Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GU/GI > Male Sexual Dysfunction - Exam 2 > Flashcards

Male Sexual Dysfunction - Exam 2 Flashcards

1
Q

What are the required components to male sexual function?

A

intact libido: need to have the sexual desire

ability to achieve and maintain penile erection

ejaculation

detumescence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

____ causes an increase in male libido. _______ and ______ cause a decrease in male libido.

A

testosterone

hormonal or psych disorders and medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What 3 things need to be intact in order for a male to achieve and maintain an erection?

A

Intact autonomic and somatic nerve supply

Functional musculature of corpora cavernosa and pelvic floor

Intact arterial blood flow to penis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 2 normal erection pathways? What are the correlated spinal cord levels?

A

Central (psychogenic) - CNS to T11-L2

Peripheral (reflexogenic) - S2-S4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

_____ start and maintain erection. While ______ promotes vascular relaxation

A

Neurotransmitters

nitric oxide (NO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What needs to happen during the engorgement phase?

A

Relaxed smooth muscle in the corpora cavernosa and increased
blood flow to the penis

Trabecular smooth muscle compresses venous
return, promoting retention of blood and
maintaining erection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the normal ejaculation stimulated by?

A

sympathetic nervous system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the normal pathway for ejaculation?

A

Contraction of epididymis, vas deferens, seminal vesicles, prostate

Causes seminal fluid to enter the urethra → rhythmic contractions of bulbocavernosus and ischiocavernosus muscles → semen expulsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What 3 things is detumescence regulated by? What is the end result?

A

norepinephrine, endothelin, smooth muscle contraction

Increases venous outflow and restores flaccid state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

define erectile dysfunction. What is the general trend?

A

Consistent inability to attain or maintain a sufficiently rigid penile erection for sexual performance

Increasing incidence with age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

T/F: ED is part of the natural age process and most men will experience it during their lifetime

A

FALSE!!!

ED is NOT part of the normal aging process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some associated factors for ED?

A

DM, obesity, BPH, HTN, CV disease, low HDL

smoking

local radiation or sx

Depression, anxiety, stress, anger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the big 3 causes of ED? These are present in ___ of cases

A

DM, atherosclerosis, medication

greater than 80% of cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the 3 basic mechanisms of ED?

A

Failure to initiate erection (think psychogenic, endocrinologic, neurogenic)

Failure to fill penile tissue (think problem with arteries)

Failure to store adequate blood
volume in lacunar network (think venoocclusive dysfunction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

_____ is the MC organic cause of ED. Give some examples

A

Vasculogenic: disturbance of blood flow to or from penis

Atherosclerosis
traumatic arterial disease
anything that alters the veins (hypoxemia, hypercholesterolemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some neurogenic causes of ED?

A

trauma
MS
Peripheral neuropathy (especially with DM, alcoholism)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some endocrinologic reasons for ED?

A

Low testosterone
Increased prolactin - suppresses GnRH and testosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

an increase in prolactin leads to a suppression of ______ and _____ resulting in _____

A

suppresses GnRH and testosterone

less libido

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why do DM and ED have such a strong correlation?

A

due to the negative impact on
Vascular disease
Neuropathy
Decreased NO synthesis

20
Q

Most pts with ED eventually develop a ________

A

psychogenic component

21
Q

What are some medication related causes of ED?

A

Thiazides, BBs, spironolactone

estrogens, GnRH agonists/antagonists (think prostate cancer treatments)

TCAs, SSRIs

H2 antagonists (Famotidine and Ranitidine)

22
Q

What are 3 special testing you can order to evaluate ED?

A

If no response to oral meds → direct injection of vasoactive meds
+ response = intact vasculature

If no response to injection → duplex US, cavernosography, arteriography

Penile nocturnal tumescence study

23
Q

What are the medication options for ED? What are the sx options?

A

Oral phosphodiesterase-5 (PDE-5) inhibitors
Injection therapies
Testosterone replacement therapy

Vacuum devices
Penile implants
Vascular surgery

24
Q

When would you prescribe testosterone as a tx option in ED?

A

Only beneficial in men with documented hypogonadism and low testosterone levels

25
Q

When is testosterone replacement therapy CI for prostate reasons?

A

Prostate cancer
Abnormal DRE
Severe LUTS with BPH
Unexplained PSA elevation

26
Q

What are the 2 first line options for testosterone replacement therapy?

A

Transdermal and IM injection

27
Q

How often does testosterone IM injection need to be given?

A

usually every 1-2 weeks

28
Q

What are some SE of testosterone replacement therapy? What is the highlighted one?

A

**Prostate growth factor - increased prostate CA risk, BPH exacerbation

OSA worsening
Erythrocytosis
Skin irritations
Spermatogenesis suppression,
Improved bone density
Virilization, increased libido, aggression

29
Q

What is the monitoring requirements for testosterone replacement therapy? What are the 3 DDIs?

A

measure level 2-3 months after starting tx and dose changes, then 6-12 months for maintenance

warfarin
GnRH agonists/antagonists
steroids

30
Q

What is the 1st line pharm therapy for ED? What is the MOA? Need to check _____ before prescribing

A

PDE-5 Inhibitors

inhibit PDE-5 enzyme which degrades cGMP, allowing sustained inflow of blood to penis

always check testosterone first before prescribing

31
Q

Which PDE-5 inhibitors need to be taken 1 hour prior to sexual activity and on an empty stomach? How long is the duration?

A

Sildenafil (Viagra)

Vardenafil (Levitra)

4 hours

32
Q

Which PDE-5 inhibitors need to be taken 30 minutes prior to sexual activity and with food? How long is the duration?

A

Avanafil (Stendra)

4 hours

33
Q

______ has the longest duration of up to 36 hours and can also be used daily tx of LUTS due to BPH and needs to be taken with food

A

Tadalafil (Cialis)

34
Q

What are the SE of PDE-5 Inhibitors?

A

headache, flushing, dyspepsia
Dizziness and hypotension

35
Q

**What is the MAJOR CI to PDE-5 inhibitors?

A

**patients taking nitrates in any form (including PRN NTG

DO NOT use PDE-5 inhibitors and nitroglycerin together

36
Q

What is the 2nd line tx for ED?

A

Vasoactive prostaglandin (alprostadil) injected directly into penile tissue

also comes in an urethral suppository but it is more expensive

37
Q

What is the pt education point for prostaglandin injections?

A

needs to be injected on the dorsolateral side of the penis

38
Q

What are some non-pharm tx options for ED? What are the major complication?

A

vacuum device

vasucular sx- expensive, low success rate, high risk of complication

penile prosthesis: major complication is they can erode

39
Q

What is the MC drug associated with a decreased libido?

A

SSRIs

40
Q

What are the 3 criteria to diagnosis premature ejaculation?

A

Brief ejaculatory latency
Loss of control to delay or stop ejaculation
Psychological distress in patient and/or partner

41
Q

What are the tx options for primary premature ejaculation?

A

behavioral modification, counseling, medications

SSRIs: paroxetine may be most effective

topical anesthetics

combination between pharm and counseling may be most effective

42
Q

What are some physical causes of delayed ejaculation?

A

blockage of spermatic ducts
injury to nervous system
ETOH
illicit drug use
psych medication

43
Q

What is retrograde ejaculation? What is another name for it?

A

Semen enters the bladder instead of emerging through the external urethral meatus during orgasm

dry orgasm

44
Q

When are retrograde ejaculations commonly seen?

A

seen after surgery for BPH
pelvic radiation
sympathetic denervation
alpha-blockers

45
Q

When should you tx retrograde ejaculation? What 3 medications are used?

A

only if fertility is desired

Imipramine, chlorpheniramine, pseudoephedrine

46
Q

Imipramine, chlorpheniramine, pseudoephedrine are commonly used in ______. How do they work?

A

retrograde ejaculation

Help keep bladder neck closed during ejaculation

47
Q
A

GU/GI (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions