenafil? (20)
Alopecia Anaemia Anxiety Cough Diarrhoea Dizziness Fluid retention GI discomfort GI disorders Headaches Increased risk of infection Insomnia Nasal complaints Nausea Night sweats Pain Skin reactions Tremor Vasodilation Vision disorders
The onset of phosphodiesterase type-5 inhibitors when used for erectile dysfunction may be delayed if taken with (?)
food
What are the three indications for the use of tadalafil?
Pulmonary arterial hypertension
Erectile dysfunction
Benign prostatic hyperplasia
What is the indication for the use of vardenafil?
Erectile dysfunction
