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Foundations III Exam 1 (Cholley) > Erectile Dysfunction > Flashcards

Erectile Dysfunction Flashcards

1
Q

Define: erectile dysfunction

A

Inability to attain &/or maintain erection sufficient for satisfactory sexual performance

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2
Q

What 2 processes are involved in the normal physiology of erections?

A
  1. Relaxation of SM of cavernosal artery –> increased inflow of blood to corpora cavernosa
  2. Increased venous outflow resistance –> decreased outflow
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3
Q

What occurs during relaxation of SM of cavernosal arterial wall?

A
  • PNS nerves release NO
  • Increased cGMP & cAMP in cells surrounding cavernosal arteries
  • Decreased intracellular Ca
  • SM relaxation, vasodilation
  • Wider diameter of artery
  • Greater inflow of blood into corpora cavernosa
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4
Q

What occurs during increased venous outflow resistance?

A

High inflow into corpora cavernosa –> CC expands & compresses venous sinuses

Decreased outflow of blood –> sustained erection

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5
Q

What causes ED?

A

vasculogenic

neuro

psycho

endocrine

meds

disease

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6
Q

What are 2 examples of vasculogenic causes of ED?

A

Arterial inflow problem

Venous outflow problem

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7
Q

What is an example of a neuro cause of ED?

A

Prostatectomy

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8
Q

What are examples of psycho causes of ED?

A

Depression

Stress

Anxiety

Psych disorders

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9
Q

What are examples of endocrine causes of ED?

A

Hyperprolactinemia

Thyroid d/o

Sex hormone binding globulin

Hypogonadism

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10
Q

What type of meds can cause ED?

A

Anti-HTN

Antidepressant, antipsychotic

Meds that reduce testosterone

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11
Q

What disease states could cause ED?

A

Renal insufficiency, DM, hepatic disease

Prostatectomy, cystectomy

Pelvic or penile fx

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12
Q

What scale should you include in your sexual history for ED?

A

IIEF Scale

Int. Index of Erectile Fxn

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13
Q

What do you want to look for or include when examining a pt w/ potential ED?

A

Gynecomastia, galactorrhea, visual field defects

Check circulation

External genital exam

Testosterone (if decr libido)

Prolactin (if indicated)

Nocturnal penile tumescence
“postage stamp”

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14
Q

What imaging and procedures should be performed for ED?

A

Penile duplex doppler sonography

Cavernosometry/cavernosography

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15
Q

How do you tx ED?

A
  • Determine if CV status is appropriate for sex
  • Smoking cessation
  • Control wt & alcohol
  • Possible change of med
  • Treat medical condition
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16
Q

What are specific tx options for ED?

A
  • PDE5 inhibitors
  • Yohimbine
  • Vacuum erection device
  • MUSE
  • penile injection
  • constriction ring
  • splint
  • prosthesis
  • revascularization
17
Q

Describe detumescence

A

PDE5 decreases amt of cGMP –> decreased flow into penis

18
Q

What is the MOA of PDE5 inhibitors?

A

Block PDE5, permitting cGMP to continues to exert vasodilatory effect

Prolongs erection

19
Q

What are ADEs of PDE5 inhibitors?

A

Congestion, flushing, HA, dyspepsia, back pain/myalgia

Visual changes, loss of vision

Priapism

20
Q

What are 4 names of PDE5 inhibitors?

A

Sildenafil

Tadalafil

Vardenafil

Avanafil

21
Q

When should you take PDE5 inhibitors? What should you avoid taking them w/?

A
  • Take 30-60 mins before sex along w/ physical stimulation

- Avoid after meal

22
Q

Which PDE5 inhibitor has the longest half life?

A

Tadalafil

Stays in system for 36hrs

23
Q

What are risks of penile injection?

A 
Pain
Infection
Bleeding
Fibrosis --> curvature
Priapism
24
Q

What is priapism?

A

Persistent penile erection that continues hrs beyond sexual stimulation & lasts > 4 hrs

Emergency!

25
Q

How do you tx priapism?

A

Placement of 18-19 gauge needle into corpus cavernosum.

Aspiration of cavernosal blood.

Infusion of saline.

Injection of phenylephrine

Shunt

26
Q

What is the goal of tx of priapism?

A

prevent fibrosis, loss of cavernosal tissue, & recurrent priapism

27
Q

What can you use to treat venous leakage?

A

Constriction ring

28
Q

What type of tx is indicated for focal arterial occlusion of cavernosal artery?

A

Penile revascularization

Foundations III Exam 1 (Cholley) (12 decks)

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