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Pharmacotherapy 4271 > Erectile Dysfunction (Final) > Flashcards

Erectile Dysfunction (Final) Flashcards

1
Q

true or false: erectile dysfunction may be an indicator of CV disease

A

true

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2
Q

explain the normal physiology of an erection

A
  1. starts with the nervous system
    - sensory stimulation causes acetylcholine to be released which works with cGMP and cAMP to produce an erection
  2. erections are primarily a vascular event
    - corpus cavernosum and spongiosum fill with blood causing swelling and elongation.
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3
Q

during the initiation of an erection, is the arterial blood flow or the venous blood flow affected

A

increase in arterial blood flow - results in filling of sinuses

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4
Q

in order to prolong an erection, is the arterial blood flow or venous blood flow affected

A

decrease in venous OUTflow

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5
Q

an increase in arterial blood flow is mediated through acetylcholine induced (vasoconstriction/vasodilation)

A

vasodilation

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6
Q

erections require libido and _____ stimulates libido

A

testosterone

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7
Q

true or false: ED only occurs when there is an abnormality in the hormonal system

A

false - can occur if there is an abnormality in the nervous, vascular or hormonal system

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8
Q

what are the medications that can cause ED

A
  • anticholinergics (decrease flow of blood therefore ED)
  • dopamine antagonists (affects CNS/neuronal therefore ED)
  • estrogens (opp. of testosterone therefore ED)
  • antifungals (lower testosterone therefore ED)
  • antiandrogens (lower testosterone therefore ED)
  • antihypertensives (decreases blood flow therefore ED)
  • CNS depressants (affects CNS/neuronal therefore ED)
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9
Q

treatment of this type of cancer can also cause ED as treatment consists of surgery, radiation and hormonal treatments which can affect the normal mechanisms

A

prostate cancer

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10
Q

what are some medical conditions/lifestyle factors that can reduce the blood flow to the corpora therefore induce ED

A
  • peripheral vascular disease
  • atherosclerosis
  • smoking
  • sedentary lifestyle
  • penile trauma or surgery
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11
Q

what are some medical conditions/lifestyle factor that can affect nerve conduction therefore induce ED

A
  • spinal cord injury
  • stroke
  • DM
  • MS
  • dementia
  • penile trauma or surgery
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12
Q

what are some medical conditions/lifestyle factors related to endocrine disorders therefore induce ED

A
  • hypogonadism
  • thyroid disorders
  • prolactinoma
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13
Q

if erections with partner ARE NOT better than erections alone or sleep, what is the first step to addressing this issue?

A

address psychosocial issues

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14
Q

if erections with partner are better than erections alone or sleep, what is the first step to addressing this issue, and the patient is not taking any alpha-blockers or nitrates?

A

PDE5 inhibitors

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15
Q

if erections with partner are better than erections alone or sleep, what is the first step to addressing this issue, and the patient is taking alpha-blockers or nitrates?

A

Alprostadil VDE (vaccuum device)

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16
Q

what are some nonpharm treatments for ED

A
  • smoking cessation
  • weight loss
  • avoidance of recreational drugs
  • stress management
  • exercise
  • address sexual avoidance
  • address lack of sexual arousal
  • vaccuum erection devices (VED)
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16
Q

this is the first line treatment option for ED. cGMP is responsible for decreasing calcium levels and therefore produce an erection. This medication inhibits the conversion of cGMP to inactive GMP, therefore driving the pathway towards that of producing an erection

A

PDE5 inhibitors

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17
Q

true or false: it is safe for patients that do not have ED to use PDE5 inhibitors

A

false - can lead to priaprism (prolonged erection)

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18
Q

what are the 3 available PDE5 inhibitors

A
  1. sildenafil (Viagra)
  2. vardenafil (Levitra)
  3. tadalafil (Cialis)
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19
Q

true or false: sildenafil should be taken 30-60 mins prior to sexual activity with food

A

false - 30-60 mins prior ON AN EMPTY STOMACH

20
Q

true or false: vardenafil should be taken 30-60 mins prior to sexual activity with food

A

false - 30-60 mins prior ON AN EMPTY STOMACH

21
Q

true or false: tadalafil should be taken 1 hr prior to sexual activity without regard to food

A

true

22
Q

true or false: the duration of action of sildenafil is ~4 hours but can be up to 12 hours

A

true

23
Q

true or false: the duration of action of vardenafil is ~4 hours but can be up to 12 hours

A

true

24
Q

true or false: the duration of action of tadalafil is ~4 hours but can be up to 12 hours

A

false - 36 hours

25
Q

what are the most common s/e of PDE5 inhhibitors

A
  • facial flushing
  • h/a
  • dyspepsia
  • nasal congestion
  • dizziness
26
Q

what are some rare s/e of PDE5 inhibitors

A
  • hearing loss
  • priaprism
27
Q

what is a s/e specific to sildenafil and vardenafil

A
  • blue vision
28
Q

what is a s/e specific to vardenafil

A
  • QT prolongation
29
Q

what are s/e specific to tadalafil

A
  • myalgia
  • back pain
30
Q

PDE5-inhibitors are metabolized by this enzyme therefore need to be mindful of inducers (carbamazepine) and inhibitors (clarithromycin and ketoconazole)

A

CYP 3A4

31
Q

how long should sildenafil and vardenafil be spaced from taking nitrates

A

24 hours

32
Q

how long should tadalafil be spaced from taking nitrates

A

48 hours

33
Q

this medication should spaced from PDE5 inhibitors by 4 hours

A

alpha blockers

34
Q

this is considered a second line option for ED. comprised of a pump, cylinder and constriction band. the cylinder is poushed up against the abdomen, the vaccuum is activated, removing air and creating pressure that draws blood toward the gland of the penis. to prolong erection the band is placed at the base of the penis

A

vaccuum erection device (VED)

35
Q

what is the maximum time period the constriction band should be left on

A

30 mins

36
Q

what are some advantages of VEDs

A
  • non-invasive
  • effective
37
Q

what are some diadvantages of VEDs

A
  • not discrete
  • patients may fail to ejaculate
  • caution in patients taking OACs
38
Q

this is considered 2nd or 3rd line Tx for ED. it stimulates adenylyl cyclase which increases cAMP, which decreases calcium therefore causes an erection. this is delieverd directly to the corpus cavernosum. is useful in patients with problems with nerve conduction

A

intracavernosal injections

39
Q

what is the onset of action of intracavernosal injections

A

5-15 mins

40
Q

what is the duration of action of intracavernosal injections

A

~ 1 hr

41
Q

what are some common a/e associated with intracavernosal injections

A
  • penile pain (burning, ache)
  • fibrosis (scarring of tissue)
  • hematoma (bad bruise)
42
Q

what are some rare a/e of intracavernosal injections

A
  • priaprism
  • infections
43
Q

what is the max amount if intracavernosal injections that should be used per week

A

3/week

44
Q

who should intracavernosal injections not be used in

A

patients who are at high risk of poor injection technique (RA, obese, psych conditions)

45
Q

this is another option for ED. it is moderately effective, and less invasive than intercavernosal injections. it has the same MOA as intracavernosal injections and is also delievered directly to the corpus cavernosum

A

urethral inserts

46
Q

what are some common a/e in urethral inserts

A
  • urethral pain
  • urethral injury
  • priaprism
47
Q

which treatment option has a risk of vaginal burning and itch in female partners

A

urethral inserts

48
Q

when should urethral inserts be used prior to sex

A

10-30 mins

Pharmacotherapy 4271 (29 decks)

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