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Therapeutics > Men's Health II > Flashcards

Men's Health II Flashcards

1
Q

Erectile Dysfunction etiology

A

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

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2
Q

Physical causes of ED

A

-injury
-surgeries
-medicines
-radiation

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3
Q

Drug-induced sexual dysfunction

A

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

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4
Q

lifestyle causes of ED

A

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

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5
Q

Erection subtypes

A

-psychogenic
-reflexogenic
-nocturnal

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6
Q

Erection mech

A

-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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7
Q

Nocturnal penile tumescence

A

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

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8
Q

ED treatment

A
  1. treat/eliminate known causes
  2. Oral PDE-5 inhibitors
  3. Intraurethral or Intracavernous TX
  4. Possible combo therapy
  5. Penile Prosthesis
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9
Q

Treatment of underlying cause of ED

A

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

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10
Q

Alternative to Oral PDE-5 inhibitors if contraindicated

A

-vacuum erection devicce

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11
Q

Oral therapies for ED

A

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

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12
Q

PDE-5 inhibitor drugs

A

-Sildenafil (Viagra)
-Tadalafil (Cialis)

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13
Q

PDE-5 inhibitor dosing

A

-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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14
Q

Sildenafil (VIagra) dosing

A

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

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15
Q

Tadalafil (Cialis) dosing

A

-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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16
Q

PDE-5 inhibitor drug interaction

A

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

17
Q

Sildenafil 25mg starting dose

A

-hepatic impairment
-low clearance
-drug interaction

18
Q

PDE-5 inhibitor potential side effects

A

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

19
Q

PDE-5 inhibitor precautions

A

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

20
Q

PDE-5 inhibitor pt education

A

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

21
Q

PDE-5 inhibitors for pulmonary HTN

A

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

22
Q

Ro Sparks

A

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

23
Q

Vacuum erection devices

A

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

24
Q

Transurethral therapy of ED

A

-Alprostadil Pellets (MUSE)
-suppository

25
Q

alprostadil pellets (Muse)

A

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

26
Q

Alprostadil pellet (MUSE) directions

A

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

27
Q

Intracavernosal injections

A

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

28
Q

Alprostadil injection

A

-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

29
Q

Side effects of alprostadil injections

A

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

30
Q

Alprostadil injection dosing

A

-2.5 mcg start
-10-20 mcg
-60mcg max

-titrate to dose that produces erection lasting 1 hour

31
Q

Trimix

A

-IC injection
-papverine
-phentolamine
-prostaglandin E1

32
Q

Penile Prostheses

A

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

33
Q

Focused shock wave therapy

A

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

34
Q

Other therapies to treat ED

A

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

35
Q

Priapism

A

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

36
Q

Priapism cause

A

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

37
Q

Drug induced priapism

A

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

38
Q

ischemic (painful) Priapism treatment

A

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

39
Q

non-ischemic priapism treatment

A

cold packs and compression

Therapeutics (78 decks)

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