Lecture 2 - ED Flashcards
Cut-off for normal T levels in patients?
300, > 300 = normal
IIEF-5 Questionnaire lower score means…
more severe ED
TLC for ED
inc lean body mass and manage weight
Target BMI < 30 If obese
limit alc to 1 drink/day women, 2/day men
stop smoking
Sildenafil (Viagra) Dosage
Initial = 50mg
Range = 25-100mg
Sildenafil time before intercourse
1hr
onset = 15-60min, duration 4 hours
Tadalafil (Cialis) Dosage
initial = 10mg
range = 5-20mg
Tadalafil time before intercourse
1-12hrs, generally 1-2hrs before
onset = 15-45min
Duration up to 36hrs
Vardenafil (Levitra) Dosage
Initial = 10mg
Range = 2.5-20mg
Vardenafil time before intercourse
1hr
onset = 25min
Duration = up to 4 hrs
Avanafil (Stendra) Dosage
initial = 100mg
range = 50-200mg
Avanafil time before intercourse
30 min
Onset = 30min
Duration = up to 6hrs
Ischemic Priapism
Med emergency
more common, immediately treat
How to treat Ischemic Priapism
- inject phenylephrine
- Aspiration of blood
Repeat as needed q3-5min
place shunt if aspiration fails
Non-ischemic priapism
less common, dont treat just observe
resolve itself over time
Sildenafil + Vardenafil SE
visual disturbances, higher in elderly
Vardenafil = QTc prolongation
Tadalafil SE
back and muscle pain due to inhibition of PDE 11
PDE5 inhib Contraindications
Nitrates, can cause sig decrease in BP
Space out 24-48hrs if need to take both
PDE5 inhibitor advantages
effective
discreet
easy to use
well tolerated
sildenafil generic
PDE5 inhibitor disadvantages
new agents costly
systemic vasodilation
DI = nitrates and alpha-blockers
Doesn’t inc libido
Alprostadil MOA
acts directly on vascular and penile smooth muscle to inc production of cAMP, resulting in smooth muscle relaxation and erection
Alprostadil method of admin
needle into penis or MUSE ( pellet up your pp hole)
rotate sites when injecting
Alprostadil SE
Higher risk priapism
penile pain, plaque, hematoma, hypotension
Penile Plaques
caused by fibrous of tunica albuginea or corpora due to injection
some med or surgical interventions to remove, watchful waiting
Vacum Erection Device
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
When is Test used in pts with ED?
only fit they have low T levels, not if they have normal
Test Level info
normal is 300-1100, lvls draw as fasting at 8am
Hypogonadism presentation
ED
dec libido
gynecomastia
small balls
reduced hair growth
dec muscle mass
inc body fat
TRT SE
fluid retention, CV
Gynecomastia
hepatotoxicity
inc prostate
CA/BPH risk
