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443-SRH and MSK > erectile dysfunction > Flashcards

erectile dysfunction Flashcards

1
Q

interpersonal relationship among 2 people in romantic relationship, who may or may not be actively engaged in sexual relations

A

intimacy

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2
Q

experience of pleasure from one’s senses leading to an increased awareness of an appreciation for one’s own body

A

sensuality

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3
Q

any combination of sexual behaviour, sensual activity, emotional intimacy, or sense of sexual identity (a bio-psyco-social process + cultural and interpersonal factors)

A

sexuality

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4
Q

consistent or recurrent inability of male to attain and maintain an erection of the penis sufficient to permit satisfactory sexual intercourse

A

ED

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5
Q

inability of male to perform sexual act

A

impotence

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6
Q

dick changes with aging

A

Arousal becomes delayed, less rigidity in erection
Weaker, shorter orgasms
Prolonged plateau and diminished urge to ejaculate
More rapid detumescence with a prolonged refractory period

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7
Q

physiology of a flaccid penis

A

SNS
arterial and smooth muscle contracted

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8
Q

physiology of an erect penis

A

PNS
NO primary mediator
vasodilation + decrease in peripheral vascular resistance

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9
Q

pulmonary RF for ED

A

COPD, OSA

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10
Q

endocrine RF for ED

A

hypogonadism (meh), DM, obesity

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11
Q

CV RF for ED

A

HPTN, hypercholesterolemia, vascular disease, strole

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12
Q

why is a man with ED a cardiac pt until proven otherwise

A

endothelial dysfunction leads to ED leads to early death

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13
Q

lfiestyle RF for ED

A

obesity
sedetary lifestyle
bike riding
smoking, alcohol
shift work
poor diet

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14
Q

COVID can cause ED through mechs like

A

endothelial dysfxn, psyc distress, impaired pulmonary hemodynamics, exacerbation of CV diseases, impact on T levels, sensory loss

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15
Q

what Anti-HPTN drugs worsen ED? which would be chosen instead

A

worsen: BB, thiazides, aldosterone antagonists, centrally acting
better: CCB, ARB, ACEi

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16
Q

what hormone affecting drugs worsen/ cause ED

A

antiandrogens: spironolactone, cimetidine
CS, E, P, GnRH agonists, 5alpha reductase inhibitors

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17
Q

which psyc meds worsen ED

A

SSRIs, SNRIs, TCAs, MAOi, 1st gen neuroleptics, risperidone

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18
Q

which psyc meds are preferred for ED

A

buproprion, mirtazapine, quetiapine, olanzapine, aripiprazole

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19
Q

list 3 assessment tools for ED

A

SQoL assessment, self esteem and relationship questionnaire (SEAR), erectile dysfunction inventory of tx satisfaction (EDITS), # of events (penetration, attempts), international index of erectile function (IIEF)

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20
Q

what are first line ED tx

A

PDE5i, psychotherapy

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21
Q

what are second line ED tx

A

IV inj, intraurethral suppositories, vacuum erection device

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22
Q

nonpharm ED tx

A

Counseling of both partners
Lifestyle: smoking cessation, avoid EtOH, substance misuse, healthy diet, exercise, adequate sleep

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23
Q

pharm classes for ED

A

PDE1
prostaglandin E1
MUSE
injections
trazodone

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24
Q

PDEi response for ED is ____ in diabetics

A

lower

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25
Q

PDEi response is ______ dependent

A

dose

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26
Q

PDEi SEs

A

flushing, headache, dyspepsia, nasal congestion, visual disturbances (more with sildenafil)

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27
Q

PDE5i may increase risk of

A

malignant malenoma or basal cell carcinoma

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28
Q

PDEi eye safety

A

nonarteritic anterior ischemic optic neuropathy (NAION)
new/ worsening glaucoma
change in colour perception

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29
Q

how do PDEi change colour perception

A

PDE6 interacts with sildenafil in retina for blue tinged vision

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30
Q

what is NAION

A

Non-arteritic anterior ischemic optic neuropathy (NAION): acute ischemia of optic nerve, infarct may result, visual field defect or vision loss may occur
Counsel pt to inform MD if experiencing vision loss

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31
Q

what is an absolute contraindication for PDE5i

A

nitrates

32
Q

CV effects of sildenafil may be potentially hazardous in include (5)

A

active coronary ischemia (not on nitrateS)
CHF and boarderline low BP
boarderline low volume status
complicated, multidrug AHA regimen
meds that can prolong half life (P450 3A4i, 2C9i)

33
Q

PDEi should monitor for dizziness with

A

alpha antagonists

34
Q

how long to trial PDEi

A

4 mths

35
Q

what is the only PDEi you can use on demand

A

tadalafil 20mg

36
Q

how long before sex to take sildenafil

A

30min-4hrs

37
Q

how long before sex to take tadalafil

A

stat = 20mg (max 3x/wk)
15min-36h if 5mg daily

38
Q

how long before sex should you take vardenafil

A

15min-4hrs

39
Q

which PDEi have their Cmax decreased with high fat meal

A

sildenafil, verdenafil

40
Q

which PDEi is most associated with visual disturbances

A

sildenafil

41
Q

prostaglandin E MOA

A

↑ cAMP = SM relaxation, vaso occlusion, erection (endogenous NO not required)

42
Q

how long before sex to inject Prostaglandin E1

A

<1hr, erection can occur within 5min

43
Q

max usage of sildenafil

A

1dose/d

44
Q

max use of vardenafil

A

1dose/day

45
Q

max use of tadalafil

A

3 on demand 20mg doses/ week
one 5mg/day

46
Q

max use of PGE1

A

1 dose/24h, 3 doses/wk

47
Q

when are PGE1s used

A

when systemic therapies are CI
- inject into area instead

48
Q

PGE1 AEs

A

penile pain, priapism

49
Q

PGE1 contraindications

A

any condition that increases the risk of priapism (sick cell anemia, multiple myeloma, leukemia, anatomical penile deformity)

50
Q

MUSE is

A

alprostadil- a PGE1

51
Q

what should you use for ED pts who refuse injections + failed on PDEi

A

MUSE

52
Q

aloprostil AEs (MUSE)

A

penile pain, urethral burring, vaginal irritation for partner

53
Q

which meds are used for ED injections

A

papaverine
phentolamine
PGE1

54
Q

what is triple therapy for ED

A

papaverine
phentolamine
PGE1

55
Q

papaverine is a _____ with MOA ______

A

nonspec PDEi
↑cAMP and cGMP in penile erectile tissue

56
Q

papaverine SEs

A

penile fibrosis, potential hepatotoxicity

57
Q

phentolamine is a ___________ and blocks ___________

A

alpha 1,2 selective antagonist
blocks sympathetic receptors that controls tone

58
Q

drawbacks of injections for ED include

A

nonspontaneous, manual dexterity, eyesight, priapism, fibrosis, dropout/ adherence

59
Q

trazodone MOA for ED

A

facilitates 5HT and DA pathways

60
Q

trazodone SEs

A

priapism, sedation

61
Q

which NHPs are used for ED

A

yohimbine
panax gingseng
butea superba
L-arginine

62
Q

Yohimbine MOA

A

a2-antagonist, acts at brain center to control libido, penile erection

63
Q

yohimbine is used for ____ ED with evidence of ____

A

psychogenic ED
mixed evidence but superior to placebo

64
Q

panex gingseng MOA

A

increase cGMP + relaxation of corpus cavernosum

65
Q

role of panax ginseng

A

psyc ED

66
Q

which NHP is not recommended rn for ED
1. yohimbine
2. panax ginseng
3. butea superba
4. L0arginine

A

3

67
Q

L-arginine MO for ED

A

NO production

68
Q

role of L arginine in ED

A

use with PDE5i if resistant

69
Q

most effective tx for ED
1. PDEi
2. penile devices
3. penile prosthesis
4. NHPs like yohimbine

A

2

70
Q

how to monitor for efficacy of ED tx

A

dose required, number and quality of erections after taking meds
internationl index of erectile function
secual encounter profile

71
Q

what is classified as priapism

A

Unwanted erection lasting >4hrs + not associated with sexual desire

72
Q

what is the danger with priapism

A

if >36hrs = permanent ED
better chances if restoring normal fxn if ER fast

73
Q

what is the most common type of priapism

A

low flow

74
Q

tx of priapism

A

early stage = ice packs and cold showers
analgesia
decompression (remove at least 5ml)
intracavernosaal sympathomimetics
oral sympathomimetics
shunt surgery

75
Q

what re some Intracavernosal sympathomimetics you can use in priapism

A

phenylephrine for rapid vasoconstriction

76
Q

what oral sympathomimetics can be given for priapism

A

terbutaline po 5-10mg, pseudoephedrine po
caution CV risk

443-SRH and MSK (24 decks)

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