Erectile dysfunction

Question 1

Definition of erectile dysfunction?

Answer 1

inability to achieve or maintain an erection for >3 months

Question 2

What drug has the least likely to cause erectile dysfunction?

Answer 2

furosemide
testosterone-abuse=no

Question 3

How does an erection happen?

Answer 3

stimulation= release of acetylcholine= more cGMP= nitric acid= relaxation of corpora= fills with blood

Question 4

General causes of ED?

Answer 4

vascular disease, hormonal disease, neurologic disease, psychogenic, meds

Question 5

What lifestyle choices increase ED risk?

Answer 5

smoking, obese, sedentary

Question 6

What is ED an early sign of?

Answer 6

CAD

Question 7

A condition that is most linked with ED?

Answer 7

Diabetes

Question 8

What therapy changes are needed if DM and ED?

Answer 8

higher doses of PDE5i

Question 9

What are some neurological causes of ED?

Answer 9

spine injury, stroke, parkinsons, MS, epilepsy, neuropathies

Question 10

Hormonal causes of ED?

Answer 10

hypothalmic, thyroid issues, hyperprolactemia

Question 11

What drugs cause hyperprolactemia?

Answer 11

cimetidine, ranitidine, methyldopa

Question 12

What general drugs cause ED?

Answer 12

anticholinergic, suppress mental, reduce blood flow to penis

Question 13

Nonpharm for ED?

Answer 13

stop smoking
no alcohol
improve diet/exercise
psychotherapy

Question 14

How do PDE5i work?

Answer 14

stops PD innactivating cGMP= more nitrates

Question 15

Which PDE5 is more efficacious?

Answer 15

all the same

Question 16

IN regards to future doses what can we say about efficacy?

Answer 16

improved success with more doses

Question 17

How long should trial of PDE5 be?

Answer 17

6-8 times

Question 18

WHich PDE5 takes the longest to work?

Answer 18

tadalifil

Question 19

Which PDE% lasts the longest?

Answer 19

tadalifil

Question 20

Which PDE5 has less absorption with high fat meal?

Answer 20

vardenafil

Question 21

Which PDE5 has less Tmax with high fat meal?

Answer 21

sildenafil

Question 22

WHich PDE5 does not need renal adjustment?

Answer 22

vardenafil

Question 23

What CYP metabolizes PDE5?

Answer 23

3A4, 2C9(sildenafil/vardenafil)

Question 24

Contraindication with PDE5?

Answer 24

nitrates

Question 25

How long to wait to use nitrospray if used sildenafil, tadalfil?

Answer 25

sildenafil- 24 hours tadalafil- 48 hours

Question 26

interactions with PDE5?

Answer 26

ketoconazole, erythromycin, grapefruit

Question 27

What conditions should you avoid PDE5?

Answer 27

recent stroke/MI, unstable angina, bad HF,

Question 28

S/e of PDE5?

Answer 28

headache, fatigue, flushing, dizzy,

Question 29

WHich PDE5 causes more colour vision changes?

Answer 29

Sildenafil

Question 30

WHich PDE5 causes more back pain?

Answer 30

tadalafil

Question 31

WHich PDE5 causes more hypotension changes?

Answer 31

sildenafil

Question 32

Serious s/e of PDE5?

Answer 32

unilateral hearing loss NAION-eye issues priapism, chest pain

Question 33

WHat to do if no effect on PDE5?

Answer 33

when was it taken (enough time) with food? increase dose or switch

Question 34

How does alprostadil work?

Answer 34

increases production of cGMP

Question 35

How is alprostadil administered?

Answer 35

injection intraurethral insert

Question 36

How long does alprostadil?

Answer 36

10 min onset lasts for 1 hour

Question 37

Max use of alprostadil?

Answer 37

3x/week

Question 38

Special administration instruction for intraurethral?

Answer 38

empty bladder first

Question 39

s/e of alprostadil?

Answer 39

penile fibrosis urethral pain dizzy headache

Question 40

Issues with alprostadil?

Answer 40

priaprism is more common

Question 41

How does papaverine work?

Answer 41

stops PD and increase cGMP

Question 42

Onset and duration of papaverine?

Answer 42

10 min 1 hour

Question 43

max use of papaverine?

Answer 43

3 x a week or 2 times in succession

Question 44

Issue with papaverine?

Answer 44

bad s/e of fibrosis, hypotension, hepatotoxicity

Question 45

How does phentolamine work?

Answer 45

alpha blocker to increase cholinergic= better filling

Question 46

Issue with phentolamine?

Answer 46

no monotherapy only combo

Question 47

S/e of penis pump?

Answer 47

numb, cold, blue

Question 48

Are PDE5 helpful for female sex dysfunction?

Answer 48

no maybe if caused by SSRI

Question 49

What is flibanserin for?

Answer 49

hypoactive sexual desire disorder

Question 50

s/e of flibanserin?

Answer 50

dizzy, nausea, bad fainting and hypotension

Question 51

Is flibanserin worth it?

Answer 51

1 extra sexual satisfying event per month