Reproductive: physiology, agents for erectile dysfxn

Question 1

What causes an erection?

Answer 1

PANS stimulation via pelvic splanchnic nerves stimulate NO release

Question 2

What is the NO release cause?

Answer 2

relaxation of corpus cavernosum and corpus spondgiosum => allows blood to accumulate in trabeculae of erectile tissue

Question 3

What causes stimulation for ejaculation?

Answer 3

SANS stimulation via lumbar splanchnic nerves

Question 4

SANS stimulation mediates what?

Answer 4

movement of mature spermatoza from epididymis and vas deferens into ejactulatory duct

Question 5

What are the accessory glands associated with ejaculation?

Answer 5

bulbourethral (Cowper) glands;
prostate;
seminal vesicles

Question 6

What do the accessory glands do?

Answer 6

secrete fluids that aid in sperm survival and fertility

Question 7

What innervates the bulbospongiosus and ischiocavernous muscles at the base of the penis?

Answer 7

somatic motor efferents of the pudendal nerve

Question 8

What does the stimulation of the bulbospongiosus and ischiocavernous muscles cause?

Answer 8

stimulates rapid ejection of semen out the urethra during ejaculation;
peristaltic waves in vas deferens aid in complete ejection of semen through urethra

Question 9

Injury to the bulb of the penis may result in what?

Answer 9

extravasation of urine from urethra into superficial perineal space

Question 10

If injury does occur in the penis, where will urine accumulate?

Answer 10

may pass into scrotum, into penis and onto anterior abdominal wall

Question 11

Where is the injury if the accumulation of fluid occurs in the scrotum, penis, and anterolateral abdominal wall?

Answer 11

laceration of either the membranous or penile urethra (deep to Scarpa fascia)

Question 12

What are common causes of a laceration of either membranous or penile urethra?

Answer 12

trauma to perineal region (saddle injury);

laceration of urethra during catherization

Question 13

What are the selective PDE 5 inhibitors?

Answer 13

Sildenafil;
Vardenafil;
Tadalafil

Question 14

What are the actions of PDE 5 inhibitors?

Answer 14

inhibits enzyme PDE 5, which inactivates cGMP leading to increase cGMP => vasodilation more blood inflow => BETTER ERECTION

Question 15

What should PDE 5 inhibitors not be taken with? why?

Answer 15

nitrates which increase cGMP production => SEVERE HYPOTENSION

Question 16

What are the PGE1 agents?

Answer 16

alprostadil

Question 17

What is the action of PGE1 agent?

Answer 17

increase cAMP=> smooth muscle relaxation

Question 18

How should alprostadil be administered?

Answer 18

transurethral or intracavernosal injection

Question 19

What are the contraindications for PGE1 agents?

Answer 19

intercourse w/ pregnant women may stimulate uterine contractions unless condom used;
conditions leading to priapism=> SCA, multiple myeloma, leukemia

Question 20

What is testosterone used for?

Answer 20

replacement/supplementation for males whose androgen concentrations are below normal

Question 21

When should testosterone be used?

Answer 21

IF diminished libido is significant patient complaint