Erectile Dysfunction Flashcards
Medication Causes of ED
- Diuretics
- Opiates
- Dopamine antagonists
- Finasteride
- Gemfibrozil
- Spironolactone
What is the least invasive treatment for ED
Vacuum erection device
What is often the first line treatment for ED
oral phosphodiesterase inhibitor
Goal of treatment of ED must consider what?
satisfaction of both the patient and the partner
Vacuum erection Devices (VED) who is this most appropriate for?
Since these are not discreet and can take 30 minutes to work, this is best for couple in a stable relationship
Yohimbine (oral tree bark supplement)
- reduces peripheral alpha adrenergic tone
- so, permits cholinergic tone
When are PDEs contraindicated
if patient is taking nitrate
What is a side effect of PDE isoenzyme type 6?
cyanopsia (seeing with blue tint)
**most common with sildenafil (Viagra)
What is the side effect associated with PDE Isoenzyme type 11?
myalgia and muscle pain
**most common with tadalafil (Cialis)
What is the difference in regards to food and absorption with sildenafil and Tadalafil?
Sildenafil has decreased absorption with food
Tadalafil (Cialis) absorption is not affected by food
Which PDE is not recommended in severe hepatic impairment?
Tadalafil (Cialis)
Which PDE doesn’t have an active metabolite?
Tadalafil (Cialis)
Discuss differences in PDE inhibitors and the cytochrome P450 3A4 system
Sidenafil should be decreased with any potent inhibitor
Tadalafil should be reduced only with the MOST potent (ex. ketozonazole, ritonavir)
What are the 2 most common adverse effects of PDE?
headache
facial flushing
dyspepsia*
nasal congestion*
What is the most concerning ADE for PDEs?
Nonarteritic anterior ischemic optic neuropathy
-sudden, unilateral, painless blindness, which may be irreversible
Who is at risk for NAION - nonarteritic anterior ischemic optic neuropathy?
- smokers*
- 50+
What is the most concerning ADE for Vardenafil (Levitra)
QT prolongation
What most often is the cause for priapism?
excessive dosing
Priaprism Treatment
- Ice packs on perineum and penis
- Walk up stairs
- Oral pseudophedrine (alpha-agonist effect)
- Aspiration of corpus cavernosum
- injection of alpha-adrenergic agent (phenylephrine, epinephrine, or methylene blue into the corpus cavernosa)
Third Princeton consensus conference for cardiovascular risk stratification: Low risk
- asymptomatic cardiovascular disease with <3 risk factors
- Well controlled HTN
- Mild CHF
- Mild valvular disease
- MI >8 weeks ago
Can a low risk patient be started on a phosphodiesterase inhibitor?
yes
Third Princeton consensus conference for cardiovascular risk stratification: Intermediate risk
- > 3 CV risk factors
- Mild/Moderate stable angina
- Recent stroke in past 2-8 weeks
- Moderate CHF
- History of stroke, TIA, or PAD
Can an intermediate risk patient be started on phosphodiesterase inhibitor?
complete CV workup with treadmill stress test to see if they are healthy enough for sexual activity (then, reclassify as low or high risk)
Third Princeton consensus conference for cardiovascular risk stratification: High risk
- Unstable angina
- Uncontrolled HTN
- Severe CHF
- Recent MI in past 2 weeks
- Moderate to severe valvular disease
- High-risk for arrhythmias
- obstructive hypertrophic cardiomyopathy
