Erectile Dysfunction Flashcards
Which drugs can cause ED?
Antihypertensives
Antipsychotics/antidepressants
Androgen deprivation
Tobacco
Alcohol
What are the most common arteriogenic causes of ED?
CVD
Iatrogenic
Trauma
What the options if PDE5 inhibitors fail?
Intra-cavernosum injection to directly cause vasodilation Penis pump - sucks venous blood in and bands around base Implanted, inflatable devices that sit in the cavernosal body
What is Peyronie disease?
Weakening of the cavernosum due to plaques causing ED
What do you elicit on Hx?
Sexual Hx - ?Partner specific, Libido, premature ejaculation Nocturnal erection
CVD risk factors
Psychiatric Hx
Endo Hx
Partner Hx
What do you do Ix for ED?
Fasting glucose Fasting cholesterol ECG Testosterone, LH, and prolactin TFT’s PSA
What is the most common cause ED overall?
Arteriogenic
What are the common side effects of PDE5 inhibitors
Headaches - tolerance develops
What are the organic causes of ED?
Vasculogenic (arteriogenic, cavernosal, mixed)
Neurogenic
Anatomic
Endocrinologic
How do you treat ED?
Correct underlying disease if possible
Phosphodiesterase inhibitors (viagra) - most response to it
What do you do on Ex for ED?
Systemic disease
External genitalia
DRE
What is the most common cause of ED in patients in the 20s?
Psychogenic
Why might PDE5 inhibitors failed?
Failure to use adequate sexual stimulation
Failure to use adequate dose
Failure to wait long enough from dosing to sexual stimulation
Which drugs are interact with PDE5 inhibitors? Why?
Nitrates
Risk of hypotension due to vasodilation
How can neurogenic causes be organised?
Central
Spinal
Peripheral
