Impotence Flashcards
1
Q
What is impotence?
A
- Inability in a man to achieve an erection or orgasm
- Erectile dysfunction
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2
Q
How do erections occur?
A
- Erections result from neuronal release of nitric oxide (NO) which, via cGMP and calcium, hyperpolarises and thus relaxes vascular and trabecular smooth muscle cells, allowing engorgment
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3
Q
What are the organic causes of impotence?
A
- The big three:
- Smoking
- Alcohol
- Diabetes
- Endocrine
- Hypogonadism
- Hyperthyroidism
- Hyperprolactinaemia
- Drugs
- Digoxin
- Beta blockers
4
Q
How is impotence treated?
A
- Treat causes
- Counselling
- Oral phosphodiesterase (PDE5) inhibitors
- Increase cGMP
- the erection is not automatic, it depends on an erotic stimuli
- SILDENAFIL - taken 1/2-1hr before sex but food and alcohol disturb its absorption
5
Q
What are the side effects of sildenafil?
A
6
Q
What are the contraindications of sildenafil?
A
7
Q
What are the cautions for sildenafil?
A
- Angina especially if during sex
- Bleeding, peptic ulcer
- Marked hepatic or renal impairment
- Dyspnoea on minimal effort (sex may be unsupportable)
8
Q
What are some interactions with sildenafil?
A
9
Q
How is a patient that presents with impotence worked up?
A
10
Q
What are the three key questions that should be asked during a work up when a patient presents with impotence?
A
11
Q
What is the mode of action of sildenafil?
A
It slows rate at which cGMP is degraded
