Lecture 2 - ED

Question 1

Cut-off for normal T levels in patients?

Answer 1

300, > 300 = normal

Question 2

IIEF-5 Questionnaire lower score means…

Answer 2

more severe ED

Question 3

TLC for ED

Answer 3

inc lean body mass and manage weight
Target BMI < 30 If obese
limit alc to 1 drink/day women, 2/day men
stop smoking

Question 4

Sildenafil (Viagra) Dosage

Answer 4

Initial = 50mg
Range = 25-100mg

Question 5

Sildenafil time before intercourse

Answer 5

1hr
onset = 15-60min, duration 4 hours

Question 6

Tadalafil (Cialis) Dosage

Answer 6

initial = 10mg
range = 5-20mg

Question 7

Tadalafil time before intercourse

Answer 7

1-12hrs, generally 1-2hrs before
onset = 15-45min
Duration up to 36hrs

Question 8

Vardenafil (Levitra) Dosage

Answer 8

Initial = 10mg
Range = 2.5-20mg

Question 9

Vardenafil time before intercourse

Answer 9

1hr
onset = 25min
Duration = up to 4 hrs

Question 10

Avanafil (Stendra) Dosage

Answer 10

initial = 100mg
range = 50-200mg

Question 11

Avanafil time before intercourse

Answer 11

30 min
Onset = 30min
Duration = up to 6hrs

Question 12

Ischemic Priapism

Answer 12

Med emergency

more common, immediately treat

Question 13

How to treat Ischemic Priapism

Answer 13

1. inject phenylephrine
2. Aspiration of blood
   Repeat as needed q3-5min

place shunt if aspiration fails

Question 14

Non-ischemic priapism

Answer 14

less common, dont treat just observe

resolve itself over time

Question 15

Sildenafil + Vardenafil SE

Answer 15

visual disturbances, higher in elderly

Vardenafil = QTc prolongation

Question 16

Tadalafil SE

Answer 16

back and muscle pain due to inhibition of PDE 11

Question 17

PDE5 inhib Contraindications

Answer 17

Nitrates, can cause sig decrease in BP
Space out 24-48hrs if need to take both

Question 18

PDE5 inhibitor advantages

Answer 18

effective
discreet
easy to use
well tolerated
sildenafil generic

Question 19

PDE5 inhibitor disadvantages

Answer 19

new agents costly
systemic vasodilation
DI = nitrates and alpha-blockers
Doesn’t inc libido

Question 20

Alprostadil MOA

Answer 20

acts directly on vascular and penile smooth muscle to inc production of cAMP, resulting in smooth muscle relaxation and erection

Question 21

Alprostadil method of admin

Answer 21

needle into penis or MUSE ( pellet up your pp hole)

rotate sites when injecting

Question 22

Alprostadil SE

Answer 22

Higher risk priapism
penile pain, plaque, hematoma, hypotension

Question 23

Penile Plaques

Answer 23

caused by fibrous of tunica albuginea or corpora due to injection

some med or surgical interventions to remove, watchful waiting

Question 24

Vacum Erection Device

Answer 24

Vacuum creates neg pressure and draws blood into corpora
effective in combo with alprostadil

CI in pts with clotting disorders, forms of leukemia, other blood conditions

complications: coolness, petechiae, numbles, pain with ejaculation, penile injury

Question 25

When is Test used in pts with ED?

Answer 25

only fit they have low T levels, not if they have normal

Question 26

Test Level info

Answer 26

normal is 300-1100, lvls draw as fasting at 8am

Question 27

Hypogonadism presentation

Answer 27

ED dec libido gynecomastia small balls reduced hair growth dec muscle mass inc body fat

Question 28

TRT SE

Answer 28

fluid retention, CV Gynecomastia hepatotoxicity inc prostate CA/BPH risk