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LMCC Part II > Erectile Dysfunction > Flashcards

Erectile Dysfunction Flashcards

1
Q

what are the two broad classes of RD etiology

A

organic
psychogenic

  • must evaluate for underlying pathology of organic ED
  • psychogenic is present in majority of cases–> consider patient and partner
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2
Q

list the classes of organic etiology for ED

A 
vascular
anatomical/structural
neurogenic
metabolic/endocrine
medication
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3
Q

what are the vascular causes of ED

A

**DM
**CVD/PVD
HTN
pelvic or retroperitoneal irradiation

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4
Q

what are the anatomical/structural causes of ED

A

cavernous fibrosis
peyronie’s disease
hypospadias/epispadias
pelvic trauma or surgery

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5
Q

what are the neurogenic causes of ED

A 
MS
stroke
alzheimers 
parkinsons
spinal cord injury
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6
Q

what are the metabolic/endocrine causes of ED

A

hypogonadism
hyperprolactinemia
hypothyroid
hyperthyroid

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7
Q

what are the medication causes of ED

A

antihypertensives (CCB, beta blockers, thiazide)

antidepressants (SSRIs, TCAs, MAOIs)

diuretics (thiazides, spironolactone)

hormones (progesterone, estrogens, corticosteroids, 5 alpha reductase inhibitors)

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8
Q

what recreational drugs can cause ED

A

smoking
EtOH
marijuana

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9
Q

what are the psychogenic etiologies of ED

A 
performance anxiety
depression/anxiety
stress
traumatic past experiences
marital or relationship discord
history of sexual abuse
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10
Q

define ED

A

inability to achieve or maintain penile erection adequate for satisfactory sexual activity

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11
Q

what should you ask on HPI for ED

A

onset–sudden, gradual

non sustained erection?

presence of nocturnal or morning penile erections?

difficulty with arousal, ejaculation, orgasms (alone or with partner)

loss of libido

prior tx or diagnostic testing for ED

sexual history

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12
Q

what to ask on sexual history for ED

A 
stable or new relationship
duration of relationship
age disparity
health of partner
alternative sexual activities
condoms
previous STIs
past or present sexual abuse 
anxiety about sexual performance

consider interviewing patients partner

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13
Q

red flag for ED

A

lack of rigid nocturnal erections suggests vascular or neurogenic etiology

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14
Q

what should you think in sudden onset ED

A

reversible causes like meds, psych, trauma

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15
Q

what should you think in gradual onset ED

A

organic causes

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16
Q

what should you think in non sustained erection

A

anxiety

vascular leak

17
Q

what should you think in present nocturnal/morning erections but struggle with partner or alone with stim

A

psych

18
Q

what meds to ask specifically for ED

A

anti androgens
anti HTN
anti arrhythmics
antidepressants

19
Q

what risk screening should u do if someone presents with ED

A

CV risk assessment

ED is a strong predictor of CAD, stroke, mortality

20
Q

what to look for on exam for ED

A 
secondary sex characteristics/?hypogonadism
gynecomastia
nipple discharge (hyperprolactinemia) 
decreased male hair distribution
testicular atrophy
signs of hyper or hypothyroid

visual field deficits (pituitary tumour)
pinprick and touch sensation to penile shaft and perineum
screening neuro exam

evaluate penis for size, scars, fibrosis/plaques, urethral meatus, elasticity (foreskin phimosis), curvature
evaluate scrotum for testicular size and consistency

DRE–size, consistency and tenderness of prostate

21
Q

what are the special tests on evaluating ED

A

bulbocavernosus reflex–anal sphincter contraction in response to squeezing glans of penis (neurogenic ED)

cremasteric reflex–elevation of ipsilateral testicle in response to stroke of medial thigh (thoracolumbar erection center integrity)

22
Q

labs for ED

A 
CBC
urea
Cr
fasting glucose
lipid profile 
morning total testosterone
prolactin 
TSH
US

special:
nocturnal penile tumescence testing
neurophysiologic testing
psych eval

23
Q

conservative management of ED

A

psychosocial–> patient or couple counselling

lifestyle modification–> weight reduction, smoking cessation, reduce etoh, increase exercise, reduce cholesterol and fat

drugs–> remove causative agents and replace, improve compliance with DM and CVD meds

24
Q

first line medications for ED

A

PDE5 inhibitors (phosphodiesterase 5 inhibitors)

25
Q

what medication is a contraindication with PDE5 inhibitors

A

nitrate drugs

26
Q

list the PDE5 inhibitors

A

sildenafil/viagra (1 hour before, lasts 4 hrs)

tadalafil/cialis (1-12 hours before, lasts up to 36 hrs)

vardenafil (1 hr before, lasts up to 4 hours…faster onset than viagra)

27
Q

second line ED tx

A

intracavernosal injection and transurethral therapy –> PGE1, alpha agonist

vacuum constriction pump

28
Q

contraindications to vacuum constriction pump

A

sickle cell anemia
blood dyscrasias
patients on anticoagulants

LMCC Part II (52 decks)

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