1. treat/eliminate known causes 2. Oral PDE-5 inhibitors 3. Intraurethral or Intracavernous TX 4. Possible combo therapy 5. Penile Prosthesis

Men's Health II Flashcards by Brooke Thornburg

Erectile Dysfunction etiology

-DM
-HTN
-cornary artery disease
-MS, Parkinson’s, stroke
-low testosterone (rare)

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Physical causes of ED

-injury
-surgeries
-medicines
-radiation

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Drug-induced sexual dysfunction

-antidepressants
-anti-HTN
-estrogens/anti-androgens
-5-a reductase inhibitors
-chemo

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lifestyle causes of ED

-alcohol
-tobacco
-obesity
-inadequate sleep/fatigue
-stress

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Erection subtypes

-psychogenic
-reflexogenic
-nocturnal

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Erection mech

-PSNS
-ACH –> NO
-NO –> cGMP
-cGMP = inc Ca
=RELAXATION
-inc blood flow that squeezes vein shut to prevent draining of blood

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Nocturnal penile tumescence

-3-6 erection/night
-influenced by T levels
-controlled by sacral nerves (REM sleep, PSNS, full bladder)

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ED treatment

treat/eliminate known causes
Oral PDE-5 inhibitors
Intraurethral or Intracavernous TX
Possible combo therapy
Penile Prosthesis

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Treatment of underlying cause of ED

-D/C drugs if cause
-testosteone tc if hypogonadism
-counseling if psychogenic

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Alternative to Oral PDE-5 inhibitors if contraindicated

-vacuum erection devicce

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Oral therapies for ED

-first line for most
-smooth muscle relaxation
-PDE-5 inhibitors
-sexual stimulation required

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PDE-5 inhibitor drugs

-Sildenafil (Viagra)
-Tadalafil (Cialis)

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PDE-5 inhibitor dosing

-many men may not respond to starting dose
-adjust dose to produce erection that lasts no longer than 1 hour
-adjust dose-renal disease

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Sildenafil (VIagra) dosing

-50-100mg
-DI w CYP3A4
-lower dose w a-blocker
-take on empty stomach

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Tadalafil (Cialis) dosing

-10mg-20mg
-2.5-5mg if daily
-does NOT inc BP
-ok to take w food
-daily low dose may be more effective

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PDE-5 inhibitor drug interaction

-CYP3A4 inhibitors (grapefruit juice)
-prolongs effect of drug
-food delays absorption

Sildenafil 25mg starting dose

-hepatic impairment
-low clearance
-drug interaction

PDE-5 inhibitor potential side effects

-headache
-flushing
-dyspepsia
-nasal congestion
-light sensitivity
-nasal congestion
-sudden vision loss

PDE-5 inhibitor precautions

-pts on nitrates
-pts on a-blockers (start at lower dose)
-pt w severe CAD
-report erections > 4 hours

PDE-5 inhibitor pt education

-take 1-2 hrs prior to intercourse
-or daily dosing
-report long erection, visual/hearing complaints, dizziness, palpitations
-avoid nitrates

PDE-5 inhibitors for pulmonary HTN

-sildenafil (Revatio) 20mg PO TID
-tadalafil (adcirca) 40mg PO qd

Ro Sparks

-sildenafil 55mg + tadalafil 22 mg
-sublingual
-15 min onset

Vacuum erection devices

-very effective
-slower onset
-base ring maintains erection
-bruising, numbness
-pain, blue penis
-avoid in sickle cell pts

Transurethral therapy of ED

-Alprostadil Pellets (MUSE)
-suppository

alprostadil pellets (Muse)

-125, 250, 500, 1000 mcg -pts prefer over injection but less effective -5-10 min onset

Alprostadil pellet (MUSE) directions

-urinate -insert suppository -role penis for 10-30 sec -max of 2 doses per day -use w oral agents?

Intracavernosal injections

-Alprostadil injection (Caverject) -if pt fails PDE-5 inhibitors

Alprostadil injection

-may be best for neurogenic ED -teach injection technique -many disc after one year -max 1/day, 3 per week -highly effective -no sexual stimulation required

Side effects of alprostadil injections

-local irritation -penile pain -risk of priapism -cavernosal plagues or areas of fibrosis

Alprostadil injection dosing

-2.5 mcg start -10-20 mcg -60mcg max -titrate to dose that produces erection lasting 1 hour

Trimix

-IC injection -papverine -phentolamine -prostaglandin E1

Penile Prostheses

-semi-rigid insert -pump (irreversible replace every 5-10 years)

Focused shock wave therapy

-non-invasive -targets vasc function -not FDA approved

Other therapies to treat ED

-Yohimbine -Prelox -Ginger root -American Ginseng -Potency wood -horny goat weed -gingko

Priapism

-condition in which penis remains erect for hours in absence of stimulation or after stimulation has ended -non/ischemic (painful)

Priapism cause

-drugs -sickle cell -pelvic tumors -leukemias -genital trauma -unknown most cases

Drug induced priapism

-ED drugs -antidepressants (bupropion, trazadone, fluoxetine, sertraline, lithium) -antipsychotics (clozapine, chlorpromazine) -anticoagulants (heparin, warfarin) -cocaine -alcohol, prazosin, hydroxyzine

ischemic (painful) Priapism treatment

-phenylephrine 0.1-1mg -blood aspiration -saline irrigation

non-ischemic priapism treatment

cold packs and compression