Genitourinary & Nephrology Flashcards
Pathophys of Erection
Acetylcholine –> Inc. NO and inc. PDE (prostaglandin E)
NO –> inc. cGMP
PDE –> in. cAMP
Both cGMP and cAMP decrease Calcium
Diseases that decrease blood flow, resulting in common organic causes of ED
- DM
- HTN
- Heart Disease
The #1 reason patient’s stop taking their ____ is because of sexual dysfunction.
SSRI/SNRI
Blood pressure meds that can cause sexual dysfunction
- BB
- Clonidine
- Methyldopa
Antipsychotics that can cause sexual dysfunction
- Haloperidol
- Chlorpromazine
- Thioridazine
- Fluphenazine
Basically all 1st generations and SSRI/SNRI’s (but less than 1st gens)
BPH Meds that can cause ED
Finasteride
Dutasteride
Silodosin
Opoids that can cause ED
ALL OF THEM
Methadone to a higher extent
Can nicotine and excessive alcohol cause ED?
YES!
The International Index of Erectile Function (IIEF): is it better to have a higher score or a lower score?
A higher score
Severe ED: Score of 5-7
If a patient is on an oral phosphodiesterase inhibitor and has not been reporting improvements in sexual function then what is a 2nd line tx option?
Intracavernosal therapy
If a pt undergoes intracavernosal therapy but does not seem to be improving then what is the next (3rd line) tx for ED?
Intraurethral alprostadil
If a pt undergoes intraurethral alprostadil therapy but does not seemt o be improving then what is the next (last line) therapy option for ED?
Penile prosthesis
Explain the pathophysiology of phosphodiesterase inhibitors?
Inhibits phosphodiesterase which slows down the breakdown of cGMP. This allows for the depression of calcium which relaxes smooth muscle –> erection!
What should be avoided while using phosphodiesterase inhibitors?
Alcohol and nitrates
A pt really wants to be put on a PDE inhibitor for his ED but it is also imperative that he takes his vasodilators. What should you council him on in regards of timing of these medications?
SPACE THEM OUT!
With Viagra and Levitra wait 24 hrs after taking the ED med before taking the nitrate.
If taking Cialis wait 48 hours
Which PDE inhibits both PDE-5 and PDE-6? What is the importance of PDE-6?
Sildenafil (Viagra)
PDE-6 is connected to rods and cones so if pt has visual changes they need to stop taking sildenafil (Viagra)
What 2 doses does alprostadil come in?
- ) Intracanvernous injection (Caverject or Edex)
2. ) Intraurethral (MUSE)
MOA of Alprostadil
Increases cAMP which decreases Ca+